Norwich Heart Failure Specialist Nurses

Description

Service model The services will be delivered by heart failure nurses, working with other professionals across a range of settings and organisations including General Practice and acute settings. The service will: o Provide expert clinical knowledge and skills in the management of patients with confirmed diagnosis of Heart Failure. o Develop joint clinics as required with GPSI/Community HFSN/Consultant Cardiologist including titration of medication providing a step up and step down service. o Develop support programme/groups to provide education & support to heart failure patients, including end of life issues in collaboration with palliative care team. o Improve multidisciplinary working/service. To devise a multidisciplinary service which is equitable and responsive to the needs of patients within tertiary, secondary and primary care settings with a suspected or confirmed diagnosis of chronic heart failure. o Provide education of heart failure to other members of healthcare teams within Primary and Secondary Care in order for clinicians to arrange for people with suspected heart failure to be offered appropriate investigations (for example ECG, BNP tests and echo) that will confirm or refute the diagnosis. For those in whom heart failure is confirmed, its cause should be identified and treatments most likely to both relieve their symptoms and reduce their risk of death should be offered. o Support and encourage adherence to recognised clinical guidelines among clinicians. o Establish care management plans with the patient. o Referral on patients for additional services.