Microsoft Word - Lynne Viv Dot Core Indicators Non 2011 _2_.Doc

Heart Education Awareness Resource and Training through E-Learning (Hearte Project) HEART DISEASE EDUCATIONAL FRAMEWORK “HEARTe has been designed primarily for use by registered health professionals across primary and acute services who are involved in general areas which include cardiac care, however wider health and social partnership agencies may also benefit from using it". Adapted with permission from NHS Fife's Heart Disease Managed Clinical Network Competency Framework Capability 1: Describe the normal anatomy and physiology of the heart, coronary circulatory system and the conduction system

Indicators Required knowledge and skills Indicative Resources/ Suggested reading KSF link 1.1 Demonstrate knowledge of the Ability to describe: Core Hearte Module 1 anatomy and physiology of the The heart in relation to other major structures in dimension heart. the body. 1, 2, 4 Identify the physical characteristics of the heart.

Identify the main parts of the heart.

1.2 Understand the coronary Identify the blood vessels of the heart. Core Hearte Module 1 circulatory system. Describe the basic function of the coronary arteries. dimensions Discuss how the coronary arteries help to keep the 1, 2, 6 heart healthy.

1.3 Describe the conduction system Identify the sinoatrial (SA) node. Core of the heart. Identify the atrioventricular (AV) node. dimensions Identify the bundle of His. 1, 2, 6 Hearte Module 1 Describe the basic function of the heart’s conduction system. Discuss how the conduction system relates to a healthy heart.

1.4 Describe diagnostic tests Correct blood pressure measurement Core British Hypertensive Society suitable for investigation of cardiac Correct manual pulse measurement dimensions http://www.bhsoc.org conditions Electrocardiography and positioning of leads correctly 1, 2, 6 Normal ECG components Hearte Module 1 Rationale for echocardiography and components of HWB 1, 2, tests results 4, 6 Cardiac specific blood tests and immediate actions if required 1.5 Demonstrate knowledge of self Awareness of self management and examples of using HWB1,2,4 Self Management Initiatives: management strategies that will in practice http://www.chss.org.uk/voices_scotland/projects_under_ influence beliefs/health strategies Integrate style of discussion including basic development/#self motivational interviewing techniques into your practice Review of current evidence: (introduction) http://www.health.org.uk/publications/evidence-helping- people-help-themselves/ Capability 2: Appraise the guidelines and contribute to the prevention/ reduction of heart disease Indicators Required knowledge and skills Indicative Resources/ Suggested reading KSF link 2.1 Identify individuals who may be at Awareness of ASSIGN tool HWB1 SIGN(97) w w w .si g n . a c . u k increased or high risk of developing heart Practice based register of at risk individuals HWB2 BHF www.bhf.org.uk disease HWB3 CHSS www.chss.org.uk

Heart-E Module 2 2.2 Understand the role and remit of the Background Core Keep Well http://www.keepwellscotland.org.uk/ keep well programme Inclusion dimensions HD & Stroke Action plan Criteria Contact 1, 2, 6 Hearte Module2 Assessment Details 2.3 Have a basic understanding of Drug therapy to treat: Core primary prevention pharmacology • Hypertension dimensionG SIGN 97 w w w .si g n . a c . u k 1?? • Hypercholesterolemia BHF www.bhf.org.uk CHSS www.chss.org.uk • Type1/Type 2 Diabetes Hearte module 2

2.4 Know what factors might lead to an Risk factors that impact on heart health: HWB1 increased risk of developing heart • modifiable HWB2 SIGN 97 w w w .si g n . a c . u k disease. • non-modifiable. HWB3 BHF www.bhf.org.uk CHSS www.chss.org.uk Evidenced based risk factor targets such as: • Smoking Hearte Module 2 • Physical activity • Diet • Alcohol • Diabetes in relation to cardiovascular disease • Anxiety / depression • Hypertension Capability 3: Appraise the guidelines and contribute to effective care of the patient with stable coronary heart disease

