- Email: [email protected]
NP003 The Provincial Heart Failure Strategy at Work: Creating Standardized Education Resources for British Columbia's Heart Failure Patients
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ing to multisystem organ dysfunction. It can be a benign, incidentally discovered condition, or a life-threatening disorder. Cardiac manifestations may precede, follow, or occur concurrently with involvement of the lungs and lymph nodes, which are most commonly affected. These cardiac manifestations are dependent upon location, extent and activity of the disease, and may result in conduction abnormalities, ventricular arrhythmias, heart failure, supraventricular arrhythmias, valvular dysfunction, simulated myocardial infarction, cor pulmonale, and sudden cardiac death. Although increasingly recognized, cardiac sarcoidosis is difficult to diagnose, and associated with poor prognosis. Presently, there are no set guidelines for diagnosis and management of this complex disease which usually occurs in adults before the age of 50. The purpose of this oral presentation is to present the clinical features, diagnosis, and management of cardiac sarcoidosis. A case study will be presented for review and update which will highlight the interesting facets of this condition. The information provided will contribute to knowledge development, which will benefit nurses in that they will be better equipped to support and educate the patient and their families with this very life-changing and difficult disease. This in turn, will improve quality of care for this patient population. Poster Abstracts of the 2012 Canadian Council of Cardiovascular Nurses Annual Scientific Sessions NP001 CVICU STANDARD OF PRACTICE FOR THE PATIENT WITH DELAYED STERNAL CLOSURE (DSC) H Harrington Sunnybrook Health Sciences Centre, Toronto, ON
Open chest management and delayed sternal closure (DSC) for post-operative adult cardiac surgery patients was first discussed in the literature in the late 1970’s. (Anderson et al, 2002). DSC is described as useful in the treatment of cardiac surgery patients with severe myocardial dysfunction, uncontrollable hemorrhage or intractable arrhythmias. (Mubeen et al, 2001) and those that suffer cardiac arrest post cardiac surgery (Mackay et al, 2002). These patient’s are not frequently cared for in our Cardiovascular Intensive Care Unit (CVICU) and the nursing staff expressed anxiety about trying to remember all the additional needs of this complex patient population. The development of a nursing care guideline, to assist them in providing optimal care for these patients, seemed to be the answer. A search of recent literature revealed that the nursing care of these complex patients has not been described; most discussed surgical and postoperative infection concerns. Working closely with our Cardiac Surgeons and Intensivists, a Standard of Practice was developed for the nursing care of this patient population in our CVICU. Our nursing practice council provided valuable feedback at each stage of development. A trial was
Canadian Journal of Cardiology Volume 28 2012
done in the clinical setting where the information gathered led to further revisions and the creation of the final document. A biennial review is planned to ensure best practice.
NP002 USING THE HEART MANUAL AS AN EDUCATION TOOL IN A NEW CARDIAC CHECK-IN PROGRAM TARGETING ACUTE CORONARY SYNDROME PATIENTS IMMEDIATE POST DISCHARGE N Walshaw, S Burns, B Reid-Girard, E Mulvaney, R Brown Fraser Health Authority, New Westminster, BC
People hospitalized with Acute Coronary Syndrome (ACS) may be discharged early post event and intervention. Patients experience pain, anxiety, stress, confusion and sedation during hospitalization with ACS and often overwhelmed with a new diagnosis. Despite education provided in acute care, it is frequently not engaged or remembered by patients and families. Follow-up with a specialist physician or entry into cardiac rehabilitation is often several weeks post discharge. We developed a new community-based program targeting post hospitaldischarged ACS patients using a comprehensive education tool, the Heart Manual. The Cardiac Check-In program is an interactive program developed out of Royal Columbian Hospital Cardiac Clinic. It is a five-week program delivered by an interdisciplinary team including Nurse Clinicians, a Dietitian, Nurse Practitioners, and a Cardiologist. The initial group visit is followed by four weekly interactive education sessions utilizing the Heart Manual. Developed in the United Kingdom and Canadianized by local experts in British Columbia, the Heart Manual is also well validated. It is facilitator-delivered used in clinical settings or with home-based programs. It consists of 3 workbooks, relaxation CD and diary. Interactive sessions cover immediate post discharge recommendations, nutrition, medications, physical activity and psychosocial factors. Sessions are delivered in a community centre rather than a hospital to focus on wellness rather than illness. Clients and family members in the Cardiac Check-In program engage with the Heart Manual embracing the right health information and prevent further hospital readmissions. Long term evaluation is needed to support integration of Cardiac Check-In in regional cardiac rehab programming.
