- Email: [email protected]
N061 Radiation safety in interventional cardiology: Development and implementation of a quality assurance program
S356
N058 BUILDING BRIDGES BETWEEN HEART FAILURE AND HOSPICE PALLIATIVE CARE P Strachan1, J Costigan2, C Joy3 1 McMaster University, 2 St. Mary’s General Hospital, 3 HPC Consultation Services, Vancouver, BC
Heart failure (HF) affects more than 400,000 Canadians, with over 50 000 new cases occurring annually. Death from HF may be sudden or occur following a progressive decline punctuated by periods of acute exacerbation. Evidence clearly reflects that patients with advanced HF who continue to deteriorate despite treatment optimization require supportive care that crosses traditional disease specific disciplinary boundaries to ease their suffering. Subsequently, there is a need to integrate knowledge and skills related to the care of patients with advanced HF with current pain and symptom management provided by community-based health professionals who assist patients as end-of-life approaches. Guided by results of an environmental scan and literature review, we developed an interprofessional workshop to assist health professionals from community settings to understand HF-specific issues and consider their integration into the end-of-life care of patients with advanced HF. This report will focus on findings from the workshop. We will present the HF-specific learning needs of participating community-based health providers and discuss our findings about facilitators and barriers to the integration of HF-specific care into the palliative and community settings. Implications for development of future initiatives aimed at building bridges between health professionals in HF and community-based palliative care will be presented. These findings may have significance for those who are developing collaborations between HF and hospice palliative care practice communities in other regions.
N059 INFECTIVE ENDOCARDITIS: A GUIDE TO MANAGEMENT J Noorin University Health Network, Toronto, ON
Infective Endocarditis or IE is an endovascular, microbial infection of the endocardial surface of the heart, particularly the heart valves, associated with a high degree of morbidity and mortality. Although, IE is a condition that has existed for over 450 years, new trends in epidemiology related to changes in social behaviours have made it an emerging problem. More than half of all IE cases are seen in individuals over the age of 60 years. This trend is likely due to the declining incidence of rheumatic heart disease, and the increasing proportion of elderly with degenerative valve disease requiring valve replacements. Both of these factors are associated with an increased risk of IE. In addition, changes to social behaviour, such as an increase in the incidence of body piercing, excessive alcohol consumption, and intravenous drug use have given rise to a new group at risk of IE. This presentation will provide an
Canadian Journal of Cardiology Volume 27 2011
overview of IE, including a review of the clinical presentation, epidemiology, diagnoses, treatment, and implications to the practice of nursing. Each year there are approximately 10,000 to 15,000 new cases of IE in the United States alone, with males predominating in most case series. Given the importance of prevention, early detection, and close surveillance for complications, it is imperative for nurses to understand this condition as they will have a significant role in managing these individuals and providing them with the necessary educational teaching.
N060 NURSES WANT A VOICE IN ETHICAL DECISION MAKING IN CSICU C Strain, M LeSage, A Baker, A Kaan, M McCoy St. Paul’s Hospital, Vancouver, BC
Nurses in our Cardiac Surgery Intensive Care Unit (CSICU) noticed the level of patient care seemed to be increasing. With the influx of new surgical techniques and technology nurses commented that planning care for patients has become more ethically challenging; causing nurses to question care decisions. To address specific cases, debriefing sessions with the hospital ethicist were arranged, and although helpful, the benefit was not ongoing and issues tended to resurface. The purpose of this paper is to evaluate how nurses felt about ethical decisions in the unit and to determine whether a regular, formalized ethics education session would be considered helpful to staff nurses. A survey was developed with 6 questions gauging respondent interest in workshop planning, as well as 29 other topics that used the Likert Scale to rate importance. The survey was distributed to all CSICU nurses (N⫽45). RESULTS: Response rate was 46% (21/45). Of the respondents 12.5%, (2.5/21) felt informed about ethical decisions made in the workplace and 100%, (21/21) supported a workshop. Further, several recurrent themes were identified, including: nursing guidelines and care plan development for dying patients in the CSICU, and the importance of multidisciplinary teamwork and communication. Implications for practice: The results of our survey suggest an ethical decision making workshop developed by and for CSICU nurses will provide the tools and confidence necessary to effectively contribute to decision making in ethically challenging cases. A tool for effective care planning and communication is essential in these difficult cases.
