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NP023 Incessant Ventricular Tachycardia: A Teaching Case Report
S449
CCCN Abstracts
With the introduction of mechanically ventilated patients to the cardiac intensive care unit (CICU) at Sunnybrook Health Sciences Centre, a need to prepare staff for the new challenges was presented. To manage this new patient population, the nurses in CICU were enrolled in a modified critical care education program at a local community college. A phased-in approach was necessary to continue to meet the staffing demands of the unit and the learning needs of the staff. This approach resulted in the delay of clinical application of newly-acquired knowledge and skills by several months. Strategies to bridge this gap were necessary. With feedback from staff, a series case studies and quizzes were developed by a Late Career Initiative nurse to challenge critical thinking, refresh, maintain, and support their acquired knowledge. These were disseminated to staff in multiple formats. Positive feedback from the nurses indicated the success of this effort. As such, this strategy will continue to be utilized as an ongoing educational tool for CICU. The use of this tool may encourage the nurses to reflect on clinical experiences and participate in the development of more case studies as learning tools for others.
NP023 INCESSANT VENTRICULAR TACHYCARDIA: A TEACHING CASE REPORT L Wanounou, N Marco, K Nanthakumar University Health Network – Toronto General Hospital, Toronto, ON
Ventricular Tachycardia (VT) is a debilitating, and often fatal cardiac arrhythmia. Managing care for these patients is complex and multifaceted. An increased number of individuals are now treated with Automatic Internal Cardioverter Defibrillator (AICD) s to prevent sudden death. As a result, more patients are presenting with shocks that are physically and psychologically debilitating. Toronto General Hospital’s (TGH) cardiac center is a tertiary care center that specializes in treating ventricular arrhythmias. The following is a case report detailing the challenges encountered from a nursing perceptive when treating a patient with incessant VT. W.W was a 60 yr old male from referred to TGH from rural Ontario. This unfortunate gentleman had a history of non ischemic dilated cardiomyopathy with an EF⬍20%, resuscitated cardiac arrest, mesocardia, and sleep apnea. His care comprised of an AICD implant, antiarrhythmic medications, endocardial and epicardial ablations, and sympathectomy. However, he continued to experience recurrent VT and subsequently multiple shocks from his AICD. W.W. was admitted to TGH in June of 2011 to manage his VT. The presentation will highlight the complexities of this case and the challenges involved in treating the physical and psychosocial aspects of care. This case highlights the patient’s journey and the multidimensional care delivered at our center. The lessons learned from this case generate new knowledge and insight for interprofessional team members in order to improve future outcomes.
NP024 EMERGENCY AVOIDANCE VISIT EVALUATION PROJECT: ROYAL COLUMBIAN HOSPITAL HEART FAILURE PROGRAM C Hooper, M Meloche, R Sobolyeva Fraser Health Authority, New Westminster, BC
The presentation of clients with heart failure is often complex with multiple co-morbidities. In British Columbia, there are over 90,000 people diagnosed with heart failure, and the number is estimated to double by the year 2030. Heart failure has demonstrated a significant financial burden to the health care system related to multiple emergency room visits and an increased average length of hospital stay. The Fraser Health Authority (FHA) in conjunction with Cardiac Services BC opened the Royal Columbian Hospital (RCH) Heart Function Clinic (HFC) in January 2011. The clinic team includes a Cardiologist, Nurse Practitioner, Nurse Clinician, Dietician, and Pharmacist. The purpose of the RCH HFC Heart Failure Management Strategy is to provide optimal standardized evidence-based care and client self-management education to improve client quality of life (QOL) and wellness and reduce the heart failure fiscal burden to health care. The Emergency Avoidance Visit (EAV) is a strategy utilized by the RCH HFC to provide timely diagnostic assessment and urgent heart failure management to improve the clients exacerbation of heart failure symptoms and reduce emergency room visits and hospital admissions. The evaluation project data collection utilized a mixed methodology from RCH HFC chart review, emergency department heart failure admissions data and qualitative data to assess client wellness and QOL. The conclusion of the data analysis is in the final stages of analysis.
