HEART INVESTIGATION UNIT

Transcription

1 HEART INVESTIGATION UNIT HAMILTON HEALTH SCIENCES (GENERAL SITE) INFORMATION HANDBOOK (Updated: July 2011) 1

2 TRIAGE GUIDELINES ADMITTED PATIENTS FROM ANY OF OUR REFERRING HOSPITALS Goal: to complete procedures within hours of receiving referral Factors affecting priority of in-hospital patients: Primary PCI and Rescue PCI Patient stability e.g. Hemodynamics, rhythm changes, etc. STEMI or NSTEMI with ongoing angina Patient on IV nitroglycerine Aortic stenosis Dynamic ECG changes Previous CABG or PTCA *Please call the HIU coordinator at ext if you have any questions about your patient 2

3 IMPORTANT CONSIDERATIONS PRIOR TO ANGIOGRAM Most recent bloodwork: CBC particularly hemoglobin and platelet count Coagulation factors specifically INR must be < 1.8 (has coumadin been stopped? Vit K ordered?) Creatinine (if >104 women or >120 men, IV fluid and mucomyst started?) Medications: Fondaparinux, Lovenox, Enoxaparin held day of procedure (check with physician) Diabetics Metformin held day of procedure All other scheduled medication should be given at the appropriate times unless otherwise ordered by referring MD Other issues: CHF status Intubated? (need MD to MD consult) Access site Is the patient able to lie flat for the procedure Ability to consent Patient eligible for intervention (ASA +Plavix therapy) or surgery i.e. what will be done with the results of this test? Isolation precautions *test may be deferred for any of the above issues *test will NOT be deferred for any of the above issues if it s an emergency! 3

4 SENDING YOUR PATIENT Physical Readiness: Patient must be in a hospital gown Patient must have at least one large bore functioning IV (if a medication is infusing via IV, the patient must have a plain line for potential medications given in HIU) Patient must have an ID band on If possible a pair of non-slip slippers or shoes (and the patient s cane/walker if required) Required Documentation: Patient transfer record and FRI screening tool Copies of most recent history and physical (including OR reports for any past heart surgeries/procedures, and/or vascular surgery) Copies of ECGs (most recent and significant ones) Copies of most recent diagnostic heart tests i.e. echo, stress, nuclear, etc. Copies of lab values (within hours) Copies of MAR (medication administration record) with dates and times of meds received including prn meds Please follow Patient Transfer Checklist for Urgent Inpatient to HIU When calling report to HIU please follow Template for Sending Units Report 4

5 EMERGENCY PATIENTS COMING TO HIU HIU HOTLINE ( hours, Mon Fri, nonholidays) Using the hotline will allow the referring physician to speak directly to one of HIU s interventional cardiologist Using the algorithm provided on the HIU website or the STEMI & NSTEMI algorithm provided in the handbook, a referring physician can quickly determine the most appropriate steps for an emergency referral. Please fax patient s ECG and referral form to or Please follow Checklist for EMERGENCY / Primary PCI Transfer to HIU If after hours: Please page the interventional cardiologist on call at: ext

6 REPATRIATION Once a patient is sent from your facility, expect that patient to return within hours if stable. Communication between physicians, nurses, and admitting department needs to be ongoing Physician to physician dialogue is necessary. If a patient is sent from ER, this physician should inform their cardiologist or internist on-call to expect this patient back Bed managers need to be aware of these patients (especially those sent from ER) If a bed is not available, some hospitals will take their stable patient back to their ER department (this is sometimes necessary to ensure that our CCU has a bed available for the next emergency) 6

7 RECEIVING YOUR PATIENT BACK POST-PROCEDURE HIU will call a report to the receiving unit following Template for HIU s Report Back to Sending Unit (included in the handbook) Once you receive your patient back post-procedure please assess the arterial access site (groin or wrist) immediately (the ambulance ride and transfers from bed to stretcher can cause re-bleeding and/or hematoma). *See Appendix for post-procedure care Patients will be sent back with a complete discharge summary that includes: Summary of procedures performed Patient s course while at HHS Included in the discharge summary is a recommended on-going plan that will include: Recommended medications Recommenced follow-up tests Recommended follow-up timeline for visits with the patient s family doctor and patient s cardiologist/internist Cardiac rehab is strongly recommended for your post MI patients. If one is not available in your region the patient is more than welcome to attend rehab at HHS. 7

8 ACCESSING HIU WEBSITE Information available on the HIU website is updated frequently to give users the most accurate, up-todate news. A separate section is dedicated to health care providers. This information is specific to caring for hospitalized patients who require cardiac catheterization and/or PCI. To access this information: next, click on Heart Investigation Unit next, click on For Health Care Providers 8

9 *Appendix Procedure/ Site Diagnostic Cath PCI Vital Signs Sheath insitu Q 15 min X 4 Q 30 min until sheath out & prior to sheath Post sheath Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 then Q 4 h Continuous ECG/ Telemetry Continuous ECG: - sheath insitu - during ECG/telemetry 1.5 hours post sheath Continuous ECG: - sheath insitu - during ECG/telemetry until after first Ambulation Bedrest/ HOB Elevation Bedrest 3 hours post sheath. HOB up to 30 degrees first two hours of bedrest HOB up to 45 degrees After two hours Turning side to side after one hour of bedrest Bedrest 4 hours post sheath HOB up to 30 degrees first two hours of bedrest Turning side to side after one hour of bedrest Dressing 5cm x 7.5 cm sterile elastoplast bandage As above with pressure dressing over elastoplast. Pressure dressing off prior to first ambulation. Femoral As above As Above As above As above Closure Devise Q 15 min X 4 Q 30 min X 2 As for Diagnostic Cath or PCI Bedrest 2 hours post procedure. Gauze dressing only. Q 1 hour X 4 HOB may be 45 degrees then Q 4 h after one hour of bedrest Radial / Brachial Sheath insitu Q 15 min X 4 Q 30 min until sheath out & prior to sheath Post sheath Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 then Q 4 h Continuous ECG: - sheath insitu - during As for Diagnostic Cath or PCI Bedrest one hour following procedure No HOB elevation restrictions during bedrest Radial - sterile dressing DO NOT occlude blood flow to the hand. Brachial - elastoplast bandaid with Kling gauze around elbow. Ensure radial pulse palpable. 9