HOW TO USE THE CLINICAL PATHWAY

Size: px
Start display at page:

Download "HOW TO USE THE CLINICAL PATHWAY"

Transcription

1 INCLUSION CRITERIA Primary admitting diagnosis is Congestive Heart Failure as defined by New York Heart Association. EXCLUSION CRITERIA Patients less than 19 years of age. HOW TO USE THE This is a proactive tool to avoid delays in treatment and discharge. These are not orders, only a guide to usual orders. Place the Clinical Pathway in the nurses clinical area of the chart. All health care professionals should fill in the master signature sheet at the front of the Pathway. Addressograph/sticker each page of the Pathway. PHYSICIANS: Add or delete tasks according to individual patient complexity, and initial all changes. HEALTH CARE PROFESSIONALS: Initial tasks as completed. Place N/A and initial any box where the task is not applicable to the patient. Additional tasks due to patient individuality can be added to the pathway in OTHER boxes and/or Progress Notes. 5. TRANSFER PATIENTS: if patient is transferred to another hospital in Grey-Bruce or to CCAC, send the following: Discharge Criteria - copy with patient to receiving hospital - original to stay on patient chart MAR Sheet - copy with patient to receiving hospital - original to stay on patient chart Teaching Checklist - copy with patient to receiving hospital - original to stay on patient chart Updated August Grey Bruce Health Network 1

2 POSITION NAME (Please Print) INITIAL SIGNATURE NURSE PT DIETITIAN PLANNER CCAC OTHER (Specify) All rights reserved. No part of this document may be reproduced or transmitted, in any form or by any means, without the prior permission of the copyright owner. Updated August Grey Bruce Health Network 2

3 COMORBID CONDITIONS: PROCESS PHASE 1 (Approximately 2 days) INITIAL IMPROVEMENT OF OXYGENATION - <5L O 2 REQUIRED BY PRONG; 35% BY MASK WEIGHT DECREASED SINCE ADMISSION RESPIRATORY RATE <30 PATIENT OUTCOMES* IMPROVEMENT OF CRACKLES IN LUNGS TOLERATES ACTIVITY LEVEL 2 ABSENCE OF UNSTABLE ARRHYTHMIAS Once all Patient Outcomes are achieved, move to Phase 2 ABSENCE OF CHEST PAIN PATIENT REPORTS IMPROVEMENT OF DYSPNEA CARDIAC MONITOR IF ORDERED CHEST ASSESSMENT ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) VITALS INCLUDING O 2 SATS Q4H x 24H; QID X 24H MONITOR INTAKE AND OUTPUT (24 HOURS) PERIPHERAL EDEMA (SEE CHART BELOW) DAILY WEIGHT, DISCUSS WITH PATIENT - DOCUMENTED BY NURSE AND PATIENT ASSESS ANXIETY AND INTERVENE IF NECESSARY ASSESSMENT OF PITTING EDEMA 2mm or less = 1 + Edema 2-4mm = 2 + Edema 4-6mm = 3 + Edema 6-8mm = 4 + Edema Slight pitting No visible distortion Disappears rapidly Somewhat deeper pit No readably detectable distortion Disappears in seconds (2-4 mm indent) Pit is noticeably deep May last more than 1 minute Dependent extremity looks fuller and swollen (4-6mm) Pit is very deep Lasts as long as 2-5 minutes Dependent extremity is grossly distorted (6-8mm) Assessment Chart for Pitting Edema adapted from the Guelph General Hospital Congestive Heart Failure Pathway Updated August Grey Bruce Health Network 3