NP003 THE PROVINCIAL HEART FAILURE STRATEGY AT WORK: CREATING STANDARDIZED EDUCATION RESOURCES FOR BRITISH COLUMBIA’S HEART FAILURE PATIENTS B Catlin,1 S Virani2 1
St. Paul’s Hospital, 2 Vancouver Coastal Health, Vancouver, BC
With financial support from Cardiac Services BC, a Provincial Heart Failure (HF) Strategy was established in 2010. Its mandate includes creating standardized resources for a provincial HF patient education program. This initiative is being advanced by a
S443
CCCN Abstracts
provincial working group co-led by the Provincial Clinical Nurse Specialist (CNS) and the physician lead for the Vancouver Coastal HF strategy. Currently in British Columbia (BC), there are select communities with structured heart failure patient education. However, there is no provincial HF patient education program comprised of resources that are evidenced based, inclusive of patient input, reflective of the principles of clear language and design, and easily accessible to all patients and health care professionals. The new, standardized HF education resources and program will be easily accessible by patients and health care professionals throughout BC. In this session, the BC HF Strategy will be described with a focus on the development of the provincial HF patient education resources and program. The presenters will describe the interprofessional and evidence based foundations of the program, the process by which patient input was sought and utilized in developing the education resources, and the attention paid to the principles of clear language and design in creating the resources. The resources will be presented and described in detail including how they are accessed. Lastly, feedback from practitioners and patients about the resources, program and experiences to date related to utilization across BC will be discussed with an emphasis on their significance and implications for patients and practice.
NP004 DISCHARGE READINESS: AN OPPORTUNITY FOR CHANGE IN THE TRANSITION FROM HOSPITAL TO HOME S MacDonald University of Ottawa Heart Institute, Ottawa, ON
Early discharge and a shortened length of stay to control escalating health care costs increase the necessity for effective discharge preparation and follow-up in the cardiac surgery population. The transition from hospital to home has become increasingly important for patient safety, patient satisfaction and outcomes (Weiss et al., 2007; Weiss et al., 2011). The purpose of this project was to identify the areas needed in discharge teaching and planning in order to improve self-care management for patients and their families during the transition home in the early stages post cardiac surgery (Bobay et al., 2010; Davies, 2000; Clark et al, 2005; Jacobs, V., 2000; Leclerc et al., 2002; Theobald & McMurray, 2004). 600 calls received from cardiac surgery patients and families were included in the analysis. Retrospective inductive content analysis was used to analyze the text described by the archived phone call documentation. The description of issues identified by the phone calls revealed two major themes, incision and medication issues. A patient guide focusing on these two high risk issues was developed and implemented. Initial follow-up phone calls to 26 patients 7 to 15 days post discharge revealed that 81% found the patient guide very helpful in guiding them with decision making after discharge in the areas of incision tips and medications. Only one patient sought intervention
because of a concern for his sternal wound. The preliminary results of the project suggest that this portable patient guide should be added to the discharge information packet.
