Paper
Wednesday, July 21, 2004
9:30 AM - 10:00 AM
Wednesday, July 21, 2004
2:30 PM - 3:00 PM
This presentation is part of :
PostersCollaboration is Key in Opening Doors for Evidence-Based Practice: CVNPs Implementation of Secondary Prevention Guidelines in CAD Patients
Patti McCluskey-Andre, RN, MSN, CCNS, ACNP-C, Cardiac Surgery Department, Hoag Memorial Hospital, Newport Beach, CA, USA and Margaret A. Morley, RN, MSN, CNS/ANP-C, Cardiology Department, Hoag Memorial Hospital, Newport Beach, CA, USA.
OBJECTIVE: The American Heart Association has set the standard for secondary prevention measures for patients with atherosclerotic disease. The AHA guidelines are designed to minimize future cardiac events with a recipe which includes an evidence based pharmacological regimen along with diet, exercise and smoking cessation counseling. The CV NPs identified the need to integrate these guidelines into practice as a priority within our service. DESIGN: Routine prospective data collection by NPs with the Society of Thoracic Surgeons for CV surgery and NRMI for cardiology. POPULATION: The CAD populations targeted were hospitalized patients with an acute myocardial infarction, undergoing a percutaneous coronary intervention or receiving coronary artery bypass grafting. OUTCOME VARIABLES: The adherence to the recommendations of the guidelines by time of discharge. METHODS: After examination of current practice, opportunities for development of best practices were defined. The NP's role included both the implementation and compliance by not only the medical providers but by the patient population. Multiple but standardized tools were designed to facilitate guideline utilization within this subset of hospitalized patients which included triggers for use and documentation of contraindications. The tools included preprinted order sets, progress notes, CV discharge prescription sets, transfer orders and follow up forms. All tools were designed in concert ensuring ease of use, consistency, accuracy and minimal probability for error. A patient education binder was also designed across CV specialties focusing on secondary prevention. The key to success was not only to educate and support providers but ensuring patients of a clear understanding of the preventative purpose of their therapy. FINDINGS: CV NPs facilitated a significant positive change of in-hospital utilization of research based guidelines across CAD populations. CONCLUSIONS: As providers, nurse practitioners can have a direct impact on influencing evidence based health care practices such as secondary prevention in atherosclerotic heart disease.
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Sigma Theta Tau International
July 21, 2004