Heart Education Awareness Resource and Training through eLearning (HEARTe)

Hamish at home

Hamish is discharged home. He has been referred to the cardiac rehabilitation service and receives a phone call from the cardiac rehabilitation nurse, Gillian.

There are several key areas that the cardiac nurse Gillian focuses on during her telephone assessment, she uses the SBAR* framework to provide structure and focus to her assessment.

SITUATION Gillian(Gill) contacts Hamish at home as part of his follow up care after discharge
BACKGROUND Hamish was admitted to hospital direct from his GP surgery via ambulance .He was diagnosed with a NSTEMI (non ST elevated myocardial infarction) He had a CABG (coronary artery bypass graft) performed. He had an uneventful recovery and was discharged home 6 days later.
ASSESSMENT
  • Gillian: “Hello Hamish its Gill the cardiac nurse, I am just calling to see how things have been with you since you got home from hospital?”
  • Hamish: “Things have been fine thank you and I have an appointment with my GP tomorrow”

Cardiovascular assessment

  • Gillian: “Have you had any problems with angina pains, breathlessness or ankle swelling since you got home?”
  • Hamish: “No problems at all, my ankles were slightly swollen when I was in the hospital but they seem to be getting back to normal now”

Wound Assessment including pain control

  • Gillian: “How does your chest and leg wound look? Are they clean and dry?”
  • Hamish:” Yes no problems with them both, they look like they are healing very nicely”
  • Gillian: “What about pain from your wounds, are you still taking regular pain killers?”
  • Hamish: “I have stopped the dihydrocodeine as I felt I didn’t need them anymore and they were making me a bit constipated. Flora has sorted me with her homemade soup! I am still taking 2 paracetamol 4 times a day but I was going to try and cut them down.”

Activity levels

  • Gillian: “Have you managed to get out of the house yet?”
  • Hamish: “My wife has taken me for a drive and I have been doing a short walk on my street each day. I am a bit anxious about exercising, Flora is anxious too and she wants to drive me everywhere.”

Sleeping

  • Gillian: “Are you managing to sleep well?”
  • Hamish: “It’s fine now. I had been having some bad dreams when I was in hospital but that seems to have settled down since I got home.”
  • Gillian: “Glad to hear that. It is fairly common to experience nightmares after having bypass surgery.”
RECOMMENDATION
  • Gillian: “Well Hamish it sounds as though things are progressing well for you. I’d like to give you a bit of advice about your painkillers. The best way to cut them down is to wean them down slowly and cut out only 1 dose at a time. It is best to cut out the lunch or tea time dose first and leave the bedtime and morning doses till last. Make sure you are pain free for a good few days before cutting a second dose, and if need be you can always re-start them.”
  • Hamish: “Ok that sounds sensible .I might try without my lunch time dose later and see how it goes.”
  • Gillian: “I would like to refer you to our exercise programme, this would give both you and Flora the opportunity for support. Someone should contact you within the next 2 weeks. In the meantime It is important that you follow the instructions on the information leaflet you were given by the physiotherapist on the ward.”
  • Hamish: “That sounds really helpful.”
  • Gillian: “Are you clear about my advice? Is there anything you want to ask me?”
  • Hamish: “No thanks”
  • Gillian : “If you have any further concerns you can call me back on the number on the discharge sheet. I am available Monday to Friday 9am till 5pm .If you have concerns in the evenings or weekends you can call NHS 24.Do you have the number?”
  • Hamish: “Yes it’s beside the phone.”
  • Gillian : “That’s great goodbye then.”
  • Hamish: “Goodbye and thanks.”

Pulse point

The contact with the patient could be via the telephone or face to face at home or in a clinic. Follow up care post-cardiac event varies from area to area. You can find more about this in your own area by contacting the cardiac rehabilitation network.

The importance of clear efficient communication is a goal that the NHS always strives to improve. Tools exist that actively focus on how to improve communication, in particular verbal communication. The Situation, Background, Assessment, and Recommendation (SBAR) framework tool can be used to shape communication at any stage of the patient’s journey. The tool helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBAR prompts staff to formulate information with the right level of detail.

Reference: NHS Scotland SBAR, NHS Education for Scotland Quality Improvement Zone

Page last reviewed: 09 Jun 2020