What Do You Think?

Can you help your fellow professionals with the following NEW question? Expired Supplies I am inquiring if any staff member of Cath Lab Digest knows of an organization that accepts old and expired devices (i.e., catheters, stents, etc.) for redistribution to more needy areas of the world. It seems such a shame to just discard such once-valuable commodities. If you have any information, feel free to contact me. Thank you for your time. Don Heinisch Email: dcind@enter.net cc: Donald.Heinisch@Triadhospitals.com ___________________________________________________________________________ Ergonomics and moving patients I am currently working with the AIRPAL System as well. I am looking into its advantages and how they reduce back injuries, as well as minimize the number of people required to move a patient. This would free up nurses, technicians, etc. to attend to their own responsibilities without interruption. Michael Vanin, Engineer Email: dcind@enter.net cc: cathlabdigest@hotmail.com Cath lab procedure We have electronic procedure notes that come from our hemodynamics system. They contain all patient information, vital signs, equipment, inflations, staff, times, complications, etc. The cardiologist uses these notes to dictate. Judy S. Email: jparham@armc.org cc: cathlabdigest@hotmail.com Our facility used to do this a long time ago. We would complete a form indicating which procedures were performed, i.e., right and left coronary angiogram, left ventriculogram. The report documented sheath and catheter size, groin used, whether a local was administered, and (13 x 3) for LV gram. After we stopped doing this, we began documenting procedures on the monitor report that was generated by the person responsible for monitoring the procedure. The physician dictated his report from the monitor’s report. We stopped doing this, however, because it was felt that it was the physician’s responsibility, not the cath lab staff’s, to dictate his or her catheterization report. Annie Ruppert Email: Annie.Ruppert@sharp.com cc: cathlabdigest@hotmail.com We are not required to do so, but for years, I have been filling out a diagram for some physicians, along with hemodynamic and catheter (supplies) data. Those who wish to do so can do their dictation from this sheet. It is well appreciated. Alex Holmes Email: ALEX.HOLMES@tenethealth.com cc: cathlabdigest@hotmail.com From our Witt hemodynamics system, we print a second copy of the entire procedure report, including the preliminary findings, and place it in a folder for the physician to use to dictate his final report. This folder is then filed. Carletta Williams Email: carletta@weirtonmedical.com cc: cathlabdigest@hotmail.com We provide our cardiologists with the documentation through the GE Mac Lab and then measure LV post. Other than this, we do not summarize or document in any other fashion. Once we acquire a PACS (we are negotiating for a GE System), the report will flow from data entered into the Mac Lab into the final report, which we will assist in processing; then the cardiologist will review, summarize and sign off. I anticipate this will be implemented in the next year or so at our facility. Marcia Vermilye, MSA, BS, RN Email: M.Vermilye@lph.org cc: cathlabdigest@hotmail.com As a nurse manager, I require that all pertinent information be placed in permanent documentation. We use the Quinton Q-Cath for hemodynamic/physiologic monitoring. It is programmed to insert patient vital signs every five minutes. We use the Procedure Log module as our formal report system, placing one copy in the chart and giving the physician a copy. Included are all equipment used, medications used and the patient’s pain scale, as well as their response to those medications (part of pain management). We do not overtly mention dissections, but we do mention perforations. Patti Coblentz Email: PatriciaACoblentz@ ProvenaHealth.com cc: cathlabdigest@hotmail.com Measuring productivity From our lab’s hemodynamics database, I can run reports on room turnaround times, the number of cases a particular staff person or physician handles per month, etc. The State of Georgia’s Department of Community Health CON specifications define room capacity as 1,300 procedure-equivalents per year, with a catheterization procedure counting as 1, PCI as 1.5, and an EP study as 2 procedure equivalents. When a lab can document 90% capacity for two years, the Department of Community Health generally will approve an additional room. I think they will approve an EP room without a CON. I do not currently have benchmarking data for staff productivity other than the VHA ACTION reports, which provide a great deal of good, comparative information. Judy S. Email: jparham@armc.org cc: cathlabdigest@hotmail.com