4 PROCESS PHASE 1 (Approximately 2 days) 2D ECHOCARDIOGRAM IF ORDERED CLINICAL NUTRITION CONSULTS CCAC IF ORDERED PHARMACIST IF ORDERED ECG ECG WITH CHEST PAIN, NOTIFY PHYSICIAN DIAGNOSTICS/ LABORATORY BLOOD WORK AS ORDERED CARDIAC MARKERS CHEST X-RAY ON ADMISSION (next morning if after hours) MEDICATIONS SEE MAR SHEET TREATMENTS/ INTERVENTIONS INTERMITTENT SET O 2 AT L PRN TO KEEP 85-95% NUTRITION HEALTHY HEART DIET, 2-3 gm Na SPECIAL DIET IF REQUIRED: _ UP TO ACTIVITY LEVEL 2 AS TOLERATED BY PATIENT MOBILITY/ACTIVITY * ACTIVITY LEVEL 1: ACTIVITY LEVEL 2: BED REST BED SIDE COMMODE PRIVILEGE IF STABLE FEED SELF ASSISTED BATH ANKLE / FOOT EXERCISES DEEP BREATHING / COUGHING / CALF PUMPING SIT UP FOR 20 MIN (TID) BATHROOM PRIVILEGES ORIENTATION TO UNIT AND PROCEDURES PSYCHOSOCIAL SUPPORT/ EDUCATION * INTRODUCE PATIENT PATHWAY BEGIN TEACHING CHECKLIST GIVE PATIENT EDUCATION MATERIALS TO PATIENT ENCOURAGE PATIENT AND FAMILY TO ASK QUESTIONS PLANNING * DISCUSS PLAN WITH PATIENT AND FAMILY ASSESS FOR CCAC ASSESS CRITERIA DAILY Activity Levels (1-4) adapted from the Guelph General Hospital AMI Activity Level Guideline Updated August Grey Bruce Health Network 4

5 PROCESS PHASE 2 (Approximately 2 days) INITIAL ABSENCE OF CRACKLES ON LUNGS PATIENT OUTCOMES* O 2 SATS ON ROOM AIR >90% OFF OXYGEN OR RETURNED TO PRE-HOSPITALIZATION LEVEL OF O 2 TOLERATES ACTIVITY LEVEL 3 OR RETURNED TO PRE-HOSPITALIZATION LEVEL Once all Patient Outcomes are achieved, move to Discharge Criteria ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) CONSULTS DIAGNOSTICS/ LABORATORY CHEST ASSESSMENT VITALS INCLUDING 0 2 SATS BID AND PRN WHEN STABLE ASSESS FOR EDEMA (SEE CHART BELOW) DAILY WEIGHT, DISCUSS WITH PATIENT - DOCUMENTED BY NURSE AND PATIENT ARRANGE HOME O 2 IF NEEDED CHEST X-RAY IF ORDERED ABGs IF CONSIDERED FOR HOME O 2 BLOOD WORK AS ORDERED ASSESSMENT OF PITTING EDEMA 2mm or less = 1 + Edema 2-4mm = 2 + Edema 4-6mm = 3 + Edema 6-8mm = 4 + Edema Slight pitting No visible distortion Disappears rapidly Somewhat deeper pit No readably detectable distortion Disappears in seconds (2-4 mm indent) Pit is noticeably deep May last more than 1 minute Dependent extremity looks fuller and swollen (4-6mm) Pit is very deep Lasts as long as 2-5 minutes Dependent extremity is grossly distorted (6-8mm) Assessment Chart for Pitting Edema adapted from the Guelph General Hospital Congestive Heart Failure Pathway Updated August Grey Bruce Health Network 5

6 PROCESS PHASE 2 (Approximately 2 days) MEDICATIONS SEE MAR SHEET TREATMENTS/ INTERVENTIONS CHECK WITH PHYSICIAN REGARDING DISCONTINUING INTERMITTENT SET NUTRITION HEALTHY HEART DIET, 2-3 gm Na SPECIAL DIET IF REQUIRED: UP IN ROOM AD LIB MOBILITY/ACTIVITY * ACTIVITY LEVEL 3 AS TOLERATED: SIT UP FOR MEALS SHOWER WALK IN HALL PSYCHOSOCIAL SUPPORT/ EDUCATION * REVIEW PATIENT PATHWAY COMPLETE TEACHING CHECKLIST ADDRESS ANY QUESTIONS THE PATIENT MAY HAVE DISCUSS PLANS WITH PATIENT PLANNING * CONSIDER FOR CARDIAC REHAB AND CHF CLINIC, IF APPROPRIATE, SECURE PHYSICIAN/NURSE PRACTITIONER ORDER REVIEW MEDICATIONS FOR HOME REVIEW ACTIVITY LEVELS FOR HOME ASSESS NEEDS FOR ASSESS CRITERIA DAILY SECURE ORDER ONCE INDICATORS MET Activity Levels (1-4) adapted from the Guelph General Hospital AMI Activity Level Guideline Updated August Grey Bruce Health Network 6

