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PT450 Electrophysiology Procedure Sedation And Analgesia Patient Risk Assessment - A Patient Safety Focused Retrospective Review
PT450 Electrophysiology Procedure Sedation And Analgesia Patient Risk Assessment - A Patient Safety Focused Retrospective Review 1
1
1
Wai-Ching Ma , Raelene Porter* , Annika Fingland 1 Cardiology Catheter Laboratory, Westmead Hospital, Sydney, Australia Introduction: Procedural sedation and analgesia (PSA) is routinely administered for electrophysiology (EP) studies by registered nurses under non-anaesthetist medical supervision in the cardiac catheter laboratory (CCL). With the prevalence of patient comorbidities and introduction of advanced mapping technologies, procedural complexity and length ( 6 hours) has impacted on total PSA dosage and patient recovery. Safe patient management pre, peri and post PSA administration was consequently identified as an issue by the CCL nursing team. Based on nursing concerns patients’ unsuitable for PSA or where PSA is considered ineffective must be referred for general anaesthesia (GA). Objectives: This study is a quality improvement review evaluating patient safety outcomes and impact of pre-procedure patient risk assessment. Methods: Retrospective data retrieval of patients undergoing EP study with PSA or GA from 2007 to 2012 (n¼3080) identifying patient numbers and PSA related incidents reported in the Australian Incident Management System (IIMS). Results: 1. Procedure composition changed between 2007 and 2012; Diagnostic EP decreased (62%>51%) and Supraventricular Tachycardia (SVT) ablation increased (13%> 23%). The other proportions remained constant p<0.001. 2. Logistic regression analysis detected a statistically significant interaction between procedure type and the effect of time on the odds of GA (p¼0.036). 3. There was no significant trend over time in the odds of GA for Defibrillator Check, Diagnostic EP, His Bundle ablation. There were significant increases in the odds of GA over time for Atrial Flutter ablation (OR-1.31/yr, p¼0.015), Pulmonary Veins Isolation (OR-1.45/yr, p<0.001), SVT ablation (OR¼1.24/yr, p<0.001), Ventricular Tachycardia ablation (OR¼1.60/yr, p<0.001). 4. The incidence of PSA associated complications fell from 1.1% (5/465 2007) to 0% (0/363 2012) however the trend over time failed to reach statistically significance p¼0.98. Conclusion: Data review identified a correlation between patient selection and the exclusion of high risk patients and/or procedures from PSA administration with an overall reduction in significant clinical incidents. This manoeuvrer added value and purpose to PSA administration by providing comfort and reduced anxiety in patients undergoing EP studies. Disclosure of Interest: None Declared PT451 Flexibility And Strength Measurement, And Return To Work In Phase II Rehabilitation Soraya Kerbage1, Laura Brandani1, Arnaldo Angelino1, Maximo Santos1, Raul Bianco1, Domingo Motta1, Juan Gatta Castel1, Carlos Lirio1, Cristina Barrios1, Carlos Rodriguez Correa1, Ernesto Duronto*1 1 Cardiac and Pulmonar Rehabilitation, Favaloro Foundation, Caba, Argentina Introduction: Strength and muscular flexibility exercises in a cardiovascular rehabilitation program are beneficial for both fitness and quality of life. Objectives: To measure the level of strength and muscular flexibility and the correlation with return to work at 12 months. Methods: 344 patients recruited for a lower limb exercise protocol were prospectively assessed. To evaluate strength the Epley test was used (maximum repetition using a preestablished load). For flexibility, the sit and reach test was used for trunk flexion and hamstrings stretch. As for return to work, follow up phone calls were made. For data analysis, the Student’s t test and the c2 test for matched samples were used. The data are expressed a mean mean standard deviation (SD).
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Results: Significant differences were seen as for strength and flexibility before and after training, (P<0.001 Table 1) with a non significant trend (P<0.10 Table 2) as for the return to work variable in patients who exhibited a larger difference in strength.
