SARASOTA MEMORIAL HOSPITAL POLICY

Transcription

1 PS1013 TITLE: SARASOTA MEMORIAL HOSPITAL POLICY EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY TYPE: 11/18/05 04/20/18 Clinical Non-Clinical 1 of 6 Job Title of Responsible Owner: Director, Cardiac and Neurology Progressive Care PURPOSE: POLICY STATEMENT: To establish transport requirements for cardiac monitored patients who must travel between nursing units, diagnostic/procedural areas or perioperative services. To ensure standards for patient safety, monitoring and other treatments are consistent during transport of a patient throughout the hospital system. All patients will be transported and monitored according to the medical needs of the patient. EXCEPTIONS: 1. Bayside patient: The Bayside staff will accompany their patients. 2. Specific physician orders for transport and monitoring will take precedence over the procedure below. 3. NICU patients are always transported by a nurse. 4. For transport of critical care patients: Refer to Nursing Department Policy , Guidelines for Intra-hospital Transporting of Adult Special Care Patients. 5. To transfer a patient from nursing unit to nursing unit for a new bed assignment, refer to nursing procedure Patient Transfer- Unit to Unit. DEFINITIONS: Qualified nurse: A licensed nurse, trained in basic arrhythmia interpretation, required for transport of monitored patients. (Refer to appendix A for the list of patients). Qualified clinical support: An SMH-employed paramedic or cardiovascular technologist (CVT) with current ACLS certification, transporting within the scope of their individual departmental guidelines (see Procedure). Cardiovascular Technologist: Registered Cardiac Invasive Specialist or Registered Invasive Electrophysiology Specialist in the Invasive Cardiology Department, with current ACLS certification.

2 2 of 6 PROCEDURE: 1. Patients will be transported to and from nursing units, procedural/diagnostic or perioperative areas under these guidelines. For specific interventions or treatments, refer to those policies/procedures for transport guidelines. If no guidelines are available then the nurse must utilize clinical judgment and collaborate with the nurse in the diagnostic/procedural area to determine if a nurse should travel and/or remain with the patient for the procedure. 2. Monitored patients: The chart in Appendix A will be utilized to determine which monitored patients require a nurse for transport, and when a qualified clinical support person may transport in lieu of a nurse. 3. Special Observation patients: The chart in Appendix A will be utilized to determine which patients, who may or may not be on a cardiac monitor but require special observation, require a nurse to transport. 4. If continuous observation of the patient by a nurse is warranted and a nurse in a diagnostic/procedural area is unable to observe the patient, the sending unit is responsible to send a nurse with the patient and remain with the patient until a nurse in the diagnostic/procedural area is available. An intervention RN may be utilized to observe the patient. 5. If a patient has had a procedure in perioperative services, endoscopy, or other invasive/procedural area and requires another invasive/diagnostic service, then the unit nurse or technician must give a hand- off communication with the nurse in the receiving department before the patient is transferred or on transfer if patient needs to be accompanied by a nurse. 6. If a patient is Baker Acted, their hospital assigned safety attendant will remain with them during transport and in the diagnostic/procedural area. 7. For patients in Isolation, see infection prevention policies. 8. Patient Transport Record: Anytime a patient is transported from one department to another that is not in the department s immediate area, a Patient Transport Record (form #903299) must be completed.

3 3 of 6 Refer to SMH Policy Patient Identification: Inpatient/Outpatient (01.PAT.09). a. Document on the Patient Transport Record the name of the department/unit the patient is being released from and where the patient is going. b. Document date/time of transport. c. Person releasing the patient from the department/unit and the person transporting the patient must sign the form at the patient s bedside confirming patient identification and the test/procedure. d. Once patient arrives to their destination, the person receiving the patient will sign the form after using the same process to identify the patient. RESPONSIBILITY: REFERENCES: Department directors are responsible to see that all personnel are aware of, and adhere to, this policy. SMH Nursing Department Policies. ( ) Guidelines for Intrahospital Transporting of Adult Special Care Patients ( ) Criteria for the Performance of Cardiovascular Diagnostics at the Bedside ( ) Administration and Nursing Care of Adult Patients on Specific Intravenous Medications. ( ). Admission/Discharge /Transfer Criteria: Women s Services. SMH: Author. SMH Policies. 01.PAT.09 - Patient Identification: Inpatient/Outpatient. SMH Nursing Procedure. Patient Transfer-Unit to Unit (trn02). SMH: Author. Transporting Telemetry Patients AJN 2009 Nancy J Mayer Practice Standards for Electrocardiographic Monitoring in Hospital Settings. Circulation 2004; 110: REVIEWING AUTHOR(S): Julie Polaszek, MSN, RN, Director, Cardiac and Neuro Olga Nielsen, BSN, RN-BC, PCCN-CMC, NPD, Cardiac Spence Hudon, BSN, RN, CNML, Clinical Manager, Cardiac 8CYT Nancy Olson, MSN, RN-BC, NPD Specialist, CV Services. ATTACHMENT(S): Appendix A.