7 PROCESS CRITERIA MET INITIAL 1 ACE INHIBITOR PRESCRIBED AT 2 BETA BLOCKER PRESCRIBED AT 3 WARFARIN FOR ATRIAL FIBRILLATION PRESCRIBED AT PERFORMANCE INDICATORS ASSESSMENT (OBSERVATIONS/ MEASUREMENTS/ ELIMINATION) CONSULTS DIAGNOSTICS/ LABORATORY MEDICATIONS TREATMENTS/ INTERVENTIONS NUTRITION MOBILITY/ACTIVITY PSYCHOSOCIAL SUPPORT/ EDUCATION PLANNING 4 WEIGHT MEASURED EACH DAY OF HOSPITALIZATION 5 ECHOCARDIOGRAM COMPLETED 6 SMOKING CESSATION ADVICE/COUNSELLING COMPLETED INSTRUCTIONS RE: MEDS, 7 SALT/FLUID RESTRICTIONS, DAILY WEIGHTS, SYMPTOMS OF WORSENING CHF, FOLLOW UP APPOINTMENT NEW YORK HEART ASSOCIATION (NYHA) FUNCTIONAL CLASSIFICATION IMPROVED BY ONE OR MORE GRADES SINCE ADMISSION: D/C NYHA LEVEL: IMPROVEMENT OF PERIPHERAL EDEMA SINCE ADMISSION RESPIRATORY RATE IMPROVED SINCE ADMISSION NO CHEST PAIN OR PAIN FROM DYSPNEA WEIGHT DECREASED SINCE ADMISSION BLOOD PRESSURE WITHIN STABLE LIMITS FOR INDIVIDUAL ELECTROLYTES WITHIN NORMAL LIMITS STABLE RENAL FUNCTION - CREATININE <220 ORAL MEDS STABLE x 24 HOURS OFF INOTROPES 48 HOURS PATIENT VERBALIZES UNDERSTANDING OF MEDS PATIENT VERBALIZES UNDERSTANDING OF HEALTHY HEART DIET, SALT/FLUID RESTRICTIONS PATIENT TOLERATING ACTIVITY LEVEL 3 (NO DYSPNEA/ DIZZINESS) PATIENT VERBALIZES IMPORTANCE OF DAILY WEIGHTS PATIENT VERBALIZES UNDERSTANDING OF SYMPTOMS OF WORSENING HEART FAILURE, WHEN TO CALL PHYSICIAN/COME TO HOSPITAL FOLLOW UP APPOINTMENTS: FAMILY PHYSICIAN CARDIAC REHAB CHF CLINIC Updated August Grey Bruce Health Network 7

HOW TO USE THE CLINICAL PATHWAY

HOW TO USE THE CLINICAL PATHWAY CONGESTIVE HEART FAILURE CLINICAL PATHWAY ACUTE STAGE HANOVER AND DISTRICT HOSPITAL 1. 2. 3. 4. INCLUSION CRITERIA Primary admitting diagnosis is Congestive Heart Failure as defined by New York Heart Association.

More information

HOW TO USE THE CLINICAL PATHWAY

HOW TO USE THE CLINICAL PATHWAY CONGESTIVE HEART FAILURE CLINICAL PATHWAY ACUTE STAGE GREY BRUCE HEALTH SERVICES Lion's Head Markdale Meaford Owen Sound Southampton Tobermory Wiarton 1. 2. 3. 4. INCLUSION CRITERIA EXCLUSION CRITERIA

More information

HOW TO USE THE CLINICAL PATHWAY

HOW TO USE THE CLINICAL PATHWAY ACUTE CORONARY SYNDROMES CLINICAL PATHWAY ACUTE STAGE GREY BRUCE HEALTH SERVICES Lion's Head Markdale Meaford Owen Sound Southampton Tobermory Wiarton PATIENT ID INCLUSION CRITERIA Patients who present