Indicators Required knowledge and skills Indicative KSF Resources/ Suggested reading Indicators Required knowledge and skills link Indicative Resources/ Suggested reading 4.1 Define the term acute coronary Disease processes in acute coronary syndromes: HWB6 K HWB7SF link SIGN 93 www.sign.ac.uk syndromes (ACS). BHF www.bhf.org.uk 3.1 Describe the stages Normal artery Fatty streak Core SIGN 97 w w w .si g n . a c . u k Unstable angina CHSS www.chss.org.uk of the atherosclerotic Atherosclerotic plague dimension 2 Non ST elevated myocardial infarction (NSTEMI) BHF www.bhf.org.uk G1 process FibSTrou elevateds plague myocardial infarction (STEMI) CHHearteSS www.chss.org.uk Module 4 Plague rupture, fissure and thrombosis Hearte Module 3

4.2 Recognise the signs and List the physical signs if a patient presents with ACS. HWB5 symptoms of acute chest pain. HWB6 SIGN 93 www.sign.ac.uk 3.2 Define the term stable angina PaBetho awarephysio lofog differentialy related to diagnoses stable ang (male/female)ina Core SIGN 97 w w w .si g n . a c . u k dimension 2 BHHearteF www.bhf.org.uk Module 4 G1 CHSS www.chss.org.uk 4.3 Be familiar with diagnostic tests Diagnostic tests: HWB6 HWB7 HearteSIGN Module 93 www.sign.ac.uk 3 available to confirm a diagnosis of Clinical history taking ACS. ECG Review Heart-E Module 1 Exercise tolerance test Hearte Module 4 3.3 Demonstrate a knowledge EvCardiacidenced specificbased ris bloodk fact ospectrumr targets such as: HBW1 SIGN 97 w w w .si g n . a c . u k of management issues relating • Smoking HWB6 BHF www.bhf.org.uk to stable angina • Physical activity CHSS www.chss.org.uk 4.4 Demonstrate an understanding of Interventions• Diet available to treat ACS: HWB6 HWB7 Hearte Module 3 interventions available to treat ACS. •  AlcPrimaryohol PCI SIGN 93 www.sign.ac.uk •  DiaThrombolysisbetes control in relation to CVD  Cardiac Surgery Hearte Module 4 • Anxiety / depression • Hypertension 4.5 Demonstrate knowledge of Treatment options: Core dimension 2 SIGN 93 www.sign.ac.uk Guideline 93 secondary prevention medication. GTN Spray G1 Aspirin/clopidogrel Hearte Module 4 3.4 Ensure that individuals Up to date basic life support Resuscitation council : www.resus.org.uk Statins HWB7 British National Formulary (BNF) www.bnf.org. experiencing signs and symptoms AbleBeta-blocker to educate others on cardiac signs and symptoms Hearte Module 3 of a potential coronary event AcknACE-inhibitorowledge that rescue interventions will be required in a receive immediate interventions maDiureticsnner that is consistent with Evidence based practice Own scope of practice legislation

Capability 4: Appraise the guidelines and contribute to the effectively care of the patient with acute coronary syndromes 4.6 Have access to sources of up to Awareness of educational materials and resources. Core dimension1, 2 SIGN 93 www.sign.ac.uk date information/support about ACS Use of individual / personal development plan. G1 NHS QIS Heart Disease Standards 2010 standards

Managed Clinical Networks http://www.healthcareimprovementscotland.org Cardiology area specific information BHF www.bhf.org Professional bodies – Chest Pain Specialist Nurses CHSS www.chss.org.uk

4.7 Utilise current research and audit Demonstrate ability to utilise educational materials Core dimension 2 to inform practice relating to ACS and resources in area of practice G1 management Capability 5: Appraise the guidelines and contribute to the effective care for patients undergoing cardiac rehabilitation

Indicators Required knowledge and skills Indicative KSF Resources/ Suggested reading link

5.1 Define the term Cardiac Understand the benefit that CR has in terms of: Core dimension 5 www.sign.ac.uk Guideline 57 Rehabilitation (CR) ,6 Clinical issues Social issues British Association of Cardiac Rehabilitation www.bcs.com Confidence Outcomes Cardiac Rehabilitation ISD report 2011 www.isdscotland.org Reduction in readmission rates Misconceptions and illness beliefs

