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THE DILEMMA IN END OF LIFE LIVES ON: MORAL DISTRESS OVER END OF LIFE IN CRITICAL CARE
CCCN Abstracts
therapy guided by clinical assessment alone in patients admitted for CRT implant with severe LV dysfunction.
N047 MAGNETIC RESONANCE IMAGING (MRI) IN PATIENTS WITH CONDITIONAL CARDIAC DEVICES: ARE WE PREPARED? A CASE STUDY PRESENTATION D Campbell, R Hart Kingston General Hospital, Kingston, ON
Traditionally, the performance of MRI has been contraindicated in the presence of conventional cardiac devices. However, given the increasing number of indications for MRI and the growing number of device implants, MRI conditional devices have been developed. The safe performance of MRI in patients with these devices requires careful verification of the compatibility of these technologies. However, the lack of standardized screening protocols has led to MRI refusal of patients with these devices. Without screening protocols these patients are at risk for delayed or missed diagnosis from a less sensitive diagnostic test, increase invasiveness, or harmful side effects from an alternate diagnosis. The performance of MRI in this patient population is a huge paradigm shift for many centres nationally. The objective of our case study presentation will highlight the challenges we faced during development and implementation of a screening protocol at our center. The interprofessonal collaboration that was required between the cardiac device, and the imaging department, which lead to successful implementation despite very little evidence and experience. The importance of sharing our experience with other centers in an attempt to standardize screening protocols nationally, expedite patient access to MRI, and prospectively track our experience to ensure it is evidenced based. Standardized screening protocols are required to ensure patients with conditional devices have safe access to MRI to meet clinical demand. A prospective evaluation is necessary to determine protocol effectiveness in patient safety and risk mitigation.
N048 THE DILEMMA IN END OF LIFE LIVES ON: MORAL DISTRESS OVER END OF LIFE IN CRITICAL CARE S Wong, J White, M Kendall, M Nelson University of Ottawa Heart Institute, Ottawa, ON
Palliative care is a philosophy and a holistic approach to caring for patients with life threatening illness, chronic illness and those near death. It is care centered around alleviating pain and other distressing symptoms, offering support, attending to psychological and spiritual needs, as well as caring for the person in his or her last months, days or hours. With the advances in medicine and the curative model integrated in acute care settings, such as in intensive and coronary care units, palliative care often becomes the last option when all
S363
other treatments have been exhausted. This is not only difficult for patients and their families, but it poses moral distress for the medical and nursing team. A survey of nurses and physicians in this tertiary coronary care unit was used to assess comfort and knowledge level in providing palliative care, identify the use and effectiveness of known resources and to identify barriers in making decisions for end of life care. In response to the results of this survey, a practice algorithm was developed to assist with the quality and timely implementation of palliative care and its resources and improve communication within the interdisciplinary team and with the patients and their families. This presentation would be of interest to all who care for patients and families encountering palliative and end of life decisions, particularly in the cardiac intensive care setting.
N049 SUPPORTING PATIENT ACCESS TO CARDIAC CATHETERIZATION, INTERVENTIONS AND SURGERY: DEVELOPMENT OF A CLINICAL AND ADMINISTRATIVE PROVINCIAL WAIT LIST MANAGEMENT TOOL J Polderman, S Lauck, L Ding, S Wu, H Moore, L Bachiu, T Louis PHSA, Vancouver, BC
Timely access to cardiac catheterization, interventions and surgery is driven by national and provincial wait time benchmarks to ensure optimal patient outcomes. The diverse variables associated with provincial access include geographical distribution of population and heart disease, changes in evidence-based practice, and fluctuations in the availability of specialized clinical human resources and infrastructure. Provincially, variations in patient need and clinical capacity can result in disparity in access and present opportunities to optimize utilization of existing resources. This presentation will outline the development of a provincial waitlist management tool available to clinicians, administrators and policy-makers to view and manage the challenges of variation in access to care. We will discuss the data requirements identified within an overall provincial waitlist management strategy. We will describe the project development that utilized the complimentary skill set of information technology specialists, cardiac registry project coordinators, biostatisticians, clinicians and administrators to design, validate and implement the system. We will demonstrate the real-time data driven graphic representations and tailored reports available to users. Lastly, we will discuss the implications for practice and the use of the wait list management tool for cardiovascular nurses and other stakeholders to monitor waitlists and waiting time issues, to support datadriven planning, and facilitate timely access to cardiac procedures. Appropriate queuing and triage of cardiac patients present clinical and administrative complexities and directly impact the patient’s experience of care. Validated data coupled with
therapy guided by clinical assessment alone in patients admitted for CRT implant with severe LV dysfunction.
