- Email: [email protected]
NP025 Percutaneous MitraClip Therapy
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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
S450
months. The presentation will address patient selection, percutaneous MitraClip technique, and patient outcomes. As well any complications related to the actual procedure will be discussed. Reducing MR from a grade three or four will improve patient quality of life and prevent major complications related to traditional open heart surgery. The intention is that MitraClip procedure will reduce multiple hospital admissions related to Congestive Heart Failure.
NP026 RANDOMIZED TRIAL OF E-LEARNING VS FACE-TO-FACE EDUCATION ON PATIENT KNOWLEDGE AND TREATMENT CHOICES FOR CHOLESTEROL LOWERING INTERVENTIONS L Helden, K Morrison, A Levinson, S Ng, L Colizza McMaster Children’s Hospital, Hamilton, ON
Computer-based educational interventions may be an efficient way to improve patient knowledge, health behaviour and outcomes in children with hyperlipidemia. We studied the effectiveness and feasibility of computer-based instructional tools for teaching children and guardians in the McMaster Children’s Hospital Pediatric Lipid Clinic about dietary fibre and its health benefits, and whether it impacts on therapeutic decisions families make. Parent and youth (10 – 17 years) dyads (n⫽30) attending the clinic were randomly assigned to receive either face to face education (FACE) or receive instruction from a multimedia computer presentation (ELEARNING) on 3 treatment options: Soluble fibre supplement, supplementation with high fibre foods or usual treatment. Knowledge was assessed preintervention, immediately post and 6-12 weeks later. We also examined satisfaction with the intervention, decisional conflict, mental effort, time on task and influence of the education type on treatment choice. Knowledge test scores increased in both FACE and ELEARNING groups, with no difference between groups. Delayed posttest scores remained above baseline (p⫽0.005) and no difference between groups was seen. Participants from both groups were equally satisfied with the education intervention but the face to face education intervention took longer (60 minutes vs 30 minutes). Participants were equally divided between choosing fibre supplement vs high fibre foods with no differences between the groups. Decisional conflict was high in both groups. An e-learning educational intervention resulted in similar knowledge acquisition immediately and in delayed post-test as well as similar treatment choice, even though the e-learning intervention took half as much time.
NP027 SUPPORTING CARDIAC SCIENCES NURSES THROUGH NURSING LEADERSHIP COUNCIL C Kuttnig,1 I Nazarevich,1 L Avery,2 E Estrella-Holder,1 S Bowles2 1
St. Boniface Hospital, 2 Winnipeg Regional Health Authority,Winnipeg, MB
Canadian Journal of Cardiology Volume 28 2012
The purpose of this presentation is to describe how a Cardiac Sciences Nursing Leadership Council (CSNLC) provides a leadership role in the practice of nursing. The terms of reference for the CSNLC are to support the development and dissemination of new nursing knowledge, to provide a forum to discuss and resolve nursing practice issues and to contribute nursing expertise to decisions that effect clinical nursing care. Evidence informed nursing care and interventions are continually evolving as new research and nursing knowledge is generated. Cardiac Sciences nurses are constantly challenged to keep up to date on new nursing knowledge that may impact the care of cardiac patients and to integrate practice changes into their daily work. As well, changes and updates to existing nursing policy, procedures and evidence based tools are expected to be incorporated into relevant clinical areas within the Cardiac Sciences Program. The CSNLC facilitates the exchange of ideas and knowledge related to nursing practice and also provides a forum for nurses to contribute their nursing expertise in how to best introduce changes in diverse clinical areas. The CSNLC functions in part to ensure a nursing voice to the delivery of patient care as well as an opportunity for nurses to actively engage in new initiatives that support practice. Opportunities to liaise with internal and external stake holders facilitates a collaborative approach to advance nursing knowledge and ultimately to improve the care of cardiac patients.
NP028 WOUND CARE RESOURCE TEAM: A PILOT PROJECT R Rana, M Borzueh, L Nguyen, L Shapera St. Paul’s Hospital, Vancouver, BC
Some cardiac procedures and medications increase the risk of wounds developing, but basic nursing education does not prepare nurses to manage these, necessitating specialized wound care practitioners. However, a rise in referrals is overwhelming our wound care service, delaying initiation of definitive interventions. We are aiming to prevent or reduce complications associated with delayed treatment by providing earlier assessment and intervention. The purpose of this project was to evaluate the effectiveness of a newly-created wound care resource team (WCRT) in a cardiac setting, as measured by the number of referrals to the wound care service; staff nurses’ knowledge of basic principles of wound care; and the incidence and prevalence of pressure ulcers, pre and post implementation. This setting is two cardiac step-down units in a universityaffiliated quaternary care hospital in Vancouver, BC. The WCRT consists of six registered nurses who have received supplementary education by the hospital’s Clinical Nurse Specialist: Wound & Skin Care. Upon request, a WCRT member assesses the patient’s wound with the primary nurse and assists in the development of a treatment plan. Clinical support for carrying out the treatment plan is also offered to the primary nurse, as well as informal education on wound prevention for
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
S450
months. The presentation will address patient selection, percutaneous MitraClip technique, and patient outcomes. As well any complications related to the actual procedure will be discussed. Reducing MR from a grade three or four will improve patient quality of life and prevent major complications related to traditional open heart surgery. The intention is that MitraClip procedure will reduce multiple hospital admissions related to Congestive Heart Failure.