Our cath lab doesn’t measure staff productivity. We know we need at least three staff members to perform a procedure. Not knowing when add-ons will come along, both rooms are staffed Monday through Friday. If the schedule is light enough for just one room, then the extra staff members have the option of leaving early. As for knowing when another procedure room is needed, I read somewhere that each procedure room’s maximum is 1,000 procedures. This system works for us, as we remained at the 900 level and then added a second room. Now that our cath lab has reached 1,900 procedures, we are looking into adding a third room. Tracy Capua Email: Tracy.Capua@flaglerhospital.org cc: cathlabdigest@hotmail.com Documenting data Since our procedure note is the nurse’s note that goes on the medical record, we also document everything down to the smallest detail, using standards for nursing documentation, including inflations, etc. It is probably not necessary in every case, but I feel it is a liability issue to leave things out. Judy S. Email: jparham@armc.org cc: cathlabdigest@hotmail.com At our cath lab, we document almost everything we do, including times in the GE Mac Lab through the use of Macros. And yes, these fields and others are required for ACC-NDCR. Marcia Vermilye, MSA, BS, RN Email: M.Vermilye@lph.org cc: cathlabdigest@hotmail.com At our cath lab, we document as you do for the most part. We document patient arrival time, site verification with patient’s name, staff, local to groin site, sheath insertion and size. We document catheters used, time, right and left catheters inserted, pigtail catheter placed, LV gram and settings. For PCI procedures, we document balloons used, when inserted, when and where inflated, and when removed; the same goes for stents. We document guide exchanges, but I don’t think our wire exchanges are consistently documented. As for pacemakers and AICDs, we document the time leads are placed, where they are placed, the time that the generator is placed, the type of pacer or AICD inserted, and settings/mode. Also, for AICDs, we document rates set for the device to overdrive, pace and shock. Annie Ruppert Email: Annie.Ruppert@sharp.com cc: cathlabdigest@hotmail.com Our cath lab uses the Witt hemodynamics system. With the Witt system, we document everything needed by the medical records department, JCAHO and physicians. We record patient arrival time, allergies, NPO status, preparation, local time and site, each catheter, sheath, and wire used, all angiograms done (LV, AO, coronaries, etc.), all medications administered and why, pre- and post-aldrete scores, complications if any, patient condition in and out of the room, whom the report was given to, and where the patient was sent postprocedure. Our lab also documents every device that enters the body, when it was removed, if a balloon or stent was used, how long the inflation was (?? atms / for ?? seconds), where it was deployed, as well as the patient’s comfort level. Basically, we document sufficiently so that anyone who was present would have a full understanding of what took place. Our report is also very informative should the patient ever return to our lab. Tracy Capua Email: Tracy.Capua@flaglerhospital.org cc: cathlabdigest@hotmail.com We document all of that, but we do so through our WITT hemodynamics system. Carletta Williams Email: carletta@weirtonmedical.com cc: cathlabdigest@hotmail.com Are those your facility’s standards (i.e., what are the other departments charting)? I have always gone by the rule that you chart what you can defend in court, but don’t chart more than what is needed. I have observed some people who don’t chart anything. I have also seen people who chart everything, meaning how the patient reacts to each balloon inflation. Charting is not only showing the progress within a case, it can be a reminder of what happened. I have always charted what you have asked about. I guess that comes from my social worker days and having to testify in court and before grand juries. A good lawyer will ask you when, what and why. I can hardly remember anything that happened in a case the day before, much less months or years later. Remember that depending on your state laws, a case can be brought to court within a 7-year period, and if you are on the stand, what do you want in front of you a blank chart, or a chart that shows what happened? Kevin Rich, BS, RN, RCIS Email: ldrich3@comcast.net cc: cathlabdigest@hotmail.com Units of service I only have access to the ACTION report information, but I think some consulting firms have come up with staffing standards. You might ask your quality support people. Judy S. Email: jparham@armc.org cc: cathlabdigest@hotmail.com

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