Christmas is inextricably linked with love…..
Dean Martin sings about having his “love to keep him warm” – if you would like to spend a couple of minutes warming the cockles of your heart click here –
Smokey Robinson and his Miracles feel that if their baby loves them too, it would be Christmas every day and annually, in early December, we’re reminded that all Mariah wants for Christmas is youuuuuuu. (The remainder of the song choices in the collage are for you to ponder whilst digesting your turkey on Tuesday)
In Cardiac Rehab we love to sing and have a soundtrack to each of our weekly exercise sessions which are held in venues throughout D&G. Sometimes, the music choices are a little bit Homes under the Hammer-esque…. “Dont Go Breaking My Heart”, “Under Pressure”….. And of course who could forget the dulcet tones of Billy Rae Cyrus belting out “Achy Breaky Heart” in years gone by (for those under 30 reading this, Billy is Miley Cyrus dad). But C/R isn’t “just an exercise class” as anyone who has ever had experience of our service will testify – so what do we actually do?!
Well, since “last Christmas”, the C/R service in D&G has supported over 500 individuals following a cardiac event. The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) define priority groups for inclusion as post MI, coronary revascularisation (stents or bypass) and heart failure. Locally, we also include those with a diagnosis of angina, post valve repair/replacement, post implantation of cardiac defibrillators and resynchronisation devices, post heart transplantation and ventricular assist devices and adult congenital heart disease.
The service was set up in D&G in 1990, with an extensive, worldwide evidence base being consolidated since – C/R reduces cardiac mortality by 26% and unplanned hospital admissions by 18%. Currently based in Cluden Cardiac Unit in Crichton Hall, we are set to move into Mountainhall in early 2019. We see inpatients in both DGRI and GCH and run out patient clinics regionwide. We are a small team of nurses and physios who work closely with a wide range of health care professionals, services and organisations.
Although C/R nationally is undergoing a programme of modernisation in line with Scottish Government priorities, it maintains its traditional “menu based approach” with patients choosing the components that matter to them. So, whats on the C/R menu this Christmas, and beyond?!
To start
Identification, referral and recruitment of eligible patient populations – referrals tend to be picked up during in patient stay or from tertiary centres but we also accept referrals from other HCPs. Referrals can be sent electronically to – dumf-uhb.CardiacCommunication@nhs.net
Early initial assessment of individual patient needs – including medical history (a significant proportion of patients will have one or more co-morbidites), relevant investigations, social determinants of health, lifestyle risk factors, psychosocial health and medical risk factor management. This may take place in hospital, the patients home or out patient clinic and may be completed over more than one contact.
Agreed personalised goals – to be reviewed throughout the episode of care. This really is the “what matters to you” bit of the programme. Goals may range from “aim for 3000 steps a day” to “get back to work” to “get back to singing with the choir”.
To follow
Health behaviour change and education – this may include addressing cardiac (or other) misconceptions and illness perceptions that may lead to increased disability and distress, support of the patient’s significant other/s, goal setting and pacing skills, and facilitation of self management skills. Discussions may include – pathophysiology and symptoms, management of risk factors such as BP and lipids, occupational/vocational and driving advice, resumption of sexual relations and dealing with sexual dysfunction.
Lifestyle risk factor management – a trio of physical activity and exercise, healthy eating and body composition and tobacco cessation.
Individualised advice on ADLs and a tailored activity and exercise plan aims to increase physical fitness as well as reduce sedentary behaviour. Home based exercise plans are offered for those unable to uptake on traditional group exercise sessions and patients also get the opportunity to exercise within local authority leisure facilities. We are currently exploring the use of technology by way of short term loan of Fitbits to ascertain baseline activity levels and encourage an increase in an individuals “active minutes”.
Following baseline assessment of dietary habits, weight, BMI and waist circumference, a focus is on the adoption of a cardioprotective diet which encompasses healthier dietary choices, correcting misconceptions about diet and health, and body weight maintenance (or reduction if appropriate).
Patients who are smokers at the time of assessment are referred to the Quit Your Way service in addition to the C/R team providing education and support in the preparation and attempt at smoking cessation.
Psychosocial health – all patients are screened for psychological distress using validated tools and individual assessment allows for discussion regarding illness perceptions and self-efficacy for health behaviour change, and to determine levels of social support. Patients are encouraged to practice relaxation strategies or mindfulness exercises regularly and are offered taster sessions as part of the programme.
Medical risk management – optimisation of cardioprotective therapies is guided by regular measurement of BP, heart rate and rhythm, glucose and lipids. This provides an opportunity to discuss dosage and adherence with the patient and address their beliefs around their medication regime. It is hoped that some of the team can become independent prescribers to streamline the process of up titration of the secondary prevention medication in the longer term.
BHF Heartstart training – all patients and their family/friends are invited to attend this two-hour session to learn how to recognise an MI/cardiac arrest and deal with a life threatening emergency – perform CPR, access and use an AED, deal with choking and serious bleeding. This year 239 individuals across D&G have attended a Heartstart session run by the C/R team.
To finish
Final assessment of individual patient needs – to determine the effectiveness of our interventions, we are currently reorganising our service to create time for a more comprehensive final assessment to take place. To date this has been done quite informally but we feel it would enhance the patient experience to revisit baseline measures and formalise the ongoing management plan collaboratively. Patients are given details of local community based services and opportunities to support their self management moving forward.
Audit and evaluation – the uptake of C/R throughout the UK is variable but it is pleasing that locally we are supporting many more than the national average of around 50% of patients following a cardiac diagnosis. We have a robust audit process in place within D&G and are currently exploring how this may feed into a UK wide dataset to further strengthen the evidence base for C/R interventions.
Coffee and mints
In keeping with C/R tradition, on noteworthy occasions such as retirements and birthdays an after dinner ode to the recipient is dished out along with the coffee. With this in mind….
An ode to NHS D&G staff at Christmas
As Andy Williams famously sang, “it’s the most wonderful time of the year”
Perhaps you’ve spent the last few weeks thinking to where did 2018 disappear?
Now is the time for some fun, rest and reflection, hopefully in equal measure
To celebrate Christmas your own way and with love, kindness and pleasure
Although joyous for many, the festive season can be a sad and difficult time its true
Loneliness, loss, illness, expectation and pressure, maybe feeling more than just a bit blue
Christmas, like a heart attack, doesn’t always look like it does on the big screen
A time of remembrance and contemplation, hopes of what the year may have been
The pace of change in modern healthcare often goes at a rate of knots
Feels like there’s hardly time to do the job, let alone gather your thoughts
We all know too well of the “winter pressures” which don’t seem to relent much year long
Working difficult and unsocial hours, away from our loved ones, where we belong
It’s sometimes hard to remember that we all do a great job and are part of a fab wider team
It’s easy to criticise and get despondent when it doesn’t feel like you’re living the dream
But our local health services are truly amazing and star several thousand of a diverse cast
Staff who are caring, loyal, highly skilled and adaptable, genuine healthcare enthusiasts
So, take some time to enjoy your Christmas soundtrack and whatever is on your menu
The little things in life are often the best, regardless of the venue
Take some time to do “what matters to you” and enjoy some festive cheer
Wishing you and those special to you, health, happiness and peace throughout the New Year.
The cockles of the heart are its ventricles, named by some in Latin as “cochleae cordis”, from “cochlea” (snail), alluding to their shape. The saying means to warm and gratify one’s deepest feelings.
Mairi Small is a Senior Physiotherapist at Cardiac Rehabilitation for NHS Dumfries and Galloway
dghealth 