NP005 THE IMPACT OF CARDIAC REHABILITATION WITH STROKE PATIENTS W Clark Southlake Regional Health Centre, Newmarket, ON
Stroke is the fourth leading cause of death worldwide. Although evidence supports risk factor modification for stroke as essential to prevention, a gap exists between treatment recommendations and service availability. Cardiac rehabilitation programs are identified as a secondary prevention option for stroke hypothesizing that since cardiac and stroke patients share common risk factors they should exhibit similar evidence based improvements in risk reduction and reduced mortality. METHODS: An electronic search of MEDLINE, CINAHL, Embase and The Cochrane Library database was conducted. Full text studies that examined using cardiac rehabilitation with stroke patients were selected for appraisal. Reported outcomes included aerobic capacity, reductions in cardiac risk score, and clinical improvements in anthropometric measures. Studies were limited to English publications in the last 10 years. RESULTS: Statistically significant improvements in most anthropometric measures including aerobic capacity and reductions in cardiac risk scores were reported. Sample sizes were small and studies of short duration. No studies reported on impact on mortality. Subject bias and limited ability to generalize results occurred related to study selection criteria. CONCLUSIONS: Research applying cardiac rehabilitation to stroke is limited. Further investigation using large randomized controlled trials with consistent outcomes measurements would increase clinicians understanding of the impact of cardiac rehabilitation as an intervention for stroke. Strong findings demonstrating the efficacy of this treatment would promote collaboration within chronic disease programs in provision of secondary prevention resulting in reduced operating costs and increased accessibility for patients. PURPOSE:
NP006 COLLABORATION: A MULTI-DISCIPLINARY APPROACH TO IMPROVED HAND HYGIENE COMPLIANCE AND THE REDUCTION OF HEALTHCARE-ASSOCIATED INFECTIONS D Bartkowski, T Guinez, J Besuyen, A Moon, C Eichorst, T Reid, V Rioux, I Eakin, R Popowich, M Dunn Mazankowski Alberta Heart Institute, Edmonton, AB
Each year in Canada, 8,000 to 12,000 patients die as a result of complications of healthcare-associated infections (HAIs), the 4th leading cause of Canadian deaths. Furthermore, 220,000 individuals are affected annually by these infections. Individuals that survive a HAI experience longer hospital stays, and
ing to multisystem organ dysfunction. It can be a benign, incidentally discovered condition, or a life-threatening disorder. Cardiac manifestations may precede, follow, or occur concurrently with involvement of the lungs and lymph nodes, which are most commonly affected. These cardiac manifestations are dependent upon location, extent and activity of the disease, and may result in conduction abnormalities, ventricular arrhythmias, heart failure, supraventricular arrhythmias, valvular dysfunction, simulated myocardial infarction, cor pulmonale, and sudden cardiac death. Although increasingly recognized, cardiac sarcoidosis is difficult to diagnose, and associated with poor prognosis. Presently, there are no set guidelines for diagnosis and management of this complex disease which usually occurs in adults before the age of 50. The purpose of this oral presentation is to present the clinical features, diagnosis, and management of cardiac sarcoidosis. A case study will be presented for review and update which will highlight the interesting facets of this condition. The information provided will contribute to knowledge development, which will benefit nurses in that they will be better equipped to support and educate the patient and their families with this very life-changing and difficult disease. This in turn, will improve quality of care for this patient population. Poster Abstracts of the 2012 Canadian Council of Cardiovascular Nurses Annual Scientific Sessions NP001 CVICU STANDARD OF PRACTICE FOR THE PATIENT WITH DELAYED STERNAL CLOSURE (DSC) H Harrington Sunnybrook Health Sciences Centre, Toronto, ON
Open chest management and delayed sternal closure (DSC) for post-operative adult cardiac surgery patients was first discussed in the literature in the late 1970’s. (Anderson et al, 2002). DSC is described as useful in the treatment of cardiac surgery patients with severe myocardial dysfunction, uncontrollable hemorrhage or intractable arrhythmias. (Mubeen et al, 2001) and those that suffer cardiac arrest post cardiac surgery (Mackay et al, 2002). These patient’s are not frequently cared for in our Cardiovascular Intensive Care Unit (CVICU) and the nursing staff expressed anxiety about trying to remember all the additional needs of this complex patient population. The development of a nursing care guideline, to assist them in providing optimal care for these patients, seemed to be the answer. A search of recent literature revealed that the nursing care of these complex patients has not been described; most discussed surgical and postoperative infection concerns. Working closely with our Cardiac Surgeons and Intensivists, a Standard of Practice was developed for the nursing care of this patient population in our CVICU. Our nursing practice council provided valuable feedback at each stage of development. A trial was
Canadian Journal of Cardiology Volume 28 2012
done in the clinical setting where the information gathered led to further revisions and the creation of the final document. A biennial review is planned to ensure best practice.
