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Transitional Care Post TAVI: Bridging Gaps and Improving Outcomes
Abstracts
Oral Abstracts of the 2016 Canadian Council of Cardiovascular Nurses Annual Scientific Sessions N005 AVOIDANCE OF URINARY CATHETERIZATION REDUCES COMPLICATIONS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION S Lauck,1 D Dvir,1 JY Kwon,2 J Baumbusch,2 J Gibson,1 DA Wood,1 JG Webb1 1
St. Paul’s Hospital, Vancouver, BC
2
University of British Columbia, Vancouver, BC
The integration of best geriatric practices and mitigation of age-associated risks in transcatheter aortic valve implantation (TAVI) programs are essential to optimize outcomes. Avoidance of urinary catheterization is associated with reduced complications, especially in the elderly. Historically, the use of peri-procedure indwelling urinary catheterization was a standard cardiovascular nursing practice for TAVI patients. The purpose of the presentation is to report on a nurse-led quality improvement initiative to eliminate the use of urinary catheterization, and discuss the findings of the retrospective evaluation. Practice change occurred in 2012 in collaboration with the periand post-procedural cardiovascular nursing teams. We conducted a retrospective chart review of 408 patients who underwent transfemoral TAVI from 2011 to 2013; 188 (46.1%) received a urinary catheter while 220 (53.9%) were treated under the new protocol. The median age was 84, and 40% were women. The cohorts shared similar comorbidities, except for significant differences in the higher burden of STS predicted risk of mortality, severe pulmonary disease and pre-existing atrial fibrillation of the older cohort. In-hospital mortality was 2.2%; there were no differences in other in-hospital outcomes. The avoidance of peri-procedure urinary catheterization was associated with significantly lower incidence of hematuria (3.7% vs. 17.6%, p¼0.001), use of continuous bladder irrigation (0% vs. 2.7%, p¼0.027), urinary tract infection with the use of antibiotics (1.4% vs. 6.1%, p¼0.014), and shorter length of stay (median ¼ 3 vs. 4, p¼0.001). Nurses’ leadership in instituting a change in the use of urinary catheterization was associated with improved outcomes after TAVI.
N006 TRANSITIONAL CARE POST TAVI: BRIDGING GAPS AND IMPROVING OUTCOMES S Wong, L Montoya, B Quinlan University of Ottawa Heart Institute, Ottawa, ON
Patients undergoing Transcatheter Aortic Valve Implant (TAVI) procedures are complex, frail, and have multiple comorbidities. The purpose of this initiative was to implement a
S309
transitional care protocol designed to follow TAVI patients after discharge. For this vulnerable patient population, the provision of appropriate transitional care at discharge assists in preventing readmissions, identifying medication errors, and reducing duplications or inappropriate medical services. Standard transitional care strategies are already employed by our institution to ensure the safe and smooth movement of patients from one setting to another. However, because the discharge patterns for TAVI patients often involve multiple steps such as short stay rehab, convalescent care, or other temporary locations prior to returning home, the standardized discharge protocols could not be consistently applied. Discharge location and contact information was documented for each TAVI patient. Follow up calls were made at 3 days and 30 days, with a 1 year follow up call also planned. Calls were conducted by Advanced Practice Nurses and followed a standardized script based on guideline recommendations for post-TAVI follow up assessment and care. This presentation will discuss the evaluation results of the follow up calls including the identification of issues that patients encountered post discharge, and the changes made to practice and discharge teaching elements as a result of gaps in care.