N061 RADIATION SAFETY IN INTERVENTIONAL CARDIOLOGY: DEVELOPMENT AND IMPLEMENTATION OF A QUALITY ASSURANCE PROGRAM S Lauck, S Siegrist St. Paul’s Hospital, Vancouver, BC
S357
CCCN Abstracts
The fluoroscopically-guided interventional procedure era began in the late 1970’s and early 1980’s. The medical benefits of complex interventions that use fluoroscopy are well established. Many procedures that previously required more invasive surgery, or were not feasible are now safely and effectively performed using interventional techniques. The growing use of radiological imaging in cardiology, outside of conventional radiology departments, has challenged clinicians to establish evidence-based practice and protocols to promote patient and staff safety. Concerns related to multiple reports of skin injuries, and to scientific and media reports raising awareness about radiological practices, have forefronted the need for quality assurance programs in interventional cardiology. The purpose of this presentation is to review the recommendations from the International Commission of Radiological Protection, and other current evidence, and outline our centre’s experience in implementing best practices. We will review the health effects of radiation and the fundamental principles of radiation protection, and discuss the factors that affect dose and dose limiting techniques. We will outline the ICRP recommendations, and review various approaches adopted in interventional cardiology. We will focus on the process we developed, including staff education, documentation, patient teaching and quality assurance monitoring, and discuss the challenges and other barriers that we addressed. Simple interventions to promote best radiological practices in the cardiac cath lab, electrophysiology lab and cardiac device implantation rooms can help support these growing programs.
N062 USING OUR SKILLS TO FULL SCOPE: WHAT AN RN AND CLINICAL PHARMACIST ATRIAL FIBRILLATION CLINIC LOOKS LIKE N Cameron, A Price, L Ward VIHA, Victoria, BC
Atrial Fibrillation (AF) is the most common arrhythmia affecting 1 % of the population increasing to 10 % for patients over 80 years of age. In BC the increasing demand for AF care has resulted in the creation of four new clinics in the past eighteen months. The AFC at Royal Jubilee Hospital is comprised of an interdisciplinary team involving electrophysiology cardiologists (EP), registered nurses (RN) and a clinical pharmacist (CP). Using a collaborative care approach, drawing on the varied skills of the interdisciplinary team, RN’s and CP act as case managers under the direction of EP to provide care to AF patients. The purpose of this presentation is to share our experience in developing our clinic and medication titration protocols to meet the needs of our patients. In our clinic development, we created value added strategies by filling in gaps in service and providing comprehensive care for the AF patient. First contact with the patient is a triage tele-
phone intake followed by education. The clinician then coordinates care from time of consult to discharge. A medication regime is the first line of treatment thereby creating a need for medication titration protocols that can be implemented by an RN or CP. The protocols provide timely titration, rapid access to care, symptom reduction and improves quality of life. This process has resulted in a collaborative team approach that has streamlined care, improved clinical standards in both medication treatment and diagnostic follow up for the AF patient.
N063 ISOLATED VENTRICULAR NON-COMPACTION: A RARE FORM OF CARDIOMYOPATHY E Estrella-Holder, L Avery, A Malik St. Boniface General Hospital, Winnipeg, MB
Isolated ventricular non-compaction (IVNC) is an increasingly recognized but uncommon form of cardiomyopathy. It is caused by a failure of normal embryogenesis of the endocardium and myocardium in utero resulting in prominent ventricular trabeculations with deep intertrabecular recesses. It was first described in 1984 in a 33 year old woman by Engberding and colleagues. Since then, several case reports in adults and children have been reported. It has recently been classified as genetic cardiomyopathy. The rarity and diverse clinical manifestation of IVNC may prolong diagnosis. The delay in diagnosis poses a potential risk to the individual and may delay genetic testing of family members. The purpose of this abstract is to present a real case study of IVNC including a review of the pathogenesis, clinical presentation, diagnostic procedures, prognosis, potential complications and recommended follow up. The management including the issue of controversial use of primary prevention implantable defibrillator and the importance of genetic work-up and counseling will also be reviewed. The rarity of an IVNC diagnosis in cardiac care poses a unique challenge for cardiac nurse to remain current in their knowledge related to IVNC. Updates, such as this case study, may create an interest in the topic and subsequent future readings that may be later used by nurses in teaching patients and families regarding this genetic disorder.