Mean
SD
20.2
0.4
Flexibility 1st time
9.6
0.6
Strength 2nd time
23.5
0.5
Flexibility 2nd time
14.6
0.6
Strength 1st time
Strength difference *
3.28
.32
Flexibility difference*
4.99
.35
Strength difference median [ 2.5
Flexibility difference median [ 4.37
Return to work
lower
higher
lower
higher
no
46.4%
35.0%
35.5%
46.0%
yes
53.6%
65.0%
64.5%
54.0%
Conclusion: A strength and flexibility exercise program improves fitness and self efficiency in daily life and favors return to work. Disclosure of Interest: S. Kerbage Employee from: Favaloro Foundation, L. Brandani Employee from: Favaloro Foundation, A. Angelino Employee from: Favaloro Foundation, M. Santos Employee from: Favaloro Foundation, R. Bianco Employee from: Favaloro Foundation, D. Motta Employee from: Favaloro Foundation, J. Gatta Castel Employee from: Favaloro Foundation, C. Lirio Employee from: Favaloro Foundation, C. Barrios Employee from: Favaloro Foundation, C. Rodriguez Correa Employee from: Favaloro Foundation, E. Duronto: None Declared PT452 Barriers and Facilitators to Nurse Management of Hypertension in Rural Western Kenya: A Qualitative Analysis Rajesh Vedanthan*1, Nelly Tuikong2, Claire Hutchinson1, Evan Blank1, Jemima H. Kamano3, Sylvester Kimaiyo4, Thomas S. Inui5, Carol R. Horowitz6, Valentin Fuster7 1 Cardiology, Icahn School of Medicine at Mount Sinai, New York City, United States, 2Academic Model Providing Access to Healthcare, 3Academic Model Providing Access to Healthcare; Moi Teaching and Referral Hospital, 4Academic Model Providing Access to Healthcare; Moi University College of Health Sciences, School of Medicine, Department of Medicine, Eldoret, Kenya, 5Indiana University School of Medicine, Indianapolis, 6Icahn School of Medicine at Mount Sinai, 7Icahn School of Medicine at Mount Sinai; Centro Nacional de Investigaciones Cardiovasculares, New York City, United States Introduction: Hypertension is the leading global risk for mortality and its prevalence is increasing in sub-Saharan Africa (SSA). Unless adequately controlled, hypertension will impose large health and economic burdens. Poor treatment and control of hypertension in SSA is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy in SSA are not known. Objectives: To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. Methods: Six key informant interviews (5 men, 1 woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes which were then grouped into themes representing distinct barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses, investigator assessments using the Delphi technique, and published literature. Results: Frustration with the current system of care delivery was commonly expressed. At the same time, participants frequently expressed hope that care integration across the public health care system in Kenya would result in improved health outcomes. The salient barriers and facilitators to nurse management are summarized in the Table. Table. Barriers and facilitators to nurse management of hypertension Category
Barrier
Facilitator
Health Systems
- Access to Drugs - Insufficient Human Resources
- Integration of health system
Nurse-specific
- Inadequate training
- Confidence
Patient factors
- Preference for physicians - Lack of hypertension knowledge
- Trust of nurses
Emotional
- Stigma of HIV services at same site - Fear of displeasing clinicians
- Importance of community - Fear of death
e261
POSTER ABSTRACTS
made of baseline demographics, clinical characteristics, DTBT and in-hospital, short-term and longer term mortality. Chi-square and Student’s t tests were undertaken to identify differences between the groups. Data were expressed as percentage or mean+/-SD. Results: A total of 176 STEMI patients were examined; 96 patients self-presented to hospital and 80 patients arrived to hospital by ambulance with pre-hospital notification. There were no differences in gender; 87% vs 85% male (p¼0.83); presentation in working hours; 47% vs 40% (p¼0.45); first cardiac admission 90% vs 94% (p¼0.60); diabetes 21% vs 14% (p¼0.24); Thrombolysis in Myocardial Infarction (TIMI) risk score greater than five 22% vs 27% (p¼0.48) and anterior infarction 41% vs 41% (p¼0.74), in patients who self-presented compared to those with pre-hospital notification respectively. Those who self-presented were younger (60+/-12 years vs 64+/-14 years; p¼0.05), and less frequently achieved a DTBT< 90 minutes (45% vs 95%; p<0.0001). The median DTBT for self-presenters was 103+/-45 mins vs 52+/-25.1 mins (p<0.001). Although the number of deaths were small, mortality for self-presenters was numerically higher inhospital (3.1% vs 1.3%; p¼0.62), at 30 days (3.1% vs 1.3%; p¼0.62) and at 12 months (4.2% vs 1.3%; p¼0.38). Conclusion: Self-presenters to hospital have longer DTBT. Whilst this did not translate to poorer mortality outcomes in this study, patients who self-present remain a challenge to systems of care designed to improve DTBT. Further examination is required to pinpoint the exact cause for delay in this group of STEMI patients to improve access to timely treatment. Disclosure of Interest: None Declared
