Orientation to Cardiology

1. Orientation to Cardiology What you need to Know About 8 North

2. Overview • Floor Layout • Who is on the Cardiology Floor • Process • AMOR • Medication Reconciliation • Assessment • Drug Therapy Problems • Care Plan • Follow-Up • Pharmacy Suggestion • Documentation • Common Conditions

3. Floor Layout North Side Hallway (rooms: 00 - 32) stairs elevators service elevators patient lounge reception patient charts (AM) charge nurses fish bowl South Side Hallway (rooms: 34 - 53) PCI room

4. Who is on the Cardiology Floor Charge Nurse x 2 Nurses PSWs Doctors (Surgeons, Specialists, Hospitalists, Family Doctors) Social Worker Rehabilitation Services (OT & PT) Dietician etc.

5. Process: AMOR • AMOR: Admission Medication Order Record • Patient are usually admitted to Cardiology with a completed AMOR • Can be completed using: • patient/caregiver verbal list • patient’s medication vials, blister packs, prescription receipts, etc. • long-term care medication administration record • patient transfer record • pharmacy list • Not always an accurate representation of patient’s medications

6. Process: AMOR

7. Process: Medication Reconciliation • Obtain Medication List from Community Pharmacy • Check if pharmacy name listed on AMOR • If yes, check patient chart • If no, ask patient • If required, call pharmacy to obtain medication list • Be sure to have: • Patient’s name & DOB • Cardiology fax number • Review Pharmacy List in comparison to AMOR (if available) • Read ‘Notes’ and ‘Other Reports’ to obtain information regarding the visit, patient history, etc. in MEDITECH • Discuss home medications with the patient

8. Process: Medication Reconciliation • Complete Pharmacy Communication as Process Immediately • If medication requires clarification to AMOR • e.g., wrong dose, wrong frequency • If patient not taking medication listed on AMOR • e.g., patient not taking at home, has not filled in some time

9. Process: Medication Reconciliation • Complete Pharmacy Communication for Physician Review • If medication missing from AMOR • e.g., on community pharmacy list, additional vitamins & supplements

10. Process: Assessment • Assess patient’s medical history and reason for visit • Are all patient conditions being managed with drug therapy? • Is the patient receiving evidence-based medications? • Indicated, Safe, Effective, Convenient/Able to Adhere • Post-MI: ASA, Clopidogrel, Beta-blocker, ACE inhibitor, Statin • Atrial Fibrillation: CHADS2 & HAS-BLED risk scores • If not receiving all evidence-based medications • Is there a reason the medication may not be indicated for this patient? • assess kidney function, blood pressure, heart rate, hemoglobin • Evaluate available options for drug therapy in the context of this patient

11. Process: Drug Therapy Problems • Identify Drug Therapy Problems • drug not indicated • dose too high • dose too low • ineffective drug therapy • adverse drug reaction • additional drug therapy required • patient non-adherence

12. Process: Care Plan • Determine what actions should be taken to resolve the Drug Therapy Problem • e.g., Initiate, Discontinue, Change dose • Consider the timing of the intervention • When is it appropriate to make these changes? • e.g., now, after a procedure, when blood pressure stabilizes • Has the MRP rounded on the patient yet? (many round in the AM)

13. Process: Follow-Up • Determine what follow-up is necessary for the patient and the medications • e.g., Blood sugar, Kidney function, Hemoglobin, Side effects • Decide on the frequency of follow-up /when to follow-up next • e.g., Daily, In two days, Weekly

14. Process: Pharmacy Suggestion • If the plan is indicated at this time • Write a Pharmacy Suggestion on a Pharmacy Communication form • for Physician Review • Include reasoning behind suggestion, appropriate dose, route & frequency • Bring all Pharmacy Suggestions to the attention of the charge nurse responsible for the patient • Attach the Pharmacy Communication form to the front of the chart • The MRP will review the Pharmacy Suggestion & if agrees will sign the Pharmacy Communication form • Otherwise the MRP may write a different order or therapy may remain unchanged

15. Process: Documentation • Be sure to document this process as an ‘Intervention’ in the patient’s file on MEDITECH • Pharmacy > Pharmacist Desktop > My List > Add • Interventions > Patient > Enter • Type: • OTH – other • Medication reconciliation • Hyperglycemia • TPS – TPA/Streptokinase • Warfarin/Coumadin • Status: • A – active • C – complete

16. Process: Documentation • Once the General Information is filled in click ‘Text’ • Be sure to include the date & your initials • e.g., JUL8: Medication reconciliation complete as per the patient and Shoppers Drug Mart Long Lake Road (705-522-3030). The patient was admitted with… history of… … -SB

17. Common Conditions • Hypertension • Acute Coronary Syndromes (ACS) • Unstable Angina/Non-ST Segment Elevation Myocardial Infarction (UA/NSTEMI) • ST Segment Elevation Myocardial Infarction (STEMI) • Post-MI • Congestive Heart Failure (CHF) • Atrial Fibrillation • Diabetes & Stress Hyperglycemia • COPD Exacerbations • Infections

18. Enjoy Cardiology