4 4 of 6 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy. Committees/Sections: Date Clinical Practice Council 4/5/18 Director/Responsible Owner: Julie Polaszek, Director 4/9/18 Vice President/Executive Director: Connie Andersen, VP/Chief Nursing Officer 4/10/18 Chief of Medical Operations: (if clinical policy or appropriate ) Chief of Staff (if clinical policy or appropriate ) Medical Executive Committee: (if clinical and review requested by CMO and COS) Chief Executive Officer: David Verinder, CEO 4/13/18

5 Patients requiring a monitor and a licensed nurse trained in basic arrhythmia interpretation (Monitored patients) Patient conditions requiring any available nurse (Special Observation patients) Appendix A (APRIL 2018) All patients who have orders for cardiac monitoring will be transported with a monitor and a qualified nurse if one or more of the following patient criteria/conditions is present: a. Chest pain within the past 24 hours b. 4 hours or less post-percutaneous coronary intervention c. New-onset arrhythmia d. New (first-time) permanent pacemaker or implantable cardioverter/defibrillator implanted within the past 24 hours e. Temporary transvenous or epicardial pacemaker f. Patient pending ICD implantation, with or without wearable defibrillator (Lifevest) g. Patient with an arterial line h. Patient receiving the following medications: 1. Tikosyn-if initiated or dosage changed within the past 72 hours 2. Anti-arrhythmic infusion or vasoactive infusion 3. Pulmonary vasodilator infusion such as Flolan, Remodulin, Veletri i. Patients who have received systemic tpa for any reason within the past 24 hours j. Potassium level > 5.9 or 3.0 k. Symptomatic hypotension (i.e., light headedness, fatigue, blurry vision, confusion, weakness, nausea). l. Symptomatic hypertension (i.e., neurologic deficits, headache/migraine, sudden visual changes, vomiting, altered mental status). m. Heart rate >120 or <50 bpm and symptomatic n. Second or third degree heart block o. Evidence of respiratory distress with a respiratory rate > 25 per minute or oxygen saturation <93% p. Patient being transferred to critical care a. Blood product infusing within the first ml of transfusion b. Patient in restraints. c. Patient with continuous pulse oximetry, O2 6L/min by nasal cannula or >50% face mask. d. Patient with chest tube to portable suction.

6 6 of 6 Monitored patients who may be transported with a paramedic-trained MST in lieu of a nurse Monitored patients who may be transported with a CVT in lieu of a nurse e. OB patient presenting to ECC or other area outside OB if deemed necessary after consultation with L&D charge nurse f. Pediatrics Unit: A pediatric staff member will accompany any pediatric patient less than five (5) chronologic or developmental years of age outside of the pediatric unit if there is no parent or adult caregiver present. ECC department MST s who are paramedics may transfer an ECC monitored patient in lieu of a nurse if the patient is: a. Hemodynamically stable b. With no vasoactive or antiarrhythmic drips infusing c. With no restraints d. With no arterial invasive lines, wearable defibrillator, or temporary pacemakers. Cardiovascular technologists in Invasive Cardiology may transport a monitored Invasive Cardiology patient in lieu of a nurse if the patient is: a. Hemodynamically stable pre or post uncomplicated diagnostic catheterization, cardiac rhythm device implant, cardioversion, or TEE b. With no vasoactive or antiarrhythmic drips infusing c. With no restraints d. With no arterial invasive lines, wearable defibrillator, or temporary pacemakers. Note: Patient on Nasal High Flow (i.e. Optiflow, Vapotherm) requires RT assistance to transport.