SUBJECT: Cardiac Level I Activation & Acute Coronary Syndrome Protocols OBJECTIVE: To provide a systematic approach toward providing an immediate coordinated response to the management of the Cardiac patient and to provide a definite standard of care; preventing any further cardiac injury in the hospital. (ACLS Certified RNs may initiate ACLS medication protocol.) Definitions: Cardiac Level I (STEMI or ST elevation MI) ACS (Acute Coronary Syndrome) Process for Utilization: Activation: * Pre-hospital notification and activation of the protocols will be based on the pre-hospital report received by the staff in the Emergency Department or based on the initial triage report for patients arriving by private vehicle. * In house activation is based on nursing assessment using the Cardiac Level 1 Triage Tool and under the direction of the Hospitalist/Attending physician. Initial Responders: Emergency Department physician, Hospitalist or attending physician, ED or ICU RN, HUC (Health Unit Coordinator), Respiratory Therapy, Lab, and Clinical Coordinator 1. ED Triage/Charge Nurse/ICU RN a. Receives notification by Pre-Hospital Providers (or arrival of potential cardiac patient by private vehicle) OR Receives notification via activation of the Rapid Response Team (Administrative Policy # C-16 Code-Rapid Response Team) b. Expedites patient assessment and care delivery 2. ED Physician/Hospitalist/Attending c. Evaluates the patient d. Directs the initiation of the “Cardiac Level 1” protocol or ACS protocol e. Coordinates treatment plan with on-call Cardiologist f. Indicates appropriateness of hypothermia protocol for patients with ROSC 3. ED/ICU RN g. Coordinates patient care and activities h. Monitors patient for changes i. Facilitates medication administration as appropriate and procedures j. Provides frequent updates to physician, charge nurse, Clinical Coordinator 4. HUC k. Pulls Cardiac Level 1 or ACS order sheets l. Assists in facilitating patient disposition after ED/Unit Care 5. Pharmacy Assists in mixing and drawing up TNK or other appropriate medications 6. Respiratory Therapy m. Perform Serial EKG’s as ordered by the physician n. Monitor respiratory status as indicated 7. Lab Assist with lab draws as needed, perform tests as ordered 8. Clinical Coordinator o. Ensure all team members are present and roles clarified p. Facilitate transfer to higher level of care facility as indicated Cardiac Rehabilitation Referral Procedure:
The admitting physician will evaluate the need for cardiac rehab and if indicated will order the cardiopulmonary rehabilitation referral using the Acute Coronary Syndrome order form. Once ordered in Meditech a referral to outpatient services is generated and a follow up appointment is scheduled. Cardiac Care Coordinator:
The Cardiac Care Coordinator, as defined by Pullman Regional Hospital, is the Director of Hospitalists. The coordinator and his/her designees will be responsible for the overall review and development of the internal cardiac care operations, policy development, data analysis, performance improvement and system collaboration based on National Standards, guideline review and continuing education. They are responsible for communicating and in education the effected departments with the hospital.
Oversight Committee:
Pullman Regional Hospital’s Critical Care/Medicine Committee will be responsible for reviewing data on an annual basis for internal Quality Improvement (QI) based on the process and outcome data collected using the CMS Core Measures for acute myocardial infarction (AMI) and data received from the Regional Level 1 participants for transferred patients.
Internal data will be used to evaluate process and outcomes for
