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: n Unstable angina n Non ST segment elevation MI n 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), O 2 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!