SARASOTA MEMORIAL HOSPITAL STANDARDS OF CARE STANDARDS OF PRACTICE CARDIAC ACUTE CARE AND CARDIAC PROGRESSIVE EFFECTIVE DATE: REVISED DATE: STANDARD TYPE: 1/88 4/18 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 9 CARDIAC PROGRESSIVE STANDARD I - SAFETY The patient can expect that a safe environment will be provided free from untoward events. 1. Each patient will have a name band and will be positively identified according to Policy (01.PAT.09) Patient Identification: Inpatient/Outpatient before initiation of treatment. 2. The patient will be protected from health care associated infections according to Infection Prevention and Control policies. 3. As the patient s condition or nursing interventions warrant, the bed will be kept in the low position with the wheels locked and upper side rails in the up position and call light within reach of patient. 4. The Nursing staff will provide for the patient s safety while using electrical equipment. 4.1. All temporary pacemaker wires, when not attached to a pulse generator, will be grounded according to Nursing Procedure pac03. 5. An allergy label will be placed on the front of each patient s chart with Allergies or No Known Allergies listed as appropriate. 5.1. Allergies or No Known Allergies will be entered into the patient s electronic medical record during the admission process and updated as appropriate. 6. If restraints are necessary for the patient s safety, they will be applied according to hospital policy and nursing procedure. 7. All patients will be assessed for a fall risk and fall prevention interventions will be followed using the Fall Prevention policy (01.PAT.60). 8. Defibrillators and crash carts will be checked according to Department Policy #126.185, Maintenance of Emergency Equipment. 8.1. Suction apparatus, canister and tubing, resuscitation bag, oral airway, masks and oxygen tubing SPO² Monitor will be available on the unit. 9. Safety measures will be utilized by all personnel during transport. Patients will be transported according to SMH Policy (01.PAT.23) Transportation and Monitoring of Patients.
Page 2 of 9 9.1. In the event of an internal disaster, the staff will evacuate patients as per SMH Emergency Management Plan 00.SAF.15 10. AccuChek meters will be tested daily for quality control according to nursing procedure. 11. Medications will be administered per Nursing policies and procedures. 11.1. Cardiac staff will consult Nursing Department Policy #126.155 and 126.156 when administering cardiovascular and vasoactive medications. 12. All patients will be placed on a cardiac monitor. Alarms for cardiac monitors will be utilized with default parameter unless changes need to be made for the individual patient. Any changes to default parameters will be made by a cardiac RN. 12.1. In the event that the Leads Off alarm displays, staff are notified using the following algorithm. Buddies are assigned at the start of each shift.
Page 3 of 9 CARDIAC PROGRESSIVE STANDARD II - NURSING CARE The patient will receive nursing care based on an assessment of the patient s needs by the registered nurse. 1. Patients will be admitted to patient care areas according to their physical and psychosocial needs, unit admission criteria, and bed availability. 2. The patient will be oriented to the room, department, and to their assigned nurse upon arrival. 2.1. All patients will be placed on a cardiac monitor unless there is an order that a monitor is not required. 3. Admission assessment and reassessments will be completed as stated in Corporate Policy (00.PAT.66) Patient Assessment/Reassessment-Inpatient and Outpatient. 4. The clinical manager/communicator will make patient assignments according to Department Policy #126.054. 5. Treatments, medications, and IV s ordered will be instituted according to Nursing procedures and policies. 5.1. All patients will have an intravenous line (IV) infusing or a PRN adapter inserted (unless otherwise specified by provider) according to Department Policy #126.327, Cardiac Admission Criteria. 5.2. Peripheral and central intravenous accesses will be cared for according to Infection Control Policies. 5.3. Patients with arterial lines will be cared for as per nursing procedures car11. 5.4. Patients with temporary pacemakers will be cared for according to Nursing Procedure pac03. 5.5. Patients with epidural catheters will be managed in accordance with Nursing Department Policy (126.169) Acute and Postoperative Epidural Pain Control. 6. Vital signs will be completed as per Corporate Policy (00.PAT.66) unit routine, provider order, or as patient condition warrants. 7. Identified patient needs and subsequent nursing interventions will be evaluated and documented in the medical record. CARDIAC PROGRESSIVE STANDARD III - PLAN OF CARE The patient and/or support persons will be given the opportunity to participate in the planning of their care. 1. An interdisciplinary plan of care will be initiated on admission and coordinated by the RN that identifies nursing interventions needed to achieve expected outcomes. 2. The interdisciplinary plan is individualized to the patient s conditions or needs as identified.
Page 4 of 9 3. The plan is developed in collaboration with other health care providers and the patient/support persons as appropriate. 4. The plan will be reviewed every shift to reassess patient needs and achieved outcomes. CARDIAC PROGRESSIVE STANDARD IV- SAFETY ALARM MANAGEMENT Alarm system safety is an organizational, departmental and unit priority. The following standards apply. Based on the risk and potential harm to the patient, evidence based practices and input from clinical and medical staff the following alarms have been identified as high priority alarms: 1. Cardiac monitor alarms 2. Continuous Pulse Oximetry/Optiflow alarms 3. Bed alarm 4. Chair alarm High Priority Alarm/s: Will be responded to in a timely manner by those qualified to manage the patient and the equipment. Will be applied utilizing the individualized alarm parameters set and reviewed by qualified clinical staff involved in the patient s care. Parameters outside the default settings will be communicated to the direct care team. Will remain ON at all times unless specified by the ordering provider. May be silenced while the patient is temporarily disconnected and/or caregiver is at bedside. CARDIAC PROGRESSIVE STANDARD V - EDUCATION The patient and/or support persons will receive education that will enhance their knowledge, skills, and behaviors related to their healthcare needs. 1. Patient/support persons teaching will begin during the admission process and will be ongoing. Documentation will include the teaching plan and their response. 2. Discharge planning will begin during the admission process and continue throughout hospitalization. 3. Discharge instructions will be provided prior to discharge as per hospital policy. 3.1. Teaching materials, individualized according to patient needs, will be given to all patients.