1
1
Wai-Ching Ma , Raelene Porter* , Annika Fingland 1 Cardiology Catheter Laboratory, Westmead Hospital, Sydney, Australia Introduction: Procedural sedation and analgesia (PSA) is routinely administered for electrophysiology (EP) studies by registered nurses under non-anaesthetist medical supervision in the cardiac catheter laboratory (CCL). With the prevalence of patient comorbidities and introduction of advanced mapping technologies, procedural complexity and length ( 6 hours) has impacted on total PSA dosage and patient recovery. Safe patient management pre, peri and post PSA administration was consequently identified as an issue by the CCL nursing team. Based on nursing concerns patients’ unsuitable for PSA or where PSA is considered ineffective must be referred for general anaesthesia (GA). Objectives: This study is a quality improvement review evaluating patient safety outcomes and impact of pre-procedure patient risk assessment. Methods: Retrospective data retrieval of patients undergoing EP study with PSA or GA from 2007 to 2012 (n¼3080) identifying patient numbers and PSA related incidents reported in the Australian Incident Management System (IIMS). Results: 1. Procedure composition changed between 2007 and 2012; Diagnostic EP decreased (62%>51%) and Supraventricular Tachycardia (SVT) ablation increased (13%> 23%). The other proportions remained constant p<0.001. 2. Logistic regression analysis detected a statistically significant interaction between procedure type and the effect of time on the odds of GA (p¼0.036). 3. There was no significant trend over time in the odds of GA for Defibrillator Check, Diagnostic EP, His Bundle ablation. There were significant increases in the odds of GA over time for Atrial Flutter ablation (OR-1.31/yr, p¼0.015), Pulmonary Veins Isolation (OR-1.45/yr, p<0.001), SVT ablation (OR¼1.24/yr, p<0.001), Ventricular Tachycardia ablation (OR¼1.60/yr, p<0.001). 4. The incidence of PSA associated complications fell from 1.1% (5/465 2007) to 0% (0/363 2012) however the trend over time failed to reach statistically significance p¼0.98. Conclusion: Data review identified a correlation between patient selection and the exclusion of high risk patients and/or procedures from PSA administration with an overall reduction in significant clinical incidents. This manoeuvrer added value and purpose to PSA administration by providing comfort and reduced anxiety in patients undergoing EP studies. Disclosure of Interest: None Declared PT451 Flexibility And Strength Measurement, And Return To Work In Phase II Rehabilitation Soraya Kerbage1, Laura Brandani1, Arnaldo Angelino1, Maximo Santos1, Raul Bianco1, Domingo Motta1, Juan Gatta Castel1, Carlos Lirio1, Cristina Barrios1, Carlos Rodriguez Correa1, Ernesto Duronto*1 1 Cardiac and Pulmonar Rehabilitation, Favaloro Foundation, Caba, Argentina Introduction: Strength and muscular flexibility exercises in a cardiovascular rehabilitation program are beneficial for both fitness and quality of life. Objectives: To measure the level of strength and muscular flexibility and the correlation with return to work at 12 months. Methods: 344 patients recruited for a lower limb exercise protocol were prospectively assessed. To evaluate strength the Epley test was used (maximum repetition using a preestablished load). For flexibility, the sit and reach test was used for trunk flexion and hamstrings stretch. As for return to work, follow up phone calls were made. For data analysis, the Student’s t test and the c2 test for matched samples were used. The data are expressed a mean mean standard deviation (SD).
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Results: Significant differences were seen as for strength and flexibility before and after training, (P<0.001 Table 1) with a non significant trend (P<0.10 Table 2) as for the return to work variable in patients who exhibited a larger difference in strength.