5.2 Demonstrate an awareness Appraise the clinical care pathways for patients Core MCN resources of the CR service in your undergoing CR in your NHS area dimension1,5, 6 NHS Healthcare Quality Strategy Scotland area including inclusion and http://www.scotland.gov.uk/Resource/0039/00398674.pdf exclusion5.5 criteria Describe the evidence Inactivity HWB1 SIGN 57 www.sign.ac.uk 5.3based secondary Know the recommendations for activity HWB2 Describeprevention the measures 4 phases of CRKnowHave the a benefits Knowledge of physical of the principles activity of the patients CoreHBW4 dimension1, www.sign.ac.ukThe Knowledge Guideline Network 57 acknowledging Smokingjourney and menu based interventions previously 5, 6 www.knowledge.scot.nhs.uk/home.aspx recommended targets Knowdescribed the benefits as of stopping smoking KnowPhase how 1 to refer to the smoking cessation team Review Hearte Module 3 Diet/AlcoholPhase 2 Hearte Module 5 KnowPhase the principles3 of healthy eating with regards to recommendationsPhase 4 Know how and when to refer for dietetic support

5.4 Hypertension British Hypertensive Society www.bhsoc.org Describe some of the KnowHave the an non awareness pharmaceutical of adult interventions learning principles which can Core Know about the main model used in CR – Transtheoretical model behavioural change methodshelpHave control a knowledge hypertension of the main negotiating behaviour dimension1,2,4,5,6 Understand other models used in CR Hyperlipidaemiachange model and how it can be applied to HWB1 Knowindividuals the targets recovering for cholesterol from a incardiac the cardiac event population HWB4 KnowIncluding the non effect pharmaceutical of intervention interventions within phases which of can helpcardiac reduce rehabilitation cholesterol levels (5.3) DemonstrateBe aware ofa knowledgeother behaviour of what change drugs models are used that and may whenbe inapplied the management including illness of cholesterol beliefs Psychological factors Describe emotional reactions following a coronary event Be able to use a tool such as the HAD Scoring Tool and know when to refer on to the GP for further management BHF www.bhf.org Chest pain advice CHSS www.chss.org Be able to advise on the correct use of GTN Spray General advice Advise on sexual activity and signpost appropriately DVLA guidelines post event DVLA www.dvla.gov.uk

Capability 6: Contribute to the effective care of the patient living with heart failure

Indicators Required knowledge and skills Indicative KSF Resources/ Suggested link reading HWB6 HWB7 6.1 Define the term heart failure Pathophysiology relating to heart failure SIGN 95 www.sign.ac.uk Recognise the different types of heart failure Hearte Module 6 Differentiate LVSD and heart failure

HWB6 HWB7 6.2 Define the term decompensation and acknowledge the signs and Awareness of decompensation and who to contact SIGN 95 www.sign.ac.uk symptoms which would suggest that the patient’s condition was to ensure optimal management. worsening. Be aware of NYHA class tool Hearte Module 6 NHS QIS Heart Disease Standards 2010 standards Management issues: HBW4 SIGN 95 www.sign.ac.uk 6.3 Demonstrate a knowledge of the burden faced by patients and Activity carers/partners living with heart failure Fluid retention Hearte Module 6 Breathlessness Isolation NHS QIS Heart Disease Diet/ fluid restrictions Standards 2010 standards 6.4 Discuss the management of patients with heart failure Demonstrate an awareness of drugs used to HWB2 SIGN 95 www.sign.ac.uk optimise the care of the patients with heart failure. HWB5 HWB6 Hearte Module 6 Interventions to improve quality of life other than HWB7 BNF www.bnf.org pharmacological. Advanced therapies NHS QIS Heart Disease Standards 2010 standards Psychological issues Cognitive impairment recognition (MME) 6.5 Demonstrate an awareness of the heart failure integrated care Appraise integrated care pathway for patients Core Heart Failure Specialist pathway specific to your area diagnosed with heart failure in your area dimension1, 5, Services 6

6.6 Utilise current research and audit to inform practice relating to heart Awareness of how to access educational materials Core dimension BHF www.bhf.org.uk failure management and resources 2, CHSS www.chss.org.uk G1 6.7 Trajectory/ Prognostic indicators HWB2 Living and dying well Initiate support and care for patients and their carers during the HWB5 SIGN 95 www.sign.ac.uk trajectory/ terminal phase of their condition. HWB6 HWB7 Hearte learning module 6 NHS QIS Heart Disease Standards 2010 standards

Capability 7: Appraise the evidence and contribute to the development of effective palliative care in heart disease Indicators Required knowledge and skills Indicative KSF skills Resources/suggested reading