Page 5 of 9 CARDIAC PROGRESSIVE STANDARD VI - CONTINUUM OF CARE The patient will receive care based on the collaborative efforts of Nursing and other health professionals to achieve a continuum of patient care across all settings. 1. Nursing staff will seek input from the patient and/or support persons and other health care professionals to plan and implement care. 2. Nursing staff will communicate pertinent information needed to provide continuity of patient care. Refer to SMH Policy (01.PAT.25) Handoff Communication Guidelines. 3. The nurse will utilize available resources to facilitate an optimal transition between health care settings. CARDIAC PROGRESSIVE STANDARD VII - SATISFACTION The patient and/or support persons will be given the opportunity to communicate their responses to the hospital, illness, or care provided. 1. The Nursing staff will encourage input from the patient/support persons regarding their care. 2. The patient and/or support persons will be encouraged to complete the patient satisfaction questionnaire after discharge. 3. The nurse will serve as the patient s advocate when problems and/or complaints arise. CARDIAC PROGRESSIVE STANDARD VIII - COMFORT/PAIN MANAGEMENT The patient will have his/her comfort and pain needs effectively managed. 1. All patients will be provided with an environment conducive to rest/recovery. 2. The patient will have his/her needs for personal hygiene met appropriate to his/her condition. 3. Patient s comfort level will be assessed and comfort measures/pain management will be provided to meet patient needs.
Page 6 of 9 CARDIAC PROGRESSIVE STANDARD IX - PATIENT RIGHTS/INFORMED CARE The patient will be provided with the information necessary to participate in decisions about his/her nursing care. 1. The nurse will assess the patient s level of understanding and explain nursing treatments/procedures, allowing time for questions. 2. Consent for procedure and patient understanding will be verified prior to implementation. If further explanation is required, appropriate resources will be utilized. 3. Additional information regarding advance directives will be provided as requested by patient/s. 4. The nurse will respect the patient s right to refuse a treatment or procedure and will notify provider. CARDIAC PROGRESSIVE STANDARD X - CONFIDENTIALITY The patient can expect that confidentiality of information regarding his/her care will be maintained. 1. The patient can expect that the Nursing staff will maintain confidentiality of information regarding his/her care according to hospital policy. 2. Authorized personnel caring for the patient will have access to the medical record. 3. Standards set by the Patient Experience Program will be maintained. CARDIAC PROGRESSIVE STANDARD XI - CULTURAL/SPIRITUAL VALUES The patient will receive considerate and respectful care as demonstrated through our Patient Experience Program consistent with his/her cultural and spiritual values. 1. Patient s spiritual and cultural beliefs will be considered when planning and implementing care. 2. Patient and family interactions will be conducted in a caring, courteous, professional, and empathetic manner. 3. Available resources will be utilized to maximize patient/support persons assistance as needs are identified.
Page 7 of 9 Reviewing Authors: Spencer Hudon, RN, BSN, CNML, Clinical Manager, CAC Melody Benoit, RN, BSN, CNML, Clinical Manager, CP2 Karen Johnson, MSN, RN, Clinical Manager, CP4 Cynthia Carr, MSN, RN, Clinical Manager, CP3 Julie Polaszek, MSN, RN, Director, Cardiac/Neurology
Page 8 of 9 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date 4/6/18 Julie Polaszek, Director, Cardiac Committee/Sections (if applicable): Clinical Practice Council 4/5/18 Administrative/Director (if applicable): Vice President/Administrative Director (if applicable): 4/10/18 Connie Andersen, V.P., Chief Nursing Officer
Page 9 of 9 ADDENDUM A: CARDIAC DIVISION STANDARDIZED ALARM SETTINGS Alarm Category Cardiac Alarm Default Setting Alarm Setting adjustment at initiation. Further adjustment from default requires provider order HR/Pulse Bradycardia Asystole Pause Missed beat < 50=yellow < 20=red On On Off RN may adjust to 40 bpm for patients with a baseline HR of <54. A-Fib On RN may turn OFF for patients with Chronic Afib A-Fib with > 120 RVR Irregular Off PVC s > 20 beats/3 min HR/Pulse Tachycardia >120 bpm RN may adjust up to 150 bpm for patients with a baseline HR of >120. Non Sustained > 10 beats VT SVT >180 Pacer alarms Off RN to turn ON if patient is paced. Blood Systolic pressure >160 or < 90 Diastolic > 90 or <50 yellow Apnea RR 8-30 with apnea alarm set at 20 seconds Other Desaturation/ Pulse Oximetry SpO2 high limit < 90% with delay setting of 20 seconds 100