NP002 USING THE HEART MANUAL AS AN EDUCATION TOOL IN A NEW CARDIAC CHECK-IN PROGRAM TARGETING ACUTE CORONARY SYNDROME PATIENTS IMMEDIATE POST DISCHARGE N Walshaw, S Burns, B Reid-Girard, E Mulvaney, R Brown Fraser Health Authority, New Westminster, BC
People hospitalized with Acute Coronary Syndrome (ACS) may be discharged early post event and intervention. Patients experience pain, anxiety, stress, confusion and sedation during hospitalization with ACS and often overwhelmed with a new diagnosis. Despite education provided in acute care, it is frequently not engaged or remembered by patients and families. Follow-up with a specialist physician or entry into cardiac rehabilitation is often several weeks post discharge. We developed a new community-based program targeting post hospitaldischarged ACS patients using a comprehensive education tool, the Heart Manual. The Cardiac Check-In program is an interactive program developed out of Royal Columbian Hospital Cardiac Clinic. It is a five-week program delivered by an interdisciplinary team including Nurse Clinicians, a Dietitian, Nurse Practitioners, and a Cardiologist. The initial group visit is followed by four weekly interactive education sessions utilizing the Heart Manual. Developed in the United Kingdom and Canadianized by local experts in British Columbia, the Heart Manual is also well validated. It is facilitator-delivered used in clinical settings or with home-based programs. It consists of 3 workbooks, relaxation CD and diary. Interactive sessions cover immediate post discharge recommendations, nutrition, medications, physical activity and psychosocial factors. Sessions are delivered in a community centre rather than a hospital to focus on wellness rather than illness. Clients and family members in the Cardiac Check-In program engage with the Heart Manual embracing the right health information and prevent further hospital readmissions. Long term evaluation is needed to support integration of Cardiac Check-In in regional cardiac rehab programming.
NP003 THE PROVINCIAL HEART FAILURE STRATEGY AT WORK: CREATING STANDARDIZED EDUCATION RESOURCES FOR BRITISH COLUMBIA’S HEART FAILURE PATIENTS B Catlin,1 S Virani2 1
St. Paul’s Hospital, 2 Vancouver Coastal Health, Vancouver, BC
With financial support from Cardiac Services BC, a Provincial Heart Failure (HF) Strategy was established in 2010. Its mandate includes creating standardized resources for a provincial HF patient education program. This initiative is being advanced by a
S443
CCCN Abstracts
provincial working group co-led by the Provincial Clinical Nurse Specialist (CNS) and the physician lead for the Vancouver Coastal HF strategy. Currently in British Columbia (BC), there are select communities with structured heart failure patient education. However, there is no provincial HF patient education program comprised of resources that are evidenced based, inclusive of patient input, reflective of the principles of clear language and design, and easily accessible to all patients and health care professionals. The new, standardized HF education resources and program will be easily accessible by patients and health care professionals throughout BC. In this session, the BC HF Strategy will be described with a focus on the development of the provincial HF patient education resources and program. The presenters will describe the interprofessional and evidence based foundations of the program, the process by which patient input was sought and utilized in developing the education resources, and the attention paid to the principles of clear language and design in creating the resources. The resources will be presented and described in detail including how they are accessed. Lastly, feedback from practitioners and patients about the resources, program and experiences to date related to utilization across BC will be discussed with an emphasis on their significance and implications for patients and practice.