HWB2 SIGN 95 www.sign.ac.uk 7.1 Identify prognostic indicators that Prognostic indicators HWB5 determine poor outcome relating to heart Surprise question HWB6 disease HWB7 Hearte Module 7 Psychological/spiritual support Sudden death risk Better Together:

7.2 Demonstrate an understanding of Rationalisation of appropriate medications HWB2 Scottish Partnership for palliative care management of patents living with Optimise symptom relief HWB5 www.palliativecarescotland.org.uk terminal heart disease HWB6 HWB7 Living and dying well www.scotland.gov.uk

BNF www.bnf.org

7.3 Demonstrate an understanding of Palliative care register HWB2 Scottish Patient Safety Programme palliative care team working in non Appraise/develop an \awareness of Patient HWB5 www.scottishpatientsafetyprogramme.scot.nhs.uk/programme cancer disease Safety Programme for heart failure in your HWB6 area Gold Standard Framework for Palliative care Develop an awareness of palliative care www.scotland.gov.uk teams/key contacts within your area Hearte Module 7 7.4 Demonstrate an understanding of Referral to palliative care HWB2 Self directed study reasons of non-referral to advanced Appraise integrated pathway of care for HWB5 services/ unsuitability for further palliative care HWB6 intervention DNACPR protocol HWB7 DNACPR: www.resus.org.uk Develop a basic understanding of: Referral to electrophysiology department : http://www.scotland.gov.uk/Topics/Health/NHS-  DNACPR Resuscitation orders concerned with device therapy Scotland/LivingandDyingWell/ShortLifeGroups/-DNACPR  Deactivation of devices BHF discussion document on deactivation of devices: www.bcs.com/documents/ICS_in_patients_who_are_reaching_ the_end_of_life.pdf

Deactivation of device: http://www.improvement.nhs.uk/heart/heartfailure/Home/Patient Pathways/PatientPathwayMenu_3/DeactivationofCardiacDevic es.aspx

Capability 8 : Contribute to the care of people living with atrial fibrillation Indicators Required Knowledge & Skills Indicative KSF skills Resources/suggested reading 8.1 IK3 Define the term atrial fibrillation Understanding of the abnormal HWB1 http://www.heartelearning.org Understand the classification pathophysiology & causes of HEARTe Module 8 and causes of atrial fibrillation atrial fibrillation 8.2 HWB1 Recognise the signs and Basic understanding of abnormal HWB2 http://www.heartelearning.org symptoms of atrial fibrillation cardiac conduction pathways HEARTe Module 8 conduction and relative ECG changes

8.3 HWB4 Relative risk of stroke & other HWB5 http://www.sign.ac.uk Be aware of the stroke risk diseases including risk of sub- HWB6 http://www.mdcalc.com/chads2-score-for-atrial-fibrillation-stroke-risk/ associated with atrial fibrillation therapeutic medication regimens HEARTe Module 8 and how that risk can be reduced

8.5 Core5 Awareness of atrial fibrillation HWB4 http://www.sign.ac.uk Describe the treatment of atrial algorithm to goals of treatments HWB6 https://www.nice.org.uk/guidance/CG180 fibrillation to ensure an optimal HWB7 quality of life http://www.escardio.org/guidelines-surveys/esc- guidelines/guidelinesdocuments/guidelines-afib-ft.pdf http://www.escardio.org/guidelines-surveys/esc- guidelines/guidelinesdocuments/guidelines_focused_update_atrial_fib_ft.pdf

HEARTe Module 8 8.6 Core2 Be aware of techniques and Self management support to Core4 http://www.bhf.org.uk support services that enhance enhance quality of life following Core5 http://www.chss,org.uk self management diagnosis of atrial fibrillation HWB4 HEARTe Module 8 8.7 Core4 Consider the wider networks Demonstrate positive, proactive Core6 http://www.bhf.org.uk within individual communities approaches to raise awareness G5 http://www.nhsinform.co.uk/ that raise awareness of of atrial fibrillation in community G1 HEARTe Module 8 identification of AF setting 8.8 Develop awareness of the Core 1 Mood Cafe Be aware of the psychological psychological impact following a Core6 NES Emotion Matters impact of living with a long term diagnosis of Atrial Fibrillation HWB5 NICE condition such as atrial HWB6 HEARTe Module 8 fibrillation (including the HWB7 screening tools available)