N007 BARRIERS AND FACILITATORS OF EARLY MOBILIZATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: SUPPORTING EVIDENCE-BASED NURSING PRACTICE J Knoll, S Ahuja, P Johnson, R Rana, DA Wood, JG Webb, B Lauck St. Paul’s Hospital, Vancouver, BC
Careful case selection, minimalist peri-procedure approaches and standardized post-procedure practice are increasingly enabling next day discharge after transcatheter aortic valve replacement (TAVR). Facilitated early mobilization promotes rapid return to baseline status, reduces nosocomial complications, and decreases length of stay in the frail elderly. Cardiovascular nurses play a pivotal role in supporting patients in the early recovery phase after TAVR to mitigate the risks of geriatric deconditioning. Evidence to determine optimal bedrest time and facilitate vascular access hemostasis is lacking to support cardiovascular nursing practice. We will report on the findings of a frontline nurse-led research project aimed at providing a detailed assessment of the barriers and facilitators of early mobilization. We completed the prospective recruitment of 80 consecutive patients undergoing transfemoral TAVR between June 2015 and March 2016. We utilized a nurse-led documentation tool to record variables of interest informed by the literature. We will describe the patient cohort, and their post-procedure course in critical care, including vascular access hemostasis, hemodynamic status, and time to ambulation. We will discuss an exploratory model to identify predictors of 4-hour bedrest. Lastly, we will
Oral Abstracts of the 2016 Canadian Council of Cardiovascular Nurses Annual Scientific Sessions N005 AVOIDANCE OF URINARY CATHETERIZATION REDUCES COMPLICATIONS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION S Lauck,1 D Dvir,1 JY Kwon,2 J Baumbusch,2 J Gibson,1 DA Wood,1 JG Webb1 1
St. Paul’s Hospital, Vancouver, BC
2
University of British Columbia, Vancouver, BC
The integration of best geriatric practices and mitigation of age-associated risks in transcatheter aortic valve implantation (TAVI) programs are essential to optimize outcomes. Avoidance of urinary catheterization is associated with reduced complications, especially in the elderly. Historically, the use of peri-procedure indwelling urinary catheterization was a standard cardiovascular nursing practice for TAVI patients. The purpose of the presentation is to report on a nurse-led quality improvement initiative to eliminate the use of urinary catheterization, and discuss the findings of the retrospective evaluation. Practice change occurred in 2012 in collaboration with the periand post-procedural cardiovascular nursing teams. We conducted a retrospective chart review of 408 patients who underwent transfemoral TAVI from 2011 to 2013; 188 (46.1%) received a urinary catheter while 220 (53.9%) were treated under the new protocol. The median age was 84, and 40% were women. The cohorts shared similar comorbidities, except for significant differences in the higher burden of STS predicted risk of mortality, severe pulmonary disease and pre-existing atrial fibrillation of the older cohort. In-hospital mortality was 2.2%; there were no differences in other in-hospital outcomes. The avoidance of peri-procedure urinary catheterization was associated with significantly lower incidence of hematuria (3.7% vs. 17.6%, p¼0.001), use of continuous bladder irrigation (0% vs. 2.7%, p¼0.027), urinary tract infection with the use of antibiotics (1.4% vs. 6.1%, p¼0.014), and shorter length of stay (median ¼ 3 vs. 4, p¼0.001). Nurses’ leadership in instituting a change in the use of urinary catheterization was associated with improved outcomes after TAVI.
N006 TRANSITIONAL CARE POST TAVI: BRIDGING GAPS AND IMPROVING OUTCOMES S Wong, L Montoya, B Quinlan University of Ottawa Heart Institute, Ottawa, ON
Patients undergoing Transcatheter Aortic Valve Implant (TAVI) procedures are complex, frail, and have multiple comorbidities. The purpose of this initiative was to implement a
S309
transitional care protocol designed to follow TAVI patients after discharge. For this vulnerable patient population, the provision of appropriate transitional care at discharge assists in preventing readmissions, identifying medication errors, and reducing duplications or inappropriate medical services. Standard transitional care strategies are already employed by our institution to ensure the safe and smooth movement of patients from one setting to another. However, because the discharge patterns for TAVI patients often involve multiple steps such as short stay rehab, convalescent care, or other temporary locations prior to returning home, the standardized discharge protocols could not be consistently applied. Discharge location and contact information was documented for each TAVI patient. Follow up calls were made at 3 days and 30 days, with a 1 year follow up call also planned. Calls were conducted by Advanced Practice Nurses and followed a standardized script based on guideline recommendations for post-TAVI follow up assessment and care. This presentation will discuss the evaluation results of the follow up calls including the identification of issues that patients encountered post discharge, and the changes made to practice and discharge teaching elements as a result of gaps in care.
N007 BARRIERS AND FACILITATORS OF EARLY MOBILIZATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: SUPPORTING EVIDENCE-BASED NURSING PRACTICE J Knoll, S Ahuja, P Johnson, R Rana, DA Wood, JG Webb, B Lauck St. Paul’s Hospital, Vancouver, BC
Careful case selection, minimalist peri-procedure approaches and standardized post-procedure practice are increasingly enabling next day discharge after transcatheter aortic valve replacement (TAVR). Facilitated early mobilization promotes rapid return to baseline status, reduces nosocomial complications, and decreases length of stay in the frail elderly. Cardiovascular nurses play a pivotal role in supporting patients in the early recovery phase after TAVR to mitigate the risks of geriatric deconditioning. Evidence to determine optimal bedrest time and facilitate vascular access hemostasis is lacking to support cardiovascular nursing practice. We will report on the findings of a frontline nurse-led research project aimed at providing a detailed assessment of the barriers and facilitators of early mobilization. We completed the prospective recruitment of 80 consecutive patients undergoing transfemoral TAVR between June 2015 and March 2016. We utilized a nurse-led documentation tool to record variables of interest informed by the literature. We will describe the patient cohort, and their post-procedure course in critical care, including vascular access hemostasis, hemodynamic status, and time to ambulation. We will discuss an exploratory model to identify predictors of 4-hour bedrest. Lastly, we will