My name is Amanda and I am the Lead Advanced Nurse Practitioner specialising in cardiac surgery at St Thomas’ Hospital, working specifically with those affected by heart valve disease.
This wonderful job is a culmination of many years of experience, additional study and practice. I work closely with colleagues, patients and relatives, following prospective patients from pre–admission clinic, all the way through to their admission for valve surgery and recovery post-discharge.
The usual practice is to meet patients after they have been referred for valve surgery in the clinic, although some acutely unwell inpatients are transferred directly from their local hospitals for urgent heart valve surgery. Generally, I am in the pre-admission clinic two mornings a week and divide the remaining day between reviewing current inpatients, attending multidisciplinary team meetings, ward rounds, and liaising with local hospitals regarding unscheduled urgent inpatient referrals for heart valve surgery.
In the pre-assessment clinic, patients are seen by a Consultant Surgeon specialising in heart valve disease, who considers repairing or replacing the valve. I supplement their decision by taking a detailed medical history, where I also perform a physical examination, and listen to the heart for specific valve sounds, heart rate and rhythm to further assess their fitness for surgery. Additionally, patients have an echocardiogram, a detailed ultrasound scan of the heart and valves, and an electrocardiogram to look at the heart rate and rhythm.
I explain to the patient, and family, the journey from hospital to recovery at home. After this, I collate all the information and test results, and work with the Consultant to ensure that the patients are prepared for their operation. If any further investigations are required I organise these. Their details are then given to admissions.
I see my inpatients daily, either during the morning ward round, Consultant ward round or independently. During this time, they are reviewed, medications adjusted if needed and a care plan constructed. This is an opportunity to answer any questions and offer advice regarding their immediate and long-term recovery. Alternatively, there are daily telephone and email queries to be answered regarding similar concerns.
Complicated and urgent cases are discussed each week in the multidisciplinary team meeting, which is attended by Consultant Cardiologists and Cardiac Surgeons who consider the best plan of action. These meetings enable me to gauge the impending number of urgent referrals and plan their timely transfer and admission for surgery, liaising with the Consultant and their local hospital. Upon arrival at St Thomas’ I welcome the patient, explain the patient journey and provide them with an information leaflet. I ensure that all pre-operative investigations have been requested and completed, and submit the operating list to Theatre.
In the next blog, I’ll talk about outpatients.
You can find out more information about heart valve disease on the Heart Valve Voice website (www.heartvalvevoice.org) which I support in various projects.