NP004 DISCHARGE READINESS: AN OPPORTUNITY FOR CHANGE IN THE TRANSITION FROM HOSPITAL TO HOME S MacDonald University of Ottawa Heart Institute, Ottawa, ON
Early discharge and a shortened length of stay to control escalating health care costs increase the necessity for effective discharge preparation and follow-up in the cardiac surgery population. The transition from hospital to home has become increasingly important for patient safety, patient satisfaction and outcomes (Weiss et al., 2007; Weiss et al., 2011). The purpose of this project was to identify the areas needed in discharge teaching and planning in order to improve self-care management for patients and their families during the transition home in the early stages post cardiac surgery (Bobay et al., 2010; Davies, 2000; Clark et al, 2005; Jacobs, V., 2000; Leclerc et al., 2002; Theobald & McMurray, 2004). 600 calls received from cardiac surgery patients and families were included in the analysis. Retrospective inductive content analysis was used to analyze the text described by the archived phone call documentation. The description of issues identified by the phone calls revealed two major themes, incision and medication issues. A patient guide focusing on these two high risk issues was developed and implemented. Initial follow-up phone calls to 26 patients 7 to 15 days post discharge revealed that 81% found the patient guide very helpful in guiding them with decision making after discharge in the areas of incision tips and medications. Only one patient sought intervention
because of a concern for his sternal wound. The preliminary results of the project suggest that this portable patient guide should be added to the discharge information packet.
NP005 THE IMPACT OF CARDIAC REHABILITATION WITH STROKE PATIENTS W Clark Southlake Regional Health Centre, Newmarket, ON
Stroke is the fourth leading cause of death worldwide. Although evidence supports risk factor modification for stroke as essential to prevention, a gap exists between treatment recommendations and service availability. Cardiac rehabilitation programs are identified as a secondary prevention option for stroke hypothesizing that since cardiac and stroke patients share common risk factors they should exhibit similar evidence based improvements in risk reduction and reduced mortality. METHODS: An electronic search of MEDLINE, CINAHL, Embase and The Cochrane Library database was conducted. Full text studies that examined using cardiac rehabilitation with stroke patients were selected for appraisal. Reported outcomes included aerobic capacity, reductions in cardiac risk score, and clinical improvements in anthropometric measures. Studies were limited to English publications in the last 10 years. RESULTS: Statistically significant improvements in most anthropometric measures including aerobic capacity and reductions in cardiac risk scores were reported. Sample sizes were small and studies of short duration. No studies reported on impact on mortality. Subject bias and limited ability to generalize results occurred related to study selection criteria. CONCLUSIONS: Research applying cardiac rehabilitation to stroke is limited. Further investigation using large randomized controlled trials with consistent outcomes measurements would increase clinicians understanding of the impact of cardiac rehabilitation as an intervention for stroke. Strong findings demonstrating the efficacy of this treatment would promote collaboration within chronic disease programs in provision of secondary prevention resulting in reduced operating costs and increased accessibility for patients. PURPOSE:
NP006 COLLABORATION: A MULTI-DISCIPLINARY APPROACH TO IMPROVED HAND HYGIENE COMPLIANCE AND THE REDUCTION OF HEALTHCARE-ASSOCIATED INFECTIONS D Bartkowski, T Guinez, J Besuyen, A Moon, C Eichorst, T Reid, V Rioux, I Eakin, R Popowich, M Dunn Mazankowski Alberta Heart Institute, Edmonton, AB
Each year in Canada, 8,000 to 12,000 patients die as a result of complications of healthcare-associated infections (HAIs), the 4th leading cause of Canadian deaths. Furthermore, 220,000 individuals are affected annually by these infections. Individuals that survive a HAI experience longer hospital stays, and