N064 PERIPHERAL CHEST PAIN PROGRAM L Savard1, R Welsh2 1
Mazankowski Alberta Heart Institute, 2 University of Alberta, Edmonton, AB
In 2001, the University of Alberta Chest Pain Program (CPP) was established. This nurse practitioner (NP) led program standardized the assessment and management of moderate risk patients who presented to the emergency department (ED) with
N058 BUILDING BRIDGES BETWEEN HEART FAILURE AND HOSPICE PALLIATIVE CARE P Strachan1, J Costigan2, C Joy3 1 McMaster University, 2 St. Mary’s General Hospital, 3 HPC Consultation Services, Vancouver, BC
Heart failure (HF) affects more than 400,000 Canadians, with over 50 000 new cases occurring annually. Death from HF may be sudden or occur following a progressive decline punctuated by periods of acute exacerbation. Evidence clearly reflects that patients with advanced HF who continue to deteriorate despite treatment optimization require supportive care that crosses traditional disease specific disciplinary boundaries to ease their suffering. Subsequently, there is a need to integrate knowledge and skills related to the care of patients with advanced HF with current pain and symptom management provided by community-based health professionals who assist patients as end-of-life approaches. Guided by results of an environmental scan and literature review, we developed an interprofessional workshop to assist health professionals from community settings to understand HF-specific issues and consider their integration into the end-of-life care of patients with advanced HF. This report will focus on findings from the workshop. We will present the HF-specific learning needs of participating community-based health providers and discuss our findings about facilitators and barriers to the integration of HF-specific care into the palliative and community settings. Implications for development of future initiatives aimed at building bridges between health professionals in HF and community-based palliative care will be presented. These findings may have significance for those who are developing collaborations between HF and hospice palliative care practice communities in other regions.
N059 INFECTIVE ENDOCARDITIS: A GUIDE TO MANAGEMENT J Noorin University Health Network, Toronto, ON
Infective Endocarditis or IE is an endovascular, microbial infection of the endocardial surface of the heart, particularly the heart valves, associated with a high degree of morbidity and mortality. Although, IE is a condition that has existed for over 450 years, new trends in epidemiology related to changes in social behaviours have made it an emerging problem. More than half of all IE cases are seen in individuals over the age of 60 years. This trend is likely due to the declining incidence of rheumatic heart disease, and the increasing proportion of elderly with degenerative valve disease requiring valve replacements. Both of these factors are associated with an increased risk of IE. In addition, changes to social behaviour, such as an increase in the incidence of body piercing, excessive alcohol consumption, and intravenous drug use have given rise to a new group at risk of IE. This presentation will provide an
Canadian Journal of Cardiology Volume 27 2011
overview of IE, including a review of the clinical presentation, epidemiology, diagnoses, treatment, and implications to the practice of nursing. Each year there are approximately 10,000 to 15,000 new cases of IE in the United States alone, with males predominating in most case series. Given the importance of prevention, early detection, and close surveillance for complications, it is imperative for nurses to understand this condition as they will have a significant role in managing these individuals and providing them with the necessary educational teaching.
N060 NURSES WANT A VOICE IN ETHICAL DECISION MAKING IN CSICU C Strain, M LeSage, A Baker, A Kaan, M McCoy St. Paul’s Hospital, Vancouver, BC
Nurses in our Cardiac Surgery Intensive Care Unit (CSICU) noticed the level of patient care seemed to be increasing. With the influx of new surgical techniques and technology nurses commented that planning care for patients has become more ethically challenging; causing nurses to question care decisions. To address specific cases, debriefing sessions with the hospital ethicist were arranged, and although helpful, the benefit was not ongoing and issues tended to resurface. The purpose of this paper is to evaluate how nurses felt about ethical decisions in the unit and to determine whether a regular, formalized ethics education session would be considered helpful to staff nurses. A survey was developed with 6 questions gauging respondent interest in workshop planning, as well as 29 other topics that used the Likert Scale to rate importance. The survey was distributed to all CSICU nurses (N⫽45). RESULTS: Response rate was 46% (21/45). Of the respondents 12.5%, (2.5/21) felt informed about ethical decisions made in the workplace and 100%, (21/21) supported a workshop. Further, several recurrent themes were identified, including: nursing guidelines and care plan development for dying patients in the CSICU, and the importance of multidisciplinary teamwork and communication. Implications for practice: The results of our survey suggest an ethical decision making workshop developed by and for CSICU nurses will provide the tools and confidence necessary to effectively contribute to decision making in ethically challenging cases. A tool for effective care planning and communication is essential in these difficult cases.
