Updates from Two Groups of 2010 Award Recipients
Examination of Standards of Clinical Practice for the Care of Patients with Transradial Access for Cardiac Procedures
Michelle Glowny, MSN, RN, PCCN
Although the femoral artery has been the traditional access site for coronary angiography and percutaneous coronary intervention, use of the radial artery is rapidly gaining momentum as studies continue to demonstrate safety, efficacy and increased patient satisfaction with this approach. In 2010, radial volume at BWH increased significantly from approximately 10 to 15 percent to 50 percent, due to a renewed commitment to use this approach to improve patient outcomes and decrease vascular complications. We sought to examine the standards of practice for nursing care of the patient with transradial access by comparing our nursing practice to other practices in similar institutions.
We attended the Society for Coronary Angiography and Intervention Transradial Summit. We were able to meet with clinicians and observe a transradial case at both Penn State Heart and Vascular Institute at Hershey Medical Center and at WakeMed Heart Center in North Carolina. Although care was comparable across the sites with minor variations in protocol, some of the equipment (e.g., portable monitors, lounge chairs in each patient room) at the other sites was more conducive to patient mobilization during recovery. This observation led to a retrospective, post-procedure record review of 50 BWH transradial patients recovering in CVRR.
Results showed that 12 percent of radial patients recovered in a lounge chair, and 26 percent ambulated to BR during recovery. Compared to the group as a whole, patients who recovered in a lounge chair were male and tended to be older, weigh more, have less sedation and had undergone an outpatient diagnostic procedure. There was no clear correlation between patients out of bed to chair and risk assessment, leading to the conclusion that nursing practice is influenced by nursing judgment, time and workflow in the CVRR.
During a presentation of results, there was a multidisciplinary discussion regarding barriers to mobilization of radial patients and ideas for our practice in CVRR, including informing patients about the option of recovering in a recliner. The concept of a “radial lounge” was also introduced. Outpatients being discharged to home may be a logical population to target for recovery in a chair, and mobilization of radial patients is being monitored on a monthly basis.
Patient Advocates in the Emergency Department
Diane Miller, MSN, RN; Andrew Dundin, BS, RN; Brianna Welenc, BSN, RN; and Steven Palmer, BSN, RN, Emergency Department
We recently traveled to Wisconsin to attend The Institute for Patient and Family Centered Care Fall Conference. Our primary goal was to gain the strategic tools necessary to integrate the principles of patient and family centered care into our Emergency Department’s model of care. Our greatest lesson was that the BWH ED is at the beginning of a continuous journey toward the goal of partnering with patients and their families to provide care that supports every patient across the continuum.
Over the last year, we researched the practice of allowing and encouraging patients to have a support person with them in the ED. Practice-based evidence illustrates that engaging patients and their family members in the planning of care provides better outcomes. The patient and their family are experts in knowing themselves. The information they have regarding themselves or their loved one enhances the care experience. Currently, our most significant accomplishment has been to support the change in work flow and culture necessary for the success of our newly written and implemented ED Visitor Policy. In the past, ED patients were initially escorted to the care area alone, allowing time for caregivers to “settle them in” and ask the required private screening questions before allowing family members to the bedside. Now, the vast majority of patients presenting to the ED have the benefit of their support person accompanying them into the care area immediately as they are brought into care. The process change contributed to the dramatic improvement in our patient satisfaction, noted with our Press Ganey scores moving from the 66th to the 98th percentile in the last quarter of FY11.
Our group has grown to include members from ED registration, the Center for Patients and Families and two patient/family advisors. Our next steps include expanding to invite physician colleagues and staff from our ED Radiology group, Security and recruiting additional patient and family advisors who have been cared for in the ED. We believe with our expanded group working together, we can incorporate the guiding principles we have learned and continue to improve on the already excellent care we provide.