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Providing care in the heart of the community

How heart failure nurse specialists are making a difference to patients with complex conditions

As a community heart failure nurse specialist, my role includes providing care, advice, support, education and medication management to people who have been diagnosed with heart failure. Palliation is also an important part of my role.

In most cases, heart failure is a long-term condition with no cure. Our aim is to help in symptom control, which we achieve through treatments, lifestyle changes and medication.

Shortness of breath, fatigue, and oedema are the most common symptoms the heart failure patient suffers. Managing these is crucial for the patient’s wellbeing, and a key part of the community heart failure nurse specialist role.

Diuretics are essential in decompensating heart failure. Most diuretics regimes are oral but during a decompensating episode, oral medication may not be well absorbed and becomes less effective. This can, in some cases, lead to chronic fluid retention – potentially resulting in frequent hospital admissions for intravenous diuretic therapy.

At Northumbria Healthcare NHS Foundation Trust, we are committed to ensuring that, where possible, patients are cared for in their place of choice and any unnecessary admissions to hospital are avoided. Through integrated working across secondary and primary care, we identified that these frequent admissions were undesirable for our end-stage heart failure patients and that an alternative option, which enabled them to receive treatment at home, would be beneficial.

Over the past two years, I have been involved in a pilot enabling the administering of continuous subcutaneous infusion diuretic therapy for end-stage heart failure patients in the community. This is an alternative to intravenous therapies, enabling patients to receive care in their home environment instead of being admitted to hospital. It also has facilitated early discharges for this group of patients.

The pilot was developed and is a partnership between the palliative care teams and consultant cardiologists, closely working with the community heart failure nurse specialists team. End-stage heart failure patients are identified through joint working. A personalised management plan is developed for each patient, which provides the community nursing teams with a structure to follow when delivering the continuous subcutaneous infusion therapy.

Our team oversees and facilitates each patient’s management plan. We are a source of reference, advice and referral for the community nursing teams, patients, GPs and secondary care.

The therapy is administered via a syringe driver, and managed by community nursing teams, whose support and enthusiasm has been superb, significantly benefitting our patients. The diuretics are prescribed by the patient’s GP and dispensed in the community. Links have been formed between all the teams involved, resulting in a professional, seamless and patient-centred service.

Since we introduced this pilot, we have used this treatment for 11 end-stage heart failure patients. The figures show that we have been able to prevent hospital admissions, and facilitate early discharge. Also, if they are admitted, we have reduced the length of stay because treatment can be continued in their homes. The pilot has also given patients more choice about their place of care, which is always a priority. Feedback has shown that this improves their quality of life.