British Heart Foundation

Aneurin Bevan University Health Board (Rehab Service - South)

Address:

St Woolos Hospital, Stow Hill,
Newport NP20 4SZ


About the Programme

Brief Description of Service
In Newport the service caters for a wide variety of cardiac related illnesses, but is primarily aimed at adult patients who have been diagnosed with coronary heart disease, notably heart attack, angina and post cardiac surgery.

In line with National recommendations the cardiac rehabilitation service takes place in four phases.
h Phase I: In patient
h Phase II: Early post discharge telephone support
h Phase III: Out patient rehabilitation programme
h Phase IV: Long term maintenance in community setting

INPATIENT REHABILITATION

Content

Begins on admission and is initially aimed at alleviating fear and reducing anxiety. Education at this point may be impeded by many aspects of the patients illness (e.g. heavy sedation, feelings of hopelessness, denial). The patients educational needs are not ignored at this stage, but focus is on minute to minute needs, rather than meeting long term goals.

As the patients recovery progresses more emphasis is placed on educating them about the acute event and the illness according to individual need.

In the pre-discharge phase, due attention is paid to the patients own health beliefs and perceptions. Risk factors and lifestyle modification are discussed and a rehabilitation plan is agreed between patient, family and the multi disciplinary team. The patient should be given their patient held record.

Assessment includes:-

h Personal & family history
h Risk factors
h Psychosocial status
h Socio-economic status
h Work/leisure activities
h Activity levels

Health education information and audio visual aids are readily available to underline the pertinent points in the rehabilitation plan.

Advice on activity and mobilisation post discharge is provided and advice for forward action should they develop further chest pain.

Whenever possible, the patients family are involved in all aspects of in patient rehabilitation as appropriate.

All patients admitted with acute coronary syndromes and diagnosed with angina during an acute hospital stay, should normally be referred to the cardiac rehabilitation team within two working days.

Entry Criteria: Inpatient phase.

Acute myocardial infarction

Post coronary artery bypass graft

Post angioplasty/insertion of stents

Angina

Other e.g. cardiomyopathy, heart failure, pacemaker insertion, valve surgery, implantable defibrillators.

Prior to discharge patients are informed that they may contact the Cardiac Rehabilitation Department during office hours for advice. An answer machine is available outside of these hours and during busy periods

Health Education Support Material.

A wide range of booklets is available free of charge. Additional material is available for patients and family health education purposes including videos and DVDs. These are loaned out as required. Materials are available in ethnic minority languages and Welsh. There is good access to interpreting services if required and close contact with the Patient Liaison Officer.

IMMEDIATE POST DISCHARGE PHASE.

This phase describes the period immediately post discharge, prior to attending the formal out patient programme in approximately 4 V 6 weeks. Whenever possible, the patients family are involved in all aspects of rehabilitation as appropriate.

Telephone Contact
Following discharge patients are contacted by telephone within 7 days. Those referred by tertiary centres or via their General practitioner are contacted within 7 days of receipt of referral. Telephone contact at this stage aims to: check progress, provide additional information as required, reinforce contact number for further advice, arrange further contact as appropriate, advise on activity levels post discharge and advice on symptom recognition, management and control should they develop further chest pain. At this stage a menu driven service will be offered to address individual needs.

Contact

T: 01633 238398 F: 01633 238399

Contact 2

T: 01633 238398 F: 01633 238399

Email For Referrals

ABB_Registration_RGH@wales.nhs.uk

What to expect
when you come

Individual Assessment
An individual assessment will be offered to all patients. This will include, educating them about the acute event and the illness according to individual need. Risk factors and lifestyle modification are discussed and a rehabilitation plan is agreed between patient, family and the multi disciplinary team.
Assessment includes:-
h Clinical status
h Personal & family history
h Risk factors and risk stratification
h Psychosocial status
h Socio-economic status
h Vocational, occupational support / leisure activities
h Activity levels
h Updating or issuing of patient held record

Validated Assessment tools are used as appropriate including:-
h Quality of life assessment
h Exercise assessment
h Psychological assessment

Further contact and future attendance to the cardiac rehabilitation department will be arranged at this stage as appropriate.

A menu driven service offered at the Cardiac Rehabilitation Centre at St Woolos includes: -

h Individual counselling
h Supervised exercise
h Stress management and relaxation training
h Health Education
h Group discussion and support

Heart Manual & Angina Plan Home Based Rehabilitation Programme.
The manuals can be offered to select patients who for a variety of reasons choose not to or are unable to attend the formal out patient programme at St Woolos Hospital. The Heart manual and Angina Plan are a home based rehabilitation programme for those recovering from a myocardial infarction or following admission with angina. The manual takes the patient through the initial six week recovery period and includes audio tapes with relaxation skill training and common questions and answers for patient and spouse. Future contact is maintained by telephone as indicated by the Heart Manual guidance. Cardiac rehabilitation nurses who have undergone a specialist-training course facilitate it. Criteria for inclusion are uncomplicated myocardial infarction, diagnosis of angina, ability to read and write and access to a telephone.

Home Based Exercise Programme
An individualised home based exercise programme will be offered to those who wish to commence an exercise programme, but do not want to attend the cardiac rehabilitation programme at St Woolos and are unsuitable for the heart manual/angina plan. This will be provided during the individual assessment at the Gray Hill surgery and supervised by a physiotherapist. Follow up and exercise progression will be achieved through further consultations with the supervising physiotherapist locally the frequency of which will be arranged on an individual basis but no longer than 4 weeks.

