Download Nurse Checklist

STEMI ALERT
Apply Patient Sticker Here
Nurse Checklist
Date:
RN Name:
Patient Name: (if no sticker)
Hospital: Add your
ED Provider:
Hospital name here
STEMI reperfusion “Time to treatment goals”
Door to ECG complete and read by provider: <10 minutes
Door in door out of your facility: < 30 minutes
Fibrinolytic Therapy < 30 minutes
First medical contact (FMC) to device < 120 minutes
Check
boxes:
12 lead ECG done and to ED provider within 10 minutes. REMEMBER: TIME IS MUSCLE!
Activate STEMI ALERT
Note time of ECG and patient arrival time (door – define this) and report to STEMI scribe
Note time of onset of symptoms and report to STEMI Scribe (refrain from using “yesterday, last night, etc”)
IV 20 gauge obtained, (right arm if possible) – saline lock, obtain 2nd IV access if possible
If thrombolytic therapy is being considered, have lytics at bedside, ready to mix
Follow physician’s order or facility’s protocol for medications, oxygen, pain control, and labs
Place patient in hospital gown, all clothing (including under garments) removed and placed in bag, valuables
given to family if present or to family or placed in bag, label with patient’s identification clearly labeled.
Keep patient NPO (except for medications)
Verify transport paperwork is done (EMTALA forms) prior to EMS Arrival.
Note EMS arrival time and departure time on Data Sheets A & B
Make sure the following goes to PCI receiving hospital with the patient:
 EMTALA form
 Data Sheet B (yellow)
 ECG (verify initials of ED provider and time read are documented) historical, current and EMS
 Patient’s belonging bag with patient’s identification clearly labeled.
The following can be faxed (don’t delay transfer): (add fax number of PCI cath lab)
 Demographic sheet, pertinent lab, ED visit physician and nursing notes, medications given, CXR
Resource Numbers:
Please provide feedback/comments here,
After STEMI alert is
ED Shift Mgr _____________
for example, what went well, what went
over, place completed
STEMI data collected by:
wrong in order to improve the next
________________________
Data Sheet A, Nurse,
STEMI ALERT. (use back if needed)
Contact number: __________
RT lace in mail
Physician, and Scribe
checklists back in STEMI
alert packet
Send Data Sheet B to
receiving facility
Physician responsible for
review of STEMI patients:
_______________________
Receiving facility contact/fax:
________________________
EMS contact: _____________
www.heart.org/HEARTORG/Affiliate/Kansas-Mission-Lifeline_UCM_454367_SubHomePage.jsp
NOT PART OF THE MEDICAL RECORD
www.projectupstart.com
08.07.13