Mean
SD
20.2
0.4
Flexibility 1st time
9.6
0.6
Strength 2nd time
23.5
0.5
Flexibility 2nd time
14.6
0.6
Strength 1st time
Strength difference *
3.28
.32
Flexibility difference*
4.99
.35
Strength difference median [ 2.5
Flexibility difference median [ 4.37
Return to work
lower
higher
lower
higher
no
46.4%
35.0%
35.5%
46.0%
yes
53.6%
65.0%
64.5%
54.0%
Conclusion: A strength and flexibility exercise program improves fitness and self efficiency in daily life and favors return to work. Disclosure of Interest: S. Kerbage Employee from: Favaloro Foundation, L. Brandani Employee from: Favaloro Foundation, A. Angelino Employee from: Favaloro Foundation, M. Santos Employee from: Favaloro Foundation, R. Bianco Employee from: Favaloro Foundation, D. Motta Employee from: Favaloro Foundation, J. Gatta Castel Employee from: Favaloro Foundation, C. Lirio Employee from: Favaloro Foundation, C. Barrios Employee from: Favaloro Foundation, C. Rodriguez Correa Employee from: Favaloro Foundation, E. Duronto: None Declared PT452 Barriers and Facilitators to Nurse Management of Hypertension in Rural Western Kenya: A Qualitative Analysis Rajesh Vedanthan*1, Nelly Tuikong2, Claire Hutchinson1, Evan Blank1, Jemima H. Kamano3, Sylvester Kimaiyo4, Thomas S. Inui5, Carol R. Horowitz6, Valentin Fuster7 1 Cardiology, Icahn School of Medicine at Mount Sinai, New York City, United States, 2Academic Model Providing Access to Healthcare, 3Academic Model Providing Access to Healthcare; Moi Teaching and Referral Hospital, 4Academic Model Providing Access to Healthcare; Moi University College of Health Sciences, School of Medicine, Department of Medicine, Eldoret, Kenya, 5Indiana University School of Medicine, Indianapolis, 6Icahn School of Medicine at Mount Sinai, 7Icahn School of Medicine at Mount Sinai; Centro Nacional de Investigaciones Cardiovasculares, New York City, United States Introduction: Hypertension is the leading global risk for mortality and its prevalence is increasing in sub-Saharan Africa (SSA). Unless adequately controlled, hypertension will impose large health and economic burdens. Poor treatment and control of hypertension in SSA is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy in SSA are not known. Objectives: To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. Methods: Six key informant interviews (5 men, 1 woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes which were then grouped into themes representing distinct barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses, investigator assessments using the Delphi technique, and published literature. Results: Frustration with the current system of care delivery was commonly expressed. At the same time, participants frequently expressed hope that care integration across the public health care system in Kenya would result in improved health outcomes. The salient barriers and facilitators to nurse management are summarized in the Table. Table. Barriers and facilitators to nurse management of hypertension Category
Barrier
Facilitator
Health Systems
- Access to Drugs - Insufficient Human Resources
- Integration of health system
Nurse-specific
- Inadequate training
- Confidence
Patient factors
- Preference for physicians - Lack of hypertension knowledge
- Trust of nurses
Emotional
- Stigma of HIV services at same site - Fear of displeasing clinicians
- Importance of community - Fear of death
e261
POSTER ABSTRACTS
made of baseline demographics, clinical characteristics, DTBT and in-hospital, short-term and longer term mortality. Chi-square and Student’s t tests were undertaken to identify differences between the groups. Data were expressed as percentage or mean+/-SD. Results: A total of 176 STEMI patients were examined; 96 patients self-presented to hospital and 80 patients arrived to hospital by ambulance with pre-hospital notification. There were no differences in gender; 87% vs 85% male (p¼0.83); presentation in working hours; 47% vs 40% (p¼0.45); first cardiac admission 90% vs 94% (p¼0.60); diabetes 21% vs 14% (p¼0.24); Thrombolysis in Myocardial Infarction (TIMI) risk score greater than five 22% vs 27% (p¼0.48) and anterior infarction 41% vs 41% (p¼0.74), in patients who self-presented compared to those with pre-hospital notification respectively. Those who self-presented were younger (60+/-12 years vs 64+/-14 years; p¼0.05), and less frequently achieved a DTBT< 90 minutes (45% vs 95%; p<0.0001). The median DTBT for self-presenters was 103+/-45 mins vs 52+/-25.1 mins (p<0.001). Although the number of deaths were small, mortality for self-presenters was numerically higher inhospital (3.1% vs 1.3%; p¼0.62), at 30 days (3.1% vs 1.3%; p¼0.62) and at 12 months (4.2% vs 1.3%; p¼0.38). Conclusion: Self-presenters to hospital have longer DTBT. Whilst this did not translate to poorer mortality outcomes in this study, patients who self-present remain a challenge to systems of care designed to improve DTBT. Further examination is required to pinpoint the exact cause for delay in this group of STEMI patients to improve access to timely treatment. Disclosure of Interest: None Declared