Cardiac Rehab Service

North East Wales

Wrexham & FlintshireWrexham & Flintshire

..& a bit of Denbighshire, Shropshire, Cheshire

Quick guide to the service

• Context

– Team

– Links with other teams

• Service offered• Service offered

• Criteria for CR

• Challenges

• Opportunities

Oop North

Oop North

Oop North

The great cardiac tapestry

• Nurses – Jacqui, Kate, Lorraine, Bernice, Jo & Nina

• Exp phys – Susanne, Andrew, Jo• Physio – Claire• OT – Dawn & Rachel• Secretaries – Leanne, Angela,

Louise (HF), Alison (arrhythmia)

• CR sp• HF sp• Acute CPN sp• Arrhythmia sp• Lipid sp• ACHD sp

Louise (HF), Alison (arrhythmia)

• Dietitian - Paul• Pharmacist - Tina• Ph IV team – Audra, Gaz & others• Clinical Psychiatrists – Rob &

John

• Ward team• Consultant• GP• PN• DN• Cardio-resp• YGC, COCH• BHF

Two heads are better than one..

Two heads..

• Highly specialist skills, knowledge, experience

• Generic CR skills, knowledge, experience

Two heads..• Complex cardiac +/-

psychological +/-physiological +/-pharmacological needs. Eg refractory angina, devices, GUCH, MSK, devices, GUCH, MSK, fear

• Generic full CR assessment, cardiac knowledge, generic advice, motivation, coaching, empowering

Assess, assess, assess

• Who is this person?– Role in life

– Skills they have for managing change, health, life events

– Resources they draw upon

– Experience in life

– Aspirations

– CHD RFs

– Effects of cardiac event

Plan steps forward

• Where is individual aiming to go?

– Realistic?

– Achievable?

– Individual-centred (not HCP centred????)– Individual-centred (not HCP centred????)

• Goal setting & modifications

• Mobilising resources

• Learning – skills, knowledge, beliefs, attitude

How

• Phone

• Visit

individual

• Individual visit

• Assessment, advice,

information, guidance,

counselling, coaching,

listening….• Individual visit

us

• Written info

• Exercise, mobility, activity

assessment

• Exercise, activity sessions –

once per week

• Group & individual

educational sessions

Criteria

Keeps expanding…

Challenges & Opportunities

• Two teams become one

• More complex needs recognised

• Working without psychologist

• Funding• Funding

• NACR – fitting into a box