N061 RADIATION SAFETY IN INTERVENTIONAL CARDIOLOGY: DEVELOPMENT AND IMPLEMENTATION OF A QUALITY ASSURANCE PROGRAM S Lauck, S Siegrist St. Paul’s Hospital, Vancouver, BC
S357
CCCN Abstracts
The fluoroscopically-guided interventional procedure era began in the late 1970’s and early 1980’s. The medical benefits of complex interventions that use fluoroscopy are well established. Many procedures that previously required more invasive surgery, or were not feasible are now safely and effectively performed using interventional techniques. The growing use of radiological imaging in cardiology, outside of conventional radiology departments, has challenged clinicians to establish evidence-based practice and protocols to promote patient and staff safety. Concerns related to multiple reports of skin injuries, and to scientific and media reports raising awareness about radiological practices, have forefronted the need for quality assurance programs in interventional cardiology. The purpose of this presentation is to review the recommendations from the International Commission of Radiological Protection, and other current evidence, and outline our centre’s experience in implementing best practices. We will review the health effects of radiation and the fundamental principles of radiation protection, and discuss the factors that affect dose and dose limiting techniques. We will outline the ICRP recommendations, and review various approaches adopted in interventional cardiology. We will focus on the process we developed, including staff education, documentation, patient teaching and quality assurance monitoring, and discuss the challenges and other barriers that we addressed. Simple interventions to promote best radiological practices in the cardiac cath lab, electrophysiology lab and cardiac device implantation rooms can help support these growing programs.
N062 USING OUR SKILLS TO FULL SCOPE: WHAT AN RN AND CLINICAL PHARMACIST ATRIAL FIBRILLATION CLINIC LOOKS LIKE N Cameron, A Price, L Ward VIHA, Victoria, BC
Atrial Fibrillation (AF) is the most common arrhythmia affecting 1 % of the population increasing to 10 % for patients over 80 years of age. In BC the increasing demand for AF care has resulted in the creation of four new clinics in the past eighteen months. The AFC at Royal Jubilee Hospital is comprised of an interdisciplinary team involving electrophysiology cardiologists (EP), registered nurses (RN) and a clinical pharmacist (CP). Using a collaborative care approach, drawing on the varied skills of the interdisciplinary team, RN’s and CP act as case managers under the direction of EP to provide care to AF patients. The purpose of this presentation is to share our experience in developing our clinic and medication titration protocols to meet the needs of our patients. In our clinic development, we created value added strategies by filling in gaps in service and providing comprehensive care for the AF patient. First contact with the patient is a triage tele-
phone intake followed by education. The clinician then coordinates care from time of consult to discharge. A medication regime is the first line of treatment thereby creating a need for medication titration protocols that can be implemented by an RN or CP. The protocols provide timely titration, rapid access to care, symptom reduction and improves quality of life. This process has resulted in a collaborative team approach that has streamlined care, improved clinical standards in both medication treatment and diagnostic follow up for the AF patient.
N063 ISOLATED VENTRICULAR NON-COMPACTION: A RARE FORM OF CARDIOMYOPATHY E Estrella-Holder, L Avery, A Malik St. Boniface General Hospital, Winnipeg, MB
Isolated ventricular non-compaction (IVNC) is an increasingly recognized but uncommon form of cardiomyopathy. It is caused by a failure of normal embryogenesis of the endocardium and myocardium in utero resulting in prominent ventricular trabeculations with deep intertrabecular recesses. It was first described in 1984 in a 33 year old woman by Engberding and colleagues. Since then, several case reports in adults and children have been reported. It has recently been classified as genetic cardiomyopathy. The rarity and diverse clinical manifestation of IVNC may prolong diagnosis. The delay in diagnosis poses a potential risk to the individual and may delay genetic testing of family members. The purpose of this abstract is to present a real case study of IVNC including a review of the pathogenesis, clinical presentation, diagnostic procedures, prognosis, potential complications and recommended follow up. The management including the issue of controversial use of primary prevention implantable defibrillator and the importance of genetic work-up and counseling will also be reviewed. The rarity of an IVNC diagnosis in cardiac care poses a unique challenge for cardiac nurse to remain current in their knowledge related to IVNC. Updates, such as this case study, may create an interest in the topic and subsequent future readings that may be later used by nurses in teaching patients and families regarding this genetic disorder.
N064 PERIPHERAL CHEST PAIN PROGRAM L Savard1, R Welsh2 1
Mazankowski Alberta Heart Institute, 2 University of Alberta, Edmonton, AB
In 2001, the University of Alberta Chest Pain Program (CPP) was established. This nurse practitioner (NP) led program standardized the assessment and management of moderate risk patients who presented to the emergency department (ED) with