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Abstract
Problem Statement or Scientific Question: The access site used for percutaneous coronary intervention (PCI) continues to pose significant risks of morbidity and mortality. To enhance patient outcomes, it is crucial to pay meticulous attention to the access site both before, during, and after the procedure. However, standardized management of the access site following the patient's departure from the catheterization laboratory remains a challenging task, primarily due to the diverse pathways associated with post-PCI patient locations
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Problem Statement or Scientific Question: The access site used for percutaneous coronary intervention (PCI) continues to pose significant risks of morbidity and mortality. To enhance patient outcomes, it is crucial to pay meticulous attention to the access site both before, during, and after the procedure. However, standardized management of the access site following the patient's departure from the catheterization laboratory remains a challenging task, primarily due to the diverse pathways associated with post-PCI patient locations
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Improving Percutaneous Coronary Intervention Access Site Management Through Multidisciplinary Teamwork and Implementation of Standardized Order Sets
Sreedeepa Raveendran
Affiliations:
null
null
Abstract
Problem Statement or Scientific Question: The access site used for percutaneous coronary intervention (PCI) continues to pose significant risks of morbidity and mortality. To enhance patient outcomes, it is crucial to pay meticulous attention to the access site both before, during, and after the procedure. However, standardized management of the access site following the patient's departure from the catheterization laboratory remains a challenging task, primarily due to the diverse pathways associated with post-PCI patient locations
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Problem Statement or Scientific Question: The access site used for percutaneous coronary intervention (PCI) continues to pose significant risks of morbidity and mortality. To enhance patient outcomes, it is crucial to pay meticulous attention to the access site both before, during, and after the procedure. However, standardized management of the access site following the patient's departure from the catheterization laboratory remains a challenging task, primarily due to the diverse pathways associated with post-PCI patient locations
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
Background/Project Intent: Post-percutaneous coronary intervention (PCI) access site complications, such as bleeding, limb ischemia, neuropathy, infection, and skin changes, carry significant risks to patients. Nevertheless, by promptly identifying these complications, it is possible to reverse the trend and prevent their development or progression into more severe conditions. Within dynamic hospital settings, post-PCI patients are cared for by multiple healthcare providers. Due to differences in their backgrounds, skill sets, and location-specific demands, there can be variations in the attention given to access site management. Electronic health record (EHR) order sets (OS) have emerged as a promising tool with the potential to standardize access site management. By utilizing these order sets, healthcare providers can streamline and align their practices, ensuring consistent and standardized approaches to managing access sites in various patient scenarios
Methodology: Jamaica Hospital Medical Center is a community teaching hospital located in Queens, New York, and participates in NCDRs Cath PCI and CPMI registry. To achieve standardization in post-catheterization access site care a collaborative effort among different disciplines and departments was initiated. The initial steps involved the modification of existing post-PCI OS and creation of access site-related neurovascular assessment (NVA) order sets, which required the involvement of various stakeholders. This included information technology specialists, nurses from the cardiac catheterization laboratory, as well as those from intensive care units at all levels. Additionally, nurse practitioners, residents, fellows, and physicians who provide care to post-PCI patients played integral roles in this process. The primary objective was to achieve a utilization rate of over 90% in implementing the newly developed order set for post-PCI patients. The process of modification included: 1. Review and modification of current post-PCI orders with a focus on post-PCI access assessment. 2. Education of all providers regarding the use of new post-PCI OS. 3. Education of nursing staff regarding the importance of NVA and timely documentation as outlined in the order set (interdepartmental meetings, daily huddles, one-to-one interactions). 4. Weekly monitoring of OS and NVA flowsheet use. 5. Monthly review of data on the interdepartmental level. 6. Monthly review at the hospital quality improvement meeting and reporting until goal of >90% is met for four consecutive months (May, 2022 to Nov, 2022). 7. Biannual review and reporting of data at the hospital quality improvement meeting.
Results: Updated post-PCI and NVA order sets were implemented in June 2022. After the initial period of 4 months, use of post-PCI and NVA was consistently around or above the target level of 90%. Analysis of the utilization of both order sets uncovered a noticeable trend of decreased compliance, particularly during off-hours and when the care of post-PCI patients was assigned to new or agency nurses. The findings indicated that these specific situations posed challenges in ensuring consistent adherence to the established protocols outlined in the order sets. Recognizing this pattern of reduced compliance allows for targeted interventions and strategies to address these specific scenarios, ensuring improved adherence to standardized practices for post-PCI patient care.
Value Proposition: By fostering teamwork and interdisciplinary communication, healthcare professionals can work together to establish consistent protocols and practices, ensuring a standardized approach to complex and sophisticated challenges involving critical aspects of post-PCI patient care.
Conclusions: Achieving successful access site management in post-PCI patients continues to pose a challenge for clinicians. However, leveraging standardized electronic health record (EHR) order sets can greatly enhance care delivery. By implementing these OS, clinicians have the opportunity to not only improve patient care but also identify the strengths and weaknesses of specific approaches. This valuable insight enables them to pinpoint safe and effective pathways for optimal and long-lasting outcomes. By utilizing standardized EHR order sets, healthcare providers can effectively address the complexities of access site management, leading to improved patient outcomes and a higher quality of care.
References: C. Wells. Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, 2019. Accessed 7/8/23 at: https://pubmed.ncbi.nlm.nih.gov/3125009. M. Gessinger. Guidelines for Standard Order set. Pubmed Central. Accessed on 7/8/23 at http://:ncbi.nim.nih.gov/pmc/articles /PMC3956384. S. Sania, A Nazly. Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development. Journal of Pharmaceutical Research International (2022).
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