Transcript St. Rose Dominican Hospital

St. Rose Dominican Hospital
“Cardiac Care Team”
UPDATE
September 2003
Prepared by:
Pamela Rowse, RN
Cardiac Care Team Leader
Assistant Nurse Manager ED
“The Henderson Roses”
“Living by our Mission and Values”
St. Catherine of Siena
and
St. Rose of DeLima
Striving For Excellence
“Background”
 Early Team activities
were missing
important resources.
 Meetings were not
well attended by team
members.
 Interdisciplinary
collaboration was
fragmented.
“Reorganization”
 The Emergency
Department actively
joined the Team in
December of 2002.
 In March of 2003 –
Expansion began in the
Team Configuration.
 Benchmarks were
reviewed in detail and
discussions ensued to
meet the standards.
 The name changed from
“AMI” Team, to
“Cardiac Care Team”.
 Resources influencing
outcomes were outlined.
 Strategic Team
expansion resulted.
 Focus expanded to ALL
services impacting the
desired end product, that
being “excellence in
Cardiac Care”.
Team Members Now
Emergency
Department
Critical Care
ED
Physicians
Cardiology
Cardiologists
Pharmacy
Medical
Surgical
Nursing
Education
Case
Management
Nutrition
Services
EMS/HFD
QM/RM
Cardiac Rehab
Cardiac Cath
Lab
Radiology
Laboratory
Administration
Corporate
Communications Respiratory
Therapy
“Diagramed Full Process”
“What are the important components
to success and good patient
outcomes….?”
Chest Pain – Cardiac Emergency
 Onset of pain is the
triggering factor in
recognizing and acting on
a true cardiac emergency
 The Team realized that
this was one area where
we must have impact to be
successful in our
outcomes.
 Denial and lack of public
awareness was one of the
focuses.
“Activating 911”
 How could we achieve
early activation of the 911
system?
 HFD – Assisted us with
statistics regarding the
current stats in our
Community.
 Average time from CP to
“911” activation was “53
minutes”
 We felt it was imperative
to impact in earlier
notification of emergency
services.
“Community Education”
“Time Is Muscle”
 The Communications
Department at St. Rose
Dominican was contacted
regarding “public
education”
 Response was very
supportive and projects
discussed in conjunction
with Henderson Fire
Department/EMS
 Once More a “Team
Effort” and quality in our
delivery of care.
EMS Response
“Pre-Hospital Statistics for
Cardiac Care”
 Once “911” is activated, our
community has a maximum
dispatch response time of “2
min”
 EMS Response to the Scene is
approximately “7 min”
 Early “Cardiac Alert”
Systems were already being
put into place by HFD to
enable them to react with
expediency when arriving at
the scene for particularly
patients presenting with ST
Elevation.
“STEMI Patients”
 The Team discovered that the
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HFD was working diligently on a
program for “ST elevation MI
Protocols”
A presentation was made to the
Cardiac Care Team outlining
their plans.
This “dove-tailed” perfectly into
our Team Activities including
standing physician orders.
Early Recognition and Resource
activation took a step forward.
Presentations were scheduled for
the Emergency Department
Physicians and Cardiology.
“Emergency Department Early
Activation”
 Part of the Early Activation of
ED Resources came from the
statistics that we were given
regarding benchmarks of care
delivery.
 Timing of response from EKG,
Laboratory, and Radiology
didn’t meet our desired goal.
 It was essential to have emergent
notification of all needed
resources for an acute MI patient
delivery.
 A system for “group paging” was
discussed and implemented.
“Door To Data”
 Arrival of the EKG
Technician for accurate data
for diagnosis was imperative.
This was addressed with the
“AMI Group Pager” system.
 HFD however, helped us to
move even further in this
arena.
 Technology with their rescue
units enables them to transmit
via fax accurate and clear 12
lead EKG data directly to the
hospital ED Physician for
review.
 This would enable activation
of resources prior to the
arrival of the patient.
“Time to Lytics”
 Time to administration of
thrombolytics was an
essential benchmark.
 This component was impacted
by Nursing, Pharmacy, and
Education.
 Tracking was established to
monitor times.
 We also included the
administration of lytics in the
critical care units and
provided an educational
program through pharmacy
to facilitate this.