More information

Proof 2. CLINICAL PATHWAY PLAN CLINIQUE GENERAL SURGERY CHIRURGIE GÉNÉRAL Enhanced Recovery After Surgery (ERAS) Bowel Surgery /

Proof 2. CLINICAL PATHWAY PLAN CLINIQUE GENERAL SURGERY CHIRURGIE GÉNÉRAL Enhanced Recovery After Surgery (ERAS) Bowel Surgery / CLINICAL PATHWAY PLAN CLINIQUE GENERAL SURGERY CHIRURGIE GÉNÉRAL Enhanced Recovery After Surgery (ERAS) Bowel Surgery / Proof 2 Addressograph/Plaque Cancer Assessment Clinic (CAC) Date: yyaa mm dj Day

More information

Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis

Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis of nurse 1. Admit under ward Attending Physician: Dr. Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests 2. On admission (if not already performed in Emergency Department or in Coronary

More information

URN: Family name: Given name(s): Address: Initial Signature Print Name Role

URN: Family name: Given name(s): Address: Initial Signature Print Name Role Do Not Write in this binding margin v5.00-02/2012 Mat. No.: 10206019 SW030b The State of Queensland (Queensland Health) 2012 Contact CIM@health.qld.gov.au ÌSW030bIÎ Facility: s Never Replace Clinical Judgement

More information

Living with Congestive Heart Failure

Living with Congestive Heart Failure Living with Congestive Heart Failure Introduction Congestive heart failure, also known as chronic heart failure, is a common condition that affects millions of people every year. It is possible to control

More information

Nursing Management Plan Small or large bowel

Nursing Management Plan Small or large bowel Nursing Management Plan Small or large bowel Highlight the procedure/s and add other details: Open / Laparoscopic Assisted Hemicolectomy / Right / Left / Extended Sigmoid Colectomy / Transverse Colectomy

More information

Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year

Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart

More information

InterQual Acute Criteria: Demonstration of Condition Specific Subsets

InterQual Acute Criteria: Demonstration of Condition Specific Subsets InterQual Acute Criteria: Demonstration of Condition Specific Subsets February 24, 2011 Today s Presenters Lollie Dubiel, RN, BSN Sr. Product Manager McKesson Laura McIntire, RN, BSN, MA Clinical Lead

More information

Alberta Surgical Fractured Hip Care Pathway Version 3: Last Updated February 9, 2018

Alberta Surgical Fractured Hip Care Pathway Version 3: Last Updated February 9, 2018 Alberta Surgical Fractured Hip Care Pathway Assessment / Pain Mngmt EMS Transport Neurovascular assessment Vital signs Pain assessment Splint only (no traction) Position of comfort Start IV and use appropriate

More information

Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan

Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Acute MI/Acute Coronary Syndrome Adult Phase, When to Initiate: Acute MI/Acute Coronary Syndrome Adlt Phase Non Categorized

More information

Acute Stroke with Alteplase Administration Order Set

Acute Stroke with Alteplase Administration Order Set Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:

More information

Physician Orders ADULT: PCI Post Procedure Plan

Physician Orders ADULT: PCI Post Procedure Plan Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: PCI Post Procedure Phase, When to Initiate: Initiate Powerplan Phase Phase: Post Cath/PCI Hydration Protocol Phase,

More information

Level 1: Acute CHF with Hypotension (SBP < 90 torr)

Level 1: Acute CHF with Hypotension (SBP < 90 torr) PENNSYLVANIA HOSPITAL ED ACUTE CONGESTIVE HEART FAILURE STANDING DERS Level 1: Acute CHF with Hypotension (SBP < 90 torr) Intake: Vital signs Pulse oximetry Weight Allergies: Obtain old chart Obtain old

More information

Myocardial Infarction Order Set

Myocardial Infarction Order Set Myocardial Infarcti Order Set Date Time 1. [ ] Inpatient: [ ] CCU [ ] PCU [ ] ICU 2. Diagnosis: Admit to: Dr. 3. Code Status: [ ] See Completed Code Sheet * ote: o Code verbal order may ly be taken in

