Download NSTEMI Pathway Education for Nurses

NSTEMI Pathway Education for
Nurses
Objectives
• Demonstrate an understanding of the NSTEMI clinical
pathway.
• Understand the importance of early and consistent
education throughout hospital stay.
• Demonstrate the knowledge of the educational
material and where to access the material.
• Understand the discharge criteria including follow-up
appointment and supply of medications for home.
What is the NSTEMI Pathway
• An evidence based, streamlined approach to NSTEMI patient
management starting when a patient enters the system
through the ED and continues to post discharge.
• The focus is on early treatment and diagnosis including:
troponins, medications, interventions if necessary, and
focused education.
• Each patient that meets the criteria for an NSTEMI will be
placed on the clinical pathway through the acute admission.
• The Cardio Chest Pain/ MI Admission Power Plan MD 5712 has
been optimized to support the pathway roll out.
– Pathway NSTEMI will be checked on the order set. It will also appear in
the problem list in power chart.
• The orders and educational materials for these patients are
standardized.
Cardio Chest Pain/MI Admission
Power Plan MD 5712 Revisions
What is my role as the nurse in this pathway?
• Early and consistent education!
• Patient advisors made it clear:
– Too much information is provided in a short period of time
– Patients need time to understand and accept the diagnosis of a heart
attack
– Major lifestyle changes are hard to comprehend in the acute hospital stay
– Patients want to know the essentials to keep them safe upon discharge
• Focus is on providing the essentials of diagnosis, procedures,
medications, and follow up with secondary prevention.
• Cardiac rehab will reinforce lifestyle changes such as:
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Weight loss
Dietary Changes
Smoking Cessation
Lifestyle Modifications
NSTEMI Clinical Pathway
What is my role as the nurse in this pathway?
• You will know if your patient is on the NSTEMI pathway by:
– Checking off the order to place the patient on the pathway
– Checking the Problems/Diagnosis List
– Checking the Non-categorized orders for NSTEMI pathway
• Provide the education listed under Psychosocial
Support/Education on the NSTEMI Clinical Pathway Form for
each day.
• Document the education you provide as well as the patient
comprehension of the teaching on the back of the
Supplemental Plan of Care-Ineffective Tissue Perfusion
Cardiopulmonary Percutaneous Intervention.
• Eventually this flowsheet will be available in I-View.
• Partner with Pharmacy and Case Management to obtain new
AMI medications prior to discharge where applicable.
NSTEMI Pathway Education Tip Sheet
Day 1/2
Day 2/3
Patient/Caregiver Education
NSTEMI Clinical
Pathway
Start educating your patient with:
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Orientation to the unit and the pathway
Patient safety teaching:
o Call for Chest Pain
o Assistance to the BR
o Bed Exit alarms
Education
Taking Nitroglycerin
After a heart attack, at discharge
Symptoms of a heart attack common to
women
Smoking Cessation, creating a plan
Benefits of cardiac rehabilitation
Exit Care
Please Remember to:
Exit Care
HVIS AMI Pathway CCHS
HVIS Medications prescribed after a heart
attack
Cardiology Cardiac Catheterization CCHS
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GWN Videos
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What is a Heart attack?
The Angiography Procedure
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Continue to reinforce previous teaching
Patient/Caregiver
GWN Videos
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Patient/Caregiver Education
Document education and
response on Plan of Care
Provide continual medication
education with each medication
pass
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HVIS Dual Antiplatelet Therapy CCHS
HVIS Groin Site Care or Radial Site Care
Cardiac Rehabilitation
Smoking, You Can Quit
Discharge Criteria
Patient must verbalize an understanding
of:
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Symptoms of a heart attack
When to call 911
When to call a physician
Medication regimen and teach back
Patient must have a scheduled appointment with the
Cardiologist/NP within 7 days

Call Cardiologist’s office to make an appointment if
not already done. Input the appt. into the discharge
paperwork through Depart.
Patient has medications available at discharge:
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If the patient chooses the CCHS pharmacy,
follow normal protocol for obtaining
medications from the pharmacy at
discharge.
If the pharmacy is closed or patient wishes
to use their own pharmacy, partner with
CM to ensure pt will have medications until
they can pick them up.
Discharge Criteria
• Patient verbalizes an understanding of:
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–
–
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Symptoms of a heart attack
When to call a physician
When to call 911
Medication regimen and able to teach back
• Has a scheduled appointment with Cardiologist/NP
within 7 days
– Call the Cardiologist’s office to schedule an appointment if
not already done. Input the appointment into the discharge
paperwork through Depart.
Discharge Criteria-Adding an Appointment to
Discharge through Depart
Discharge Criteria-Adding an Appointment to
Discharge through Depart
Discharge Criteria-Adding an Appointment to
Discharge through Depart
Discharging with Medications
• If the patient chooses to use CCHS’s pharmacy:
– RN sends Pharmacy Discharge Program Form (“Purple Sheet”) to
Pharmacy
– RN Confirms meds are ready for pick up at pharmacy
• Patient can have family member obtain meds from pharmacy OR
• Upon discharge, RN can direct escort to take patient to pharmacy for
med pick up
• If the patient wishes to use their own pharmacy or CCHS
pharmacy is closed:
– Case Management and RN should partner to ensure scripts are
sent to pharmacy and patient can bridge the gap between
discharge and prescription pick up.
– Inpatient pharmacy is able to bridge medications with a
physician’s order.
NSTEMI Pathway Discharge Medication Workflow
Thank you!
• The pathways will help us to streamline and provide
consistent, patient focused care to a critical patient
population.
– It will promote efficient use of resources that reduces
unnecessary variation and costs of care.
– It maximizes the value of care and treatment by formally
integrating best practices and evidence based guidelines to
support team based care delivery.
• We will continue to learn and adapt the pathways as
needed to support continual process improvements.
• Your feedback is welcome!