NP026 RANDOMIZED TRIAL OF E-LEARNING VS FACE-TO-FACE EDUCATION ON PATIENT KNOWLEDGE AND TREATMENT CHOICES FOR CHOLESTEROL LOWERING INTERVENTIONS L Helden, K Morrison, A Levinson, S Ng, L Colizza McMaster Children’s Hospital, Hamilton, ON
Computer-based educational interventions may be an efficient way to improve patient knowledge, health behaviour and outcomes in children with hyperlipidemia. We studied the effectiveness and feasibility of computer-based instructional tools for teaching children and guardians in the McMaster Children’s Hospital Pediatric Lipid Clinic about dietary fibre and its health benefits, and whether it impacts on therapeutic decisions families make. Parent and youth (10 – 17 years) dyads (n⫽30) attending the clinic were randomly assigned to receive either face to face education (FACE) or receive instruction from a multimedia computer presentation (ELEARNING) on 3 treatment options: Soluble fibre supplement, supplementation with high fibre foods or usual treatment. Knowledge was assessed preintervention, immediately post and 6-12 weeks later. We also examined satisfaction with the intervention, decisional conflict, mental effort, time on task and influence of the education type on treatment choice. Knowledge test scores increased in both FACE and ELEARNING groups, with no difference between groups. Delayed posttest scores remained above baseline (p⫽0.005) and no difference between groups was seen. Participants from both groups were equally satisfied with the education intervention but the face to face education intervention took longer (60 minutes vs 30 minutes). Participants were equally divided between choosing fibre supplement vs high fibre foods with no differences between the groups. Decisional conflict was high in both groups. An e-learning educational intervention resulted in similar knowledge acquisition immediately and in delayed post-test as well as similar treatment choice, even though the e-learning intervention took half as much time.
NP027 SUPPORTING CARDIAC SCIENCES NURSES THROUGH NURSING LEADERSHIP COUNCIL C Kuttnig,1 I Nazarevich,1 L Avery,2 E Estrella-Holder,1 S Bowles2 1
St. Boniface Hospital, 2 Winnipeg Regional Health Authority,Winnipeg, MB
Canadian Journal of Cardiology Volume 28 2012
The purpose of this presentation is to describe how a Cardiac Sciences Nursing Leadership Council (CSNLC) provides a leadership role in the practice of nursing. The terms of reference for the CSNLC are to support the development and dissemination of new nursing knowledge, to provide a forum to discuss and resolve nursing practice issues and to contribute nursing expertise to decisions that effect clinical nursing care. Evidence informed nursing care and interventions are continually evolving as new research and nursing knowledge is generated. Cardiac Sciences nurses are constantly challenged to keep up to date on new nursing knowledge that may impact the care of cardiac patients and to integrate practice changes into their daily work. As well, changes and updates to existing nursing policy, procedures and evidence based tools are expected to be incorporated into relevant clinical areas within the Cardiac Sciences Program. The CSNLC facilitates the exchange of ideas and knowledge related to nursing practice and also provides a forum for nurses to contribute their nursing expertise in how to best introduce changes in diverse clinical areas. The CSNLC functions in part to ensure a nursing voice to the delivery of patient care as well as an opportunity for nurses to actively engage in new initiatives that support practice. Opportunities to liaise with internal and external stake holders facilitates a collaborative approach to advance nursing knowledge and ultimately to improve the care of cardiac patients.
NP028 WOUND CARE RESOURCE TEAM: A PILOT PROJECT R Rana, M Borzueh, L Nguyen, L Shapera St. Paul’s Hospital, Vancouver, BC
Some cardiac procedures and medications increase the risk of wounds developing, but basic nursing education does not prepare nurses to manage these, necessitating specialized wound care practitioners. However, a rise in referrals is overwhelming our wound care service, delaying initiation of definitive interventions. We are aiming to prevent or reduce complications associated with delayed treatment by providing earlier assessment and intervention. The purpose of this project was to evaluate the effectiveness of a newly-created wound care resource team (WCRT) in a cardiac setting, as measured by the number of referrals to the wound care service; staff nurses’ knowledge of basic principles of wound care; and the incidence and prevalence of pressure ulcers, pre and post implementation. This setting is two cardiac step-down units in a universityaffiliated quaternary care hospital in Vancouver, BC. The WCRT consists of six registered nurses who have received supplementary education by the hospital’s Clinical Nurse Specialist: Wound & Skin Care. Upon request, a WCRT member assesses the patient’s wound with the primary nurse and assists in the development of a treatment plan. Clinical support for carrying out the treatment plan is also offered to the primary nurse, as well as informal education on wound prevention for