N047 MAGNETIC RESONANCE IMAGING (MRI) IN PATIENTS WITH CONDITIONAL CARDIAC DEVICES: ARE WE PREPARED? A CASE STUDY PRESENTATION D Campbell, R Hart Kingston General Hospital, Kingston, ON
Traditionally, the performance of MRI has been contraindicated in the presence of conventional cardiac devices. However, given the increasing number of indications for MRI and the growing number of device implants, MRI conditional devices have been developed. The safe performance of MRI in patients with these devices requires careful verification of the compatibility of these technologies. However, the lack of standardized screening protocols has led to MRI refusal of patients with these devices. Without screening protocols these patients are at risk for delayed or missed diagnosis from a less sensitive diagnostic test, increase invasiveness, or harmful side effects from an alternate diagnosis. The performance of MRI in this patient population is a huge paradigm shift for many centres nationally. The objective of our case study presentation will highlight the challenges we faced during development and implementation of a screening protocol at our center. The interprofessonal collaboration that was required between the cardiac device, and the imaging department, which lead to successful implementation despite very little evidence and experience. The importance of sharing our experience with other centers in an attempt to standardize screening protocols nationally, expedite patient access to MRI, and prospectively track our experience to ensure it is evidenced based. Standardized screening protocols are required to ensure patients with conditional devices have safe access to MRI to meet clinical demand. A prospective evaluation is necessary to determine protocol effectiveness in patient safety and risk mitigation.
N048 THE DILEMMA IN END OF LIFE LIVES ON: MORAL DISTRESS OVER END OF LIFE IN CRITICAL CARE S Wong, J White, M Kendall, M Nelson University of Ottawa Heart Institute, Ottawa, ON
Palliative care is a philosophy and a holistic approach to caring for patients with life threatening illness, chronic illness and those near death. It is care centered around alleviating pain and other distressing symptoms, offering support, attending to psychological and spiritual needs, as well as caring for the person in his or her last months, days or hours. With the advances in medicine and the curative model integrated in acute care settings, such as in intensive and coronary care units, palliative care often becomes the last option when all
S363
other treatments have been exhausted. This is not only difficult for patients and their families, but it poses moral distress for the medical and nursing team. A survey of nurses and physicians in this tertiary coronary care unit was used to assess comfort and knowledge level in providing palliative care, identify the use and effectiveness of known resources and to identify barriers in making decisions for end of life care. In response to the results of this survey, a practice algorithm was developed to assist with the quality and timely implementation of palliative care and its resources and improve communication within the interdisciplinary team and with the patients and their families. This presentation would be of interest to all who care for patients and families encountering palliative and end of life decisions, particularly in the cardiac intensive care setting.
N049 SUPPORTING PATIENT ACCESS TO CARDIAC CATHETERIZATION, INTERVENTIONS AND SURGERY: DEVELOPMENT OF A CLINICAL AND ADMINISTRATIVE PROVINCIAL WAIT LIST MANAGEMENT TOOL J Polderman, S Lauck, L Ding, S Wu, H Moore, L Bachiu, T Louis PHSA, Vancouver, BC
Timely access to cardiac catheterization, interventions and surgery is driven by national and provincial wait time benchmarks to ensure optimal patient outcomes. The diverse variables associated with provincial access include geographical distribution of population and heart disease, changes in evidence-based practice, and fluctuations in the availability of specialized clinical human resources and infrastructure. Provincially, variations in patient need and clinical capacity can result in disparity in access and present opportunities to optimize utilization of existing resources. This presentation will outline the development of a provincial waitlist management tool available to clinicians, administrators and policy-makers to view and manage the challenges of variation in access to care. We will discuss the data requirements identified within an overall provincial waitlist management strategy. We will describe the project development that utilized the complimentary skill set of information technology specialists, cardiac registry project coordinators, biostatisticians, clinicians and administrators to design, validate and implement the system. We will demonstrate the real-time data driven graphic representations and tailored reports available to users. Lastly, we will discuss the implications for practice and the use of the wait list management tool for cardiovascular nurses and other stakeholders to monitor waitlists and waiting time issues, to support datadriven planning, and facilitate timely access to cardiac procedures. Appropriate queuing and triage of cardiac patients present clinical and administrative complexities and directly impact the patient’s experience of care. Validated data coupled with