More information

PEDIATRIC ASTHMA INPATIENT CARE MAP

PEDIATRIC ASTHMA INPATIENT CARE MAP DATE PATIENT PEDIATRIC ASTHMA INPATIENT CARE MAP DOB HSC NO. PHIN Approved by the Winnipeg Regional Health Authority This Care Map is to be used as a guideline and in no way replaces sound clinical judgment

More information

CHF for Clinician. AtHomeCare.com

CHF for Clinician. AtHomeCare.com CHF for Clinician AtHomeCare.com CONTACT INFORMATION FOR CLIENTS Client s Name: SOC Date: Case Manager s Name: Phone #: Physician s Name: Phone: Emergency Contact Person s Name: Phone Number: MISSION STATEMENT

More information

OBSERVATION UNIT ASTHMA PATHWAY OUTLINE Westmoreland Hospital PAGE 1 OF 5

OBSERVATION UNIT ASTHMA PATHWAY OUTLINE Westmoreland Hospital PAGE 1 OF 5 PAGE 1 OF 5 Exclusion Criteria: (Reason to admit to hospital) A. New EKG changes except sinus tachycardia B. Respiratory Rate > 40 C. Signs/symptoms of Heart Failure D. Impending respiratory failure or

More information

Central Sleep Apnea Problem Based Learning Module

Central Sleep Apnea Problem Based Learning Module Central Sleep Apnea Problem Based Learning Module Vidya Krishnan, and Sutapa Mukherjee for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee 2015 Case Section I A 75 year old

More information

ST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI

ST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI Date & Time TAVR Pre-Op Admission Clinical Pathway Page 1 of 3 1. Admit as INPATIENT to Dr.. For Surgery Today or Tomorrow 3. Diagnosis: 4. Allergies: Pharmacy Mnemonic: PRETAVR 5. Vital signs on arrival.

More information

DOWNTIME Physician Order CARD CHF Heart Failure

DOWNTIME Physician Order CARD CHF Heart Failure DOWNTIME Physician Clinical Category ADT/Comm unication Patient Status ASC Extended Recovery Observation Services Inpatient Admission CCU Admit as Inpatient History and Physical by House Physician Vital

More information

Sample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system

Sample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system Legend Mandatory fields o Optional fields Height Allergies: List or o Up to date in electronic system cm Weight Diagnosis kg Date (yyyy-mon-dd) Time (hh:mm) Anticipated Date Of Discharge (ADOD) o Greater

More information

5AB Dysrhythmia Interpretation and Management 2016

5AB Dysrhythmia Interpretation and Management 2016 5AB Dysrhythmia Interpretation and Management 2016 How to complete your biennial ECG review: A website has been created that contains the basic review information. Use this as a reference during your review.

More information

Card Open Heart POD1 POD3 Plan Post Op Day 1

Card Open Heart POD1 POD3 Plan Post Op Day 1 Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit

More information

Chronic Obstructive Pulmonary Disease (COPD) Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Chronic Obstructive Pulmonary Disease (COPD) Copyright 2014 by Mosby, an imprint of Elsevier Inc. Chronic Obstructive Pulmonary Disease () 8.18.18 Copyright 2014 by Mosby, an imprint of Elsevier Inc. Description Airflow limitation not fully reversible progressive Abnormal inflammatory response of lungs

More information

Cardiac & Pulmonary Rehab Individual Treatment Plan

Cardiac & Pulmonary Rehab Individual Treatment Plan Initial Assessment Date: Re-Assessment Date: Re-Assessment Date: Follow-Up Discharge Date: Risk Assessment Risk Assessment Risk Assessment Risk Assessment BP SpO2 BP SpO2 BP SpO2 BP SpO2 HR Edema HR Edema

More information

Ileal Conduit Diversion Surgery

Ileal Conduit Diversion Surgery Here are some words and pictures to help you understand this surgery: Bladder: the bladder stores urine that is made by the kidneys Bowels: the bowels are the parts of the body that digest food and fluids.

More information

Topic Page: congestive heart failure

Topic Page: congestive heart failure Topic Page: congestive heart failure Definition: congestive heart f ailure from Merriam-Webster's Collegiate(R) Dictionary (1930) : heart failure in which the heart is unable to maintain an adequate circulation

More information

ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4

ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4 TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:

More information

Esophagectomy Surgery

Esophagectomy Surgery Esophagectomy Surgery What is esophagectomy surgery? Esophagectomy surgery is the removal part, or all, of the esophagus. The esophagus is the tube that your food goes down on the way to your stomach.

More information

Title Protocol for the Management of Asthma

Title Protocol for the Management of Asthma Document Control Title Protocol for the Management of Asthma Author Author s job title Professional Lead, Minor Injuries Unit Directorate Emergency Services, Logistics and Resilience Department Version

More information

PPP 1. Continuation, modification, and discontinuation of a medication

PPP 1. Continuation, modification, and discontinuation of a medication PRESCRIBING POLICIES: 4.7 PHARMACIST AUTHORITY The College of Pharmacists of BC Professional Practice Policy (PPP) 58 Medication Management (Adapting a Prescription) became effective April 1, 2009. The

More information

SOP for the Prescribing and Administration of Milrinone on The Children s Heart Centre

SOP for the Prescribing and Administration of Milrinone on The Children s Heart Centre SOP for the Prescribing and Administration of Milrinone on The Children s Heart Centre Version Number 2 Date of Issue July 2017 Reference Number PAMCHC-07-2017-MHPLMLAGOFSSDS-V2 Review Interval Approved

More information

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24

More information

Instruct patient and caregivers: Need for constant monitoring Potential complications of drug therapy

Instruct patient and caregivers: Need for constant monitoring Potential complications of drug therapy Assessment Prior to administration: Assess patient for chest pain, dysrhythmias, and vital signs (initially and throughout therapy) Obtain complete medical history, including allergies, especially heart

More information

Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other

Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other Neurosurgery Pre-Op [1710] Patient Name MRN General Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT Inpatient Only Procedure (Single Response) ( ) Admit to Inpatient Diagnosis:

More information

Congestive Heart Failure (CHF):

Congestive Heart Failure (CHF): Congestive Heart Failure (CHF): Patient Self-Care Workbook Learn how to manage your condition: What about the disease process and risks? How can medicine, diet, and exercise help? What can YOU do to improve

More information

Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.

Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page. DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit

More information

PREOPERATIVE ANAEMIA PATHWAY

PREOPERATIVE ANAEMIA PATHWAY PREOPERATIVE ANAEMIA PATHWAY Surname: Unit No. Forename: DOB: / / Age: NHS Number: Likes to be called: Address: Tel. No. Religion/Spirituality: GP Name: GP Practice: Planned Operation: Postcode: Mobile

More information

ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4

ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4 ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Attending Surgeon: Medical Record Number Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART

More information

Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription

Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription CARDIAC REHAB POLICY & PROCEDURES Policy #: CR 208 Subject: Outpatient Phase Ii Cardiac Rehab Individualized Treatment Plan And Exercise Prescription Purpose: To establish guidelines for developing and

More information

Pediatric Order Set 0 through 16 yrs age Addressograph Stamp

Pediatric Order Set 0 through 16 yrs age Addressograph Stamp Date Pediatric Order Set 0 through 16 yrs age Time 1. [ ] Place in Observati: [ ] Mitored Telemetry Bed [ ] Unmitored Bed OR [ ] Admit to Inpatient: [ ] Med-Surg Telemetry Mitor [ ] Med-Surg 2. Diagnosis:

More information

Heart Failure (HF) - Primary Care Flow Charts. Pre diagnosis Symptoms or signs suggestive of HF

Heart Failure (HF) - Primary Care Flow Charts. Pre diagnosis Symptoms or signs suggestive of HF Heart Failure (HF) - Primary Care Flow Charts Pre diagnosis Symptoms or signs suggestive of HF 12 lead ECG Normal examination and 12 lead ECG HF highly unlikely Abnormal 12 lead ECG HF Possible Arrange

More information

Heart Failure (HF) - Primary Care Flow Charts. Symptoms or signs suggestive of HF. Pre diagnosis. Refer to the Heart Failure Clinic at VHK for

Heart Failure (HF) - Primary Care Flow Charts. Symptoms or signs suggestive