“Door to PTCA”
 A new cath lab was
installed at the DeLima
Campus allowing PTCA
to be completed there.
 Tracking of response
times by the
Cardiologists was
initiated.
 100% review was
established.
“Morbidity & Mortality”
 Reports were outside of
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Benchmarks
Reviewed stats from Midas
and NIRMI
Investigated the co-utilization
of NIRMI numbers with
significant co-morbidities pull
out.
Needed to pull NIRMI
numbers into current review.
Contacted another CHW
Facility regarding their
process.
Pursuing Alternatives such as
dedicated FTEs.
“Corroboration”
All Resources Must Be Included
To
Achieve “Best Practice”
“Public and Patient Education”
 It is “OUR” responsibility to
identify and provide education
for our patients and our
customers.
 Cardiac Disease in one of the
number one causes of death
and disability in our country
and we must help provide the
necessary interventions.
 It is an issue that is broad in
scope and vitally important.
 And one that the St. Rose
Cardiac Care Team didn’t take
lightly.
Nursing Education
 The education of our
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nursing staff is multifaceted and imperative.
Disease Process
Understanding.
Recognition of needs.
Intervention in a timely
and appropriate manner.
Patient Education and
Advocacy.
“Physician Education”
 Communication of the
“National Guidelines” and
“Community Standards”
 Providing “Tools” for accurate
admission orders that are
streamlined.
 Introduction of “Clinical
Pathways” to facilitate
compliance to “LOS”
standards that assists not only
medical but nursing treatment
of patients with cardiac
conditions.
 Provide information regarding
resources that will facilitate
their patient’s recovery such as
outpatient services, Rehab, PT,
Nutrition etc.
“Smoking Cessation”
 Identify all opportunities
for education.
 Provide the resources and
support for patients to
achieve this essential
goal.
 Be able to document the
efforts made.
 Achieve desired
benchmarks
Aspirin, Beta Blockers, Ace
Inhibitors
 Provide opportunity
for appropriate
documentation.
 Provide triggers for
ordering and followthrough
 Provide patient and
provider education
regarding need.
“Nutrition”
 Provide notification and
access to essential clients
by the Nutrition Team.
 Take home information
regarding daily activities
and impact of diet on
disease process.
 Follow-up Resources
regarding education and
questions.
 Disease specific “tips” for
adhering to a healthy lifestyle
“Medications”
 Patient understanding of
prescribed medications.
 Assisting patients with
financial resources to
adhere to medication
regimes outlined for
them.
 Providing resources for
education and food and
drug interactions that will
allow nursing to assist in
the education process at
discharge.
“Rehab – Exercise”
 Active participation in
the inpatient visit and
mechanism for
notification and
orders.
 Coordination with
“other” educational
processes.
 Notification of followup resources
provided.
“Discharge Instructions”
 Standardize the documents
utilized for Discharge
Instructions and
documentation by Nursing.
 Provide the tools for adequate
education of patients by the
nursing staff that is going to be
held accountable for it’s
completion.
 Establishment of a resource
library and packets for
“disease specific” education by
nursing.
 Education regarding “how to
provide Discharge Instruction”
“Our Team Challenges”
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Systems for implementation of
“action plan” such as
Dedicated fax machines for EKG
Transmissions,
Immediate registration of AMI
patients for early intervention,
Education of all staff regarding
cardiac care education and discharge
planning,
Process for reporting to the nursing
departments regarding ejection
fractions,
Standardized forms for discharge
documentation,
Materials available for after hour
discharges,
Notification of “essential” services
needed to deliver appropriate
assessment and intervention.
“Our Team Successes”
 Implementation of the STEMI
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Standing Orders.
“AMI Group Page System
Near Completion of the CHF
Standing Orders
Collaborative effort with
Community EMS for Early
Activation and Public Education.
Successful achievement of
benchmarks for “door to data
and door to lytics”
Expansion of “Active” Team to
include all necessary resources.
Active involvement of
“physicians” in outcomes and
program implementation.
“Proposals”
 Utilization of the St.
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Rose Website for:
Patient and Staff
Education
Resources and Referrals
Internet links for
information
Schedules for
“outpatient education
programs”
Contacts and
Educational Downloads
St. Rose
Serving Our Community
For Better Cardiac Care