Individual Support
Individual consultations can be arranged for those patients requiring more in-depth support, the frequency of which will be arranged on an individual basis but no longer than 4 weeks. Appropriate tools for psychological assessment are used when necessary.

Heartstart Training
Patients and their families will be offered the opportunity to attend Heartstart training as supported by the British Heart Foundation. This enables people to learn the core and essential knowledge and skills necessary to help them deal with emergency situations to the best of their ability and the importance and practical skills involved in basic life support.

OUT PATIENT REHABILITATION

A core team of multi disciplinary staff, consisting of Clinical Nurse Specialists, Physiotherapists, Dietician and pharmacist provides this. Other members of the hospital staff are utilised as and when needed for example, Social Worker and Doctor.

The out patient service is co-ordinated by the Highly Specialist Nurse. Classes are currently held at St Woolos Hospital and the Grayhill Surgery, Caldicot.

The patient is initially invited for an assessment. Initial assessment includes: -personal and family history of coronary heart disease, risk factors, physical activity levels, emotional status, vocational status and leisure activities. The information collected is recorded in a multi disciplinary integrated care pathway and a plan of rehabilitation is agreed with the patient. If not issued earlier patients should be given their patient held record.

Content

The Cardiac Rehabilitation Programme is a menu driven programme whose services include:-
h Individual counselling
h Supervised exercise
h Stress management and relaxation training
h Health Education
h Group discussion and support

Clinics are meticulously planned to balance physical, social and psychological needs of all patients. As personal approach as possible is offered.

Individual Counselling

The clinical nurse specialists are trained in counselling skills. Time is set aside for those patients requiring more in-depth support. Appropriate tools for psychological assessment are used when necessary (e.g. HAD scale).

Exercise Guidelines

Supervised exercise is co-ordinated by the team physiotherapist. The session is aimed at increasing the individuals confidence in their bodies physical abilities.

Individual exercise is based on:-
h clinical status
h risk stratification
h assessment of previous physical activity and future needs.

Patients are given advice on:-

h benefits of exercise
h safe use of equipment
h knowledge of personal limits
h ability to monitor levels of exercise
h suitable regular exercise
h ability to exercise symptom free

Stress Management

Stress management and relaxation training is provided by the clinical nurse specialists and physiotherapy technician. The stress management programme is based on three interacting approaches:

h learning relaxation skills
h learning to identify & monitor tension in daily life
h learning to use relaxation skills at times of stress

Health Education

Health education is provided both on an individual and group basis. Topics include:

h Recovery from a heart attack
h Understanding angina
h Angina and its effective management
h Healthy eating
h Smoking cessation
h Understanding your medicine
h Cardiac treatments
h Blood pressure
h Cholesterol
h Cardiac investigations
h Sexual guidance
h Alcohol
h Exercise
h Return to work
h Resuscitation
h Social & leisure activities

Health education sessions are evaluated in a number of ways including, group and individual verbal feedback. Quizzes are used to evaluate knowledge gain and behaviour change is recorded on the patients individual plan.

Verbal information is provided in a user friendly form, avoiding inappropriate medical terminology. This is supported by written information which is assessed for simplicity, clarity and attractive presentation. Videos, models and other audio visual aids are widely used as appropriate.

How long does it take

Out Patient Rehabilitation

Following the individual assessment and in consultation with the patient they will be offered the Cardiac Rehabilitation Programme at St Woolos, if appropriate. This programme meets National standards for cardiac rehabilitation and is provided by a core team of multi disciplinary staff, consisting of Clinical Nurse Specialists, Physiotherapists, Dietician and pharmacist.
At this stage patients attend twice a week for a six week programme (usually 12 contacts according to individual progress).
Entry Criteria: Out patient phase

Four weeks post cardiac event for:-

Acute myocardial infarction
Post angioplasty/insertion of stents


Six weeks post cardiac event for:-

Post coronary artery bypass graft

Angina (as soon as diagnosis is made)

Other e.g. cardiomyopathy, heart failure, pacemaker insertion, valve surgery, implantable defibrillators (according to individual need).

Exclusion Criteria
None for overall programme but exclusion from the exercise may be necessary for those who are:-

h medically unstable and require further investigation,
h are unable to participate in an exercise programme due to other factors
h have a psychiatric condition which may cause them to be a danger to themselves or others.

These individuals are included in other appropriate components depending on their individual needs.

Information on how to refer patients to the programme is made available to all relevant wards and departments, including out patients departments where patients are attending for routine follow up.

General information

LONG TERM MAINTENANCE PHASE

All patients who have completed the formal out patient programme are encouraged to progress to community based rehabilitation classes. These offer the opportunity to maintain regular exercise and other positive lifestyle changes.
An extensive network of classes has been developed following close liaison with local education authorities, leisure services and voluntary groups.
Classes have developed according to local needs and include:-

h Maintenance exercise classes with BACR trained fitness instructors, self financing
h Self help groups, self financing

Classes are held in a variety of venues including leisure centres, community education centres and village halls.
The Cardiac Rehabilitation Team provide field support for those involved with community based classes and organise regular meetings of the Community Cardiac Rehab Forum.



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