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

2. 2 CICU Relationship Based Care Mary 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. 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. 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. 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. 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. 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. 8 Attending Nurse Coverage Needs Scenario 1 *Scenario 2Scenario 3Scenario 4 Days of Week Mon - FriSun - SatMon - FriSun - Sat Hrs /Day8812 Hrs/Wk40566084 FTE1.01.21.52.1 Ability to connect with families Ability to follow STEMI patients * 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

9. 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