andrew white - rheumatic heart disease australia
TRANSCRIPT
Andrew White
Graph showing cases of ARF in Central Australia
Graph showing cases of ARF in Central Australia
Acute Rheumatic Fever
0
5
10
15
20
25
30
35
1995
1996
1997
1998
1999
2000
2001
2002
Year
Nu
mb
er
Recurrence
Diagnosis
What are the implications of this pattern for management (prevention) of RHD
Ten-year follow up of a cohort with rheumatic heart disease (RHD)
Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ
METHODS AND RESULTS
Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984
Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of
241 years The two deaths during follow-up were both due to RHD Six people
underwent valve replacement surgery all were clinically healthy when last seen
Complications included two thromboembolic events and two episodes of endocarditis
Deterioration of RHD severity was associated with ARF recurrences (relative risk 36
95 CI 17-76) and resolution of RHD was associated with having only mild valve
lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions
tended either to resolve or to become more complex and severe with a higher proportion
of aortic valve lesions and multiple valve lesions Of seven children with suspected past
ARF excluded from the original cohort because of normal cardiac findings at the time
three developed RHD including one who died due to RHD and two with moderate or
severe valve lesions
Pediatr Int 2013 Dec55(6)685-9 doi 101111ped12163 Epub 2013 Sep 20
Rheumatic silent carditis echocardiographic diagnosis and prognosis of long-
term follow up
Pekpak E1 Atalay S Karadeniz C Demir F Tutar E Uccedilar T
(Turkish Study)
METHODS
A total of 156 consecutive patients diagnosed with acute rheumatic fever were
included in the study Patients had either clinical carditis CC or silent carditis SC
RESULTS
Acute rheumatic fever was diagnosed in 156 patients and 103 of these (66) had
carditis The prevalence of SC was 282 among these 103 patients
Follow up gt 1 year
CC SC
Regurg improved 45 15
Regurg resolved 18 30
Heart 2011 7 2018 -2022
Screening study
Follow up of 100 cases after approx 1 year
Worsened in 4
Non progressive in 68
Regressed in 28
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Graph showing cases of ARF in Central Australia
Graph showing cases of ARF in Central Australia
Acute Rheumatic Fever
0
5
10
15
20
25
30
35
1995
1996
1997
1998
1999
2000
2001
2002
Year
Nu
mb
er
Recurrence
Diagnosis
What are the implications of this pattern for management (prevention) of RHD
Ten-year follow up of a cohort with rheumatic heart disease (RHD)
Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ
METHODS AND RESULTS
Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984
Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of
241 years The two deaths during follow-up were both due to RHD Six people
underwent valve replacement surgery all were clinically healthy when last seen
Complications included two thromboembolic events and two episodes of endocarditis
Deterioration of RHD severity was associated with ARF recurrences (relative risk 36
95 CI 17-76) and resolution of RHD was associated with having only mild valve
lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions
tended either to resolve or to become more complex and severe with a higher proportion
of aortic valve lesions and multiple valve lesions Of seven children with suspected past
ARF excluded from the original cohort because of normal cardiac findings at the time
three developed RHD including one who died due to RHD and two with moderate or
severe valve lesions
Pediatr Int 2013 Dec55(6)685-9 doi 101111ped12163 Epub 2013 Sep 20
Rheumatic silent carditis echocardiographic diagnosis and prognosis of long-
term follow up
Pekpak E1 Atalay S Karadeniz C Demir F Tutar E Uccedilar T
(Turkish Study)
METHODS
A total of 156 consecutive patients diagnosed with acute rheumatic fever were
included in the study Patients had either clinical carditis CC or silent carditis SC
RESULTS
Acute rheumatic fever was diagnosed in 156 patients and 103 of these (66) had
carditis The prevalence of SC was 282 among these 103 patients
Follow up gt 1 year
CC SC
Regurg improved 45 15
Regurg resolved 18 30
Heart 2011 7 2018 -2022
Screening study
Follow up of 100 cases after approx 1 year
Worsened in 4
Non progressive in 68
Regressed in 28
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Ten-year follow up of a cohort with rheumatic heart disease (RHD)
Carapetis JR1 Kilburn CJ MacDonald KT Walker AR Currie BJ
METHODS AND RESULTS
Of a cohort of 33 children seen between 1980 and 1984 27 survived until July 1984
Twenty-five of the survivors were followed up for a mean of 106 years to a mean age of
241 years The two deaths during follow-up were both due to RHD Six people
underwent valve replacement surgery all were clinically healthy when last seen
Complications included two thromboembolic events and two episodes of endocarditis
Deterioration of RHD severity was associated with ARF recurrences (relative risk 36
95 CI 17-76) and resolution of RHD was associated with having only mild valve
lesions initially (risk difference 058 95 CI 030 to 086) During follow-up valve lesions
tended either to resolve or to become more complex and severe with a higher proportion
of aortic valve lesions and multiple valve lesions Of seven children with suspected past
ARF excluded from the original cohort because of normal cardiac findings at the time
three developed RHD including one who died due to RHD and two with moderate or
severe valve lesions
Pediatr Int 2013 Dec55(6)685-9 doi 101111ped12163 Epub 2013 Sep 20
Rheumatic silent carditis echocardiographic diagnosis and prognosis of long-
term follow up
Pekpak E1 Atalay S Karadeniz C Demir F Tutar E Uccedilar T
(Turkish Study)
METHODS
A total of 156 consecutive patients diagnosed with acute rheumatic fever were
included in the study Patients had either clinical carditis CC or silent carditis SC
RESULTS
Acute rheumatic fever was diagnosed in 156 patients and 103 of these (66) had
carditis The prevalence of SC was 282 among these 103 patients
Follow up gt 1 year
CC SC
Regurg improved 45 15
Regurg resolved 18 30
Heart 2011 7 2018 -2022
Screening study
Follow up of 100 cases after approx 1 year
Worsened in 4
Non progressive in 68
Regressed in 28
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Pediatr Int 2013 Dec55(6)685-9 doi 101111ped12163 Epub 2013 Sep 20
Rheumatic silent carditis echocardiographic diagnosis and prognosis of long-
term follow up
Pekpak E1 Atalay S Karadeniz C Demir F Tutar E Uccedilar T
(Turkish Study)
METHODS
A total of 156 consecutive patients diagnosed with acute rheumatic fever were
included in the study Patients had either clinical carditis CC or silent carditis SC
RESULTS
Acute rheumatic fever was diagnosed in 156 patients and 103 of these (66) had
carditis The prevalence of SC was 282 among these 103 patients
Follow up gt 1 year
CC SC
Regurg improved 45 15
Regurg resolved 18 30
Heart 2011 7 2018 -2022
Screening study
Follow up of 100 cases after approx 1 year
Worsened in 4
Non progressive in 68
Regressed in 28
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Heart 2011 7 2018 -2022
Screening study
Follow up of 100 cases after approx 1 year
Worsened in 4
Non progressive in 68
Regressed in 28
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Your patient John 14 years old has a history of ARF when 8 You receive a letter after his cardiology review which says rdquoJohnrsquos cardiac echo shows moderate mitral regurgitation On history it appeared that John is not getting any prophylactic penicillin at all The fact that John is totally noncompliant with prophylaxis places him at great riskrdquo What are the issues Do you have any suggestions for management
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Secondary prevention should include
bull strategies aimed at improving the delivery of secondary
prophylaxis and patient care
bull the provision of education
bull coordination of available health services
bull advocacy for necessary and appropriateresources
RHD Australia Guidelines
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Secondary prophylaxis
Manyemba J Mayosi BM Penicillin for secondary prevention of rheumatic fever Cochrane Database of Systematic Reviews 2002 Issue 3
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
bull Biggest factor was availability and acceptability of staff members and belonging to community rather than pain or understanding [Z Harrington 2005]
Secondary Prevention
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Audit Townsville RHD paediatric outreach
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Townsville Model
bull Nursing led
bull One team is responsible for follow up establishment of
relationships leadership etc
bull Multidisciplinary
bull Indigenous Liaison Officer
bull Allied Health
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Townsville Model
bull Focus on the patient
bull (and family)
bull First Needle
bull Use of distraction Occupational therapist
bull Individualised care
bull Needles in hospital until patient is desensitised
bull Then at school or home
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Townsville Model
bull Medical Support
bull Cohort into a clinic
bull Continuity
bull STP funded registrar available to review patient see new
patients etc
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
Townsville
Model
bull Hospital
recognition of the
team
bull Promotion etc
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
To combat fear and pain Buzzy uses the physiologic pain relief of icy numbing and tingly vibration to block transmission of sharp pain on contact In the same way that rubbing a bumped elbow helps stop the hurt or cool running water soothes a burn Buzzy dulls sharp pain
Buzzy Bee
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
The Paediatric Outreach Service TTH
Case manages all children lt 16 yrs diagnosed with ARF ampor RHD in the
local district plus children attending boarding schools
AIMS
100 compliance of LA Bicillin prophylaxis using strategies
bullProcedural Interventions to reduce trauma amp anxiety of IMrsquos working closely
with occupational therapist
bull Establish routines amp familiarity for children amp families working
closely with THHS IHWrsquos amp ALOrsquos
bull Provision of ongoing education reinforcement of importance of
ongoing treatment for the long term emphasising the importance of
days at risk (IMI every 21 ndash 28 days)
bullProvision of home amp school outreach visits for older children who are
bicillin desensitised
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
The Paediatric Outreach Service TTH
AIMS (continued)
Reduce risk of recurrences improve general health and ensure follow up by
bullWorking with families to raise awareness of the importance of improving
personal hygiene standards amp nutritional status
bullCoordinating clinical follow up for regular medical review ECHO
dental checks annual vaccinations amp opportunistic health assessments
bull Maintaining monthly data sharing with ARF amp RHD QLD Registry
bullContacting or refer to other health services when clients move
bullUsing culturally appropriate educational resources supplied by the
ARF amp RHD QLD surveillance amp control program
bullReferring to the ARF amp RHD program district coordinator for clinical
educationin-service updates for paediatric clinicians amp nursing staff
bullNotifying ARF amp RHD coordinator when targeted education intervention is
required for clientfamily (if compliance is poor)
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance
The Paediatric Outreach Service TTH
LONG TERM GOALS
bullEnsure all suspected cases of ARF are reported to NoCS
bullAssist in the accurate diagnosis ARF as per 2012 Guidelines
bullPrevent ARF recurrences
bullMaximise prophylaxis (100) to
- prevent recurrent ARF and progression of RHD and
- allow for resolution of early stages of valvular disease
bullPrevent progression of RHD
bullContinue to achieve 100 prophylaxis compliance