Transition to Next Level of Care Management of Patient with Ventricular Assist Device

1. Transition to Next Level of Care Management of Patient with Ventricular Assist Device Home Hospital Transition

2. Long Term Acute Care Hospitals (LTAC) Acute Rehabilitation (AR) Sub-acute Rehabilitation (SAR) Home Next Level of Care

3. Patients with the following VADs can be safely discharged home: • Thoratec PVAD/IVAD on TLC II portable driver • Thoratec Heartmate XVE • Thoratec Heartmate II • Heartware HVAD * These are the common devices currently been implanted in Illinois & Indiana Dischargeable VADs

4. Patient/Caregiver Training with return demonstration and written post tests • Supervised and unsupervised excursions • Notification of first responders • EMT • Police • Ambulance service • Notification of local communityhospital • Notification sent to the electric company and request priority power restoration status • Notification of Post Hospital facility or home care services Discharge Planning

5. General physical condition: • Blood pressure • Heart rate • Temperature • Weight • VAD Function • Record and document the device specific parameters Assessment

6. Environment • Home • Safety & reliability of electrical system – 3 prong grounded outlets for the power units • Tripping hazards – clutter, loose carpet, pets • Potentially dangerous – swimming pools, open water • Stairs • Location of bedroom, bathroom, shower facilities • Emergency communication capabilities – cell phone, land phone Assessment

7. Environment • LTAC/Acute Rehab/SAR • Safety & reliability of electrical system – 3 prong grounded outlets for the power units backed by generator • Tripping/Fall hazards – wires, IV poles, furniture • Private room if possible for infection control • Room closer to nurses station to listen and respond to alarm conditions Assessment

8. Exit Site • Tissue incorporation • Drainage • Surrounding tissue for erythema, swelling, tenderness • VAD Pocket • Fluid over VAD pocket • Skin discoloration or cellulitis • Pain • Blistering • Midline Incision/Scar • Swelling • Blistering • Open blister/drainage • Cellulitis Assessment

9. Patient comfort with equipment management • Safety issues • Progression with rehab (PT/OT/Speech) • Glucose monitoring • I/O’s • Pressure Ulcers Other Assessments

10. VAD patients require close and regular monitoring of labs • CBC • CMP • Magnesium • PT/INR • BNP Laboratory Studies

11. VAD patient as an immunosupressed patient !!!! Prevention of Infection

12. Strict hand washing before and after caring for patient. Follow infection control policy and guidelines of your facility or agency. Exit site stabilization – abdominal binder Do not cohort patient with actively infected patient Prevention of Infection

13. Center specific protocol for dressing changes including protective equipment • Hand washing! • Minimize traffic in the room during dressing changes • Sterile/Aseptic dressing changes • Recognize signs & symptoms of infection and report to the VAD team/coordinator immediately! Exit site care

14. Supplies • Please provide one week of supplies for patient to go home till outpatient supplies are arranged • Please set up or provide information on ordering wound care supplies prior to discharged from your services • Active involvement of social services Exit Site Care

15. Daily Aspirin for anticoagulation for all devices • Coumadin is anticoagulation for all devices except Heart Mate XVE • Heart Failure medications • Miscellaneous medications Review of Medications

16. Key to successful patient outcomes!! • Communicate regularly with the VAD Team on the following: • Abnormal labs • Coumadin dosing • Any change in clinical status • Any signs and/or symptoms of infection • DEVICE ALARMS Communication

17. All VAD Centers have clinicians providing 24 hour clinical support Clinical Support

18. Questions???? Thank you