Cardiac Intensive Care Unit Operationalizing the Attending Nurse Role

1. Cardiac Intensive Care UnitOperationalizing the Attending Nurse Role Presented by Colleen Snydeman, RN, MSN February 15, 2012

2. CICU Relationship Based CareMary Koloroutis Transition to Relationship Based Care Model • Relationships are at the heart of all care • Patient assignments that increase continuity • Interdisciplinary team connections “We know our patients by heart”

3. CICU Attending Nurse Role Setting the Stage Accountability for patient / family continuity of care and progression of plan • Orient patient/family to MGH & CICU • Deliver Welcome packet • Encourage journaling • Implement patient/family meetings within 24 hours (benchmark is 24-48 hours) • Redefine patient/family meetings • Encourage and support patient / family participation on rounds

4. CICU Attending Nurse Role Facilitates the patient / family plan of care through communication with Interdisciplinary Team • Develops and revises patient care goals with care team via interdisciplinary care team rounds • 7:00 AM: Work Rounds with senior resident • 8:30 AM: Interdisciplinary patient care rounds • Daily: Patient specific rounds as needed • Weekly: Interdisciplinary long term care rounds • Develop long term care flowsheet • Communicates goals and plan of care to patient / family

5. CICU Attending Nurse Role Facilitator of transition of care • Attends 9:30 AM bed management meeting regarding coordination/transfer of care • Visits patient / family following transfer • Speaks with nurse caring for patient • Discharge follow up calls when indicated Coordinates meetings with clinicians for timely decision making and connects nurses to optimize handoffs across continuum • Attends Monday and Friday heart failure meetings • Attends STEMI meetings • Consults with Attending physicians as needed

6. CICU Attending Nurse Role Promotes clinical standards and patient / family relationship based care • Active involvement in CICU Practice • Family presencing • Evidence based practice • Nurse sensitive indicators • Hourly safety rounds • Safe hand-offs • Practice guidelines and standards of care • Nursing M&M rounds

7. Navigator Role CICU Attending Nurse will also function as Navigator for MGH STEMI population • Approx. 200 patients per year • Oversee processes of care: • Patient progress admission-discharge • Patient/family education • Follow up discharge calls • Communication across continuum of care • Contribute to innovative ideas for care redesign

8. Attending Nurse Coverage Needs • * Start with Scenario 1: ongoing assessment and evaluation re: • Attending Nurse workload • Ability to connect with families • Ability to follow STEMI patients • Gaps over week-end shifts Ability to connect with families Ability to follow STEMI patients

9. Next Steps • Implement Attending Nurse role: March 19th • Continuous evaluation of Attending Nurse hours of coverage • Complete work related to Navigator role for STEMI patients • Develop system to identify MGH STEMI patients • Define components of Navigator role • Develop educational content required for Attending Nurse, patients and families, MDs and others • Communicate Navigator role • Develop metrics to evaluate navigator role • Tentative Go-Live for Navigator role April 23rd