ACS Clinical Pathway

1. ACS Clinical Pathway

2. Who? • Pts with Acute Ischemic Heart Disease now described as having ACS

3. ACS - Definition • Umbrella term, encompasses the full spectrum of disease manifestations associated with ischemic heart disease: • Unstable angina • Non ST segment elevation MI • ST segment elevation MI

4. ACS - Definition • More accurately reflects the diagnostic uncertainty that exists on presentation to hospital • Emphasizes urgent nature of problem & its location • Provides a starting point for a series of decisions providing rapid determination of the optimal treatment and dx

5. ACS Clinical Pathway • Designed to provide optimal patient care for this group of patients

6. Using the Pathway • Replace the Acute MI pathway • Based on 2002 ACC/AHA Clinical Guidelines for UA, NSTEMI & STEMI • Goal: provide best practice for pts

7. Components • Consults • Tests • Assessments/Treatments • Mobility/Safety • Nutrition • Psychosocial support • Pt Education • Discharge Planning • (Medications are not listed on the pathway…will be written in medical orders…refer to standard orders sheet)

8. Using the Pathway • ACS Clinical Pathway documentation includes: • Physician Pre-Printed Order Sheets • Clinical Pathway • Patient/Family Information • Case History • Clinical Flow Sheet/part of documentation • Patient Discharge Information ACS

9. Forms Available • ACS Pathway • Pt Information Sheet • GAP Tool • Orders (admission, CCU, levels, Cath, PCI, transfer to levels) • Protocols Chest Pain (CCU, levels), O2 protocol • Flow Sheet

10. Using the Pathway • On admission to HI all patients will start the clinical pathway • Start on the day of admission column • Includes all pts transferred from other hospitals • Ensures that all tests, consults and assessments will be done

11. Using the Pathway • The physician orders should indicate pt is ordered on the ACS clinical pathway

12. Using the Pathway • Charting by exception • Only deviations to the plan are charted • Initial & time where indicated…assumed that standards of care have been met and provided unless otherwise indicated

13. Using the Pathway • When documenting on the pathway, it is not necessary to document findings elsewhere in the chart

14. Using the Pathway • Consists of 4 days • If pt stay is >4 days, Day 4 may be repeated • Intervention day is to be used when pts go for cath/PCI

15. Using the Pathway • Dates are entered on top of the pathway to indicate Day 1, Day2, etc… • Communicate to next shift by circling undone/incomplete care & putting an arrow to the next day

16. Using the Pathway • Problem list completion required with the use of the pathway • Reminder on pathway to complete the initiation/review/update of the problem list

17. Using the Pathway • Assessment of variance is done on outcome section of pathway • Pt progress and variances are documented on the pathway, nurse’s notes and medical notes

18. Using the Pathway • Interdisciplinary team in consultation with attending physician will determine if a specific pt care would be better managed off the pathway • A physician’s order is required to discontinue the pathway • Previous system of documentation resume when a patient is taken off the pathway

19. Using the Pathway • Staff are required to sign at the end of each shift in the RN signature box on pathway • Info that needs to be documented, not found on pathway, entered in nurse’s progress notes

20. Using the Pathway • Discharge day must be completed, documenting that pt has script, d/c letter, teaching and any other plans • GAP tool will indicate the meds the pt will take on discharge

21. Using the Pathway • On discharge ALL ACS pts will have the Patient Discharge Information ACS completed and signed by BOTH the nurse and the patient.

22. GOOD LUCK!