NP025 PERCUTANEOUS MITRACLIP THERAPY B Robert, R Wayne University of Ottawa Heart Institute, Ottawa, ON
The purpose of the project is to present an alternate therapy for patients who have grade three to four mitral regurgitation (MR) and are too high risk for traditional open heart surgery valve repair. Patients with calcified aortas have an increased risk of intraoperative stroke as a result of the clamping of the aorta for cardio-pulmonary bypass. The MitraClip system is designed to reduce significant MR by clipping together the non calcified leaflets of the mitral valve. From a purely technical standpoint, the procedure so far has only been demonstrated in a subgroup of patients with specific anatomical characteristics. The catheter-based MitraClip is delivered to the heart through the femoral vein allowing the heart to beat normally during the procedure thus eliminating the need for the heart-lung bypass machine. The University of Ottawa Heart Institute is in the early stages of program development by selecting twelve patients for the MitraClip procedure to be performed over the course of the next 6
CCCN Abstracts
With the introduction of mechanically ventilated patients to the cardiac intensive care unit (CICU) at Sunnybrook Health Sciences Centre, a need to prepare staff for the new challenges was presented. To manage this new patient population, the nurses in CICU were enrolled in a modified critical care education program at a local community college. A phased-in approach was necessary to continue to meet the staffing demands of the unit and the learning needs of the staff. This approach resulted in the delay of clinical application of newly-acquired knowledge and skills by several months. Strategies to bridge this gap were necessary. With feedback from staff, a series case studies and quizzes were developed by a Late Career Initiative nurse to challenge critical thinking, refresh, maintain, and support their acquired knowledge. These were disseminated to staff in multiple formats. Positive feedback from the nurses indicated the success of this effort. As such, this strategy will continue to be utilized as an ongoing educational tool for CICU. The use of this tool may encourage the nurses to reflect on clinical experiences and participate in the development of more case studies as learning tools for others.
NP023 INCESSANT VENTRICULAR TACHYCARDIA: A TEACHING CASE REPORT L Wanounou, N Marco, K Nanthakumar University Health Network – Toronto General Hospital, Toronto, ON
Ventricular Tachycardia (VT) is a debilitating, and often fatal cardiac arrhythmia. Managing care for these patients is complex and multifaceted. An increased number of individuals are now treated with Automatic Internal Cardioverter Defibrillator (AICD) s to prevent sudden death. As a result, more patients are presenting with shocks that are physically and psychologically debilitating. Toronto General Hospital’s (TGH) cardiac center is a tertiary care center that specializes in treating ventricular arrhythmias. The following is a case report detailing the challenges encountered from a nursing perceptive when treating a patient with incessant VT. W.W was a 60 yr old male from referred to TGH from rural Ontario. This unfortunate gentleman had a history of non ischemic dilated cardiomyopathy with an EF⬍20%, resuscitated cardiac arrest, mesocardia, and sleep apnea. His care comprised of an AICD implant, antiarrhythmic medications, endocardial and epicardial ablations, and sympathectomy. However, he continued to experience recurrent VT and subsequently multiple shocks from his AICD. W.W. was admitted to TGH in June of 2011 to manage his VT. The presentation will highlight the complexities of this case and the challenges involved in treating the physical and psychosocial aspects of care. This case highlights the patient’s journey and the multidimensional care delivered at our center. The lessons learned from this case generate new knowledge and insight for interprofessional team members in order to improve future outcomes.
NP024 EMERGENCY AVOIDANCE VISIT EVALUATION PROJECT: ROYAL COLUMBIAN HOSPITAL HEART FAILURE PROGRAM C Hooper, M Meloche, R Sobolyeva Fraser Health Authority, New Westminster, BC
The presentation of clients with heart failure is often complex with multiple co-morbidities. In British Columbia, there are over 90,000 people diagnosed with heart failure, and the number is estimated to double by the year 2030. Heart failure has demonstrated a significant financial burden to the health care system related to multiple emergency room visits and an increased average length of hospital stay. The Fraser Health Authority (FHA) in conjunction with Cardiac Services BC opened the Royal Columbian Hospital (RCH) Heart Function Clinic (HFC) in January 2011. The clinic team includes a Cardiologist, Nurse Practitioner, Nurse Clinician, Dietician, and Pharmacist. The purpose of the RCH HFC Heart Failure Management Strategy is to provide optimal standardized evidence-based care and client self-management education to improve client quality of life (QOL) and wellness and reduce the heart failure fiscal burden to health care. The Emergency Avoidance Visit (EAV) is a strategy utilized by the RCH HFC to provide timely diagnostic assessment and urgent heart failure management to improve the clients exacerbation of heart failure symptoms and reduce emergency room visits and hospital admissions. The evaluation project data collection utilized a mixed methodology from RCH HFC chart review, emergency department heart failure admissions data and qualitative data to assess client wellness and QOL. The conclusion of the data analysis is in the final stages of analysis.
NP025 PERCUTANEOUS MITRACLIP THERAPY B Robert, R Wayne University of Ottawa Heart Institute, Ottawa, ON
The purpose of the project is to present an alternate therapy for patients who have grade three to four mitral regurgitation (MR) and are too high risk for traditional open heart surgery valve repair. Patients with calcified aortas have an increased risk of intraoperative stroke as a result of the clamping of the aorta for cardio-pulmonary bypass. The MitraClip system is designed to reduce significant MR by clipping together the non calcified leaflets of the mitral valve. From a purely technical standpoint, the procedure so far has only been demonstrated in a subgroup of patients with specific anatomical characteristics. The catheter-based MitraClip is delivered to the heart through the femoral vein allowing the heart to beat normally during the procedure thus eliminating the need for the heart-lung bypass machine. The University of Ottawa Heart Institute is in the early stages of program development by selecting twelve patients for the MitraClip procedure to be performed over the course of the next 6