Transcript ACS Clinical Pathway Presented by: Erika MacPhee CNE

ACS Clinical Pathway
Who?
•Pts with Acute Ischemic Heart Disease
now described as having ACS
ACS - Definition
•Umbrella term, encompasses the full
spectrum of disease manifestations
associated with ischemic heart disease:
 Unstable
 Non
 ST
angina
ST segment elevation MI
segment elevation MI
ACS - Definition
•More accurately reflects the diagnostic
uncertainty that exists on presentation to
hospital
•Emphasizes urgent nature of problem & its
location
•Provides a starting point for a series of
decisions providing rapid determination of
the optimal treatment and dx
ACS Clinical Pathway
•Designed to provide optimal patient care
for this group of patients
Using the Pathway
•Replace the Acute MI pathway
•Based on 2002 ACC/AHA Clinical
Guidelines for UA, NSTEMI & STEMI
•Goal: provide best practice for pts
Components
•Consults
•Tests
•Assessments/Treatments
•Mobility/Safety
•Nutrition
•Psychosocial support
•Pt Education
•Discharge Planning
(Medications are not listed on the pathway…will
be written in medical orders…refer to standard
orders sheet)
Using the Pathway
ACS Clinical Pathway documentation
includes:
 Physician Pre-Printed Order Sheets
 Clinical Pathway
 Patient/Family Information
 Case History
 Clinical Flow Sheet/part of documentation
 Patient Discharge Information ACS
Forms Available
•ACS Pathway
•Pt Information Sheet
•GAP Tool
•Orders (admission, CCU, levels, Cath, PCI,
transfer to levels)
•Protocols Chest Pain (CCU, levels), O2
protocol
•Flow Sheet
Using the Pathway
•On admission to HI all patients will start the
clinical pathway
•Start on the day of admission column
•Includes all pts transferred from other
hospitals
•Ensures that all tests, consults and
assessments will be done
Using the Pathway
•The physician orders should indicate pt is
ordered on the ACS clinical pathway
Using the Pathway
•Charting by exception
•Only deviations to the plan are charted
•Initial & time where indicated…assumed
that standards of care have been met and
provided unless otherwise indicated
Using the Pathway
•When documenting on the pathway, it is not
necessary to document findings elsewhere
in the chart
Using the Pathway
•Consists of 4 days
•If pt stay is >4 days, Day 4 may be repeated
•Intervention day is to be used when pts go
for cath/PCI
Using the Pathway
•Dates are entered on top of the pathway to
indicate Day 1, Day2, etc…
•Communicate to next shift by circling
undone/incomplete care & putting an arrow
to the next day
Using the Pathway
•Problem list completion required with the
use of the pathway
•Reminder on pathway to complete the
initiation/review/update of the problem list
Using the Pathway
•Assessment of variance is done on
outcome section of pathway
•Pt progress and variances are documented
on the pathway, nurse’s notes and medical
notes
Using the Pathway
•Interdisciplinary team in consultation with
attending physician will determine if a
specific pt care would be better managed
off the pathway
•A physician’s order is required to
discontinue the pathway
•Previous system of documentation resume
when a patient is taken off the pathway
Using the Pathway
•Staff are required to sign at the end of each
shift in the RN signature box on pathway
•Info that needs to be documented, not
found on pathway, entered in nurse’s
progress notes
Using the Pathway
•Discharge day must be completed,
documenting that pt has script, d/c letter,
teaching and any other plans
•GAP tool will indicate the meds the pt will
take on discharge
Using the Pathway
•On discharge ALL ACS pts will have the
Patient Discharge Information ACS
completed and signed by BOTH the nurse
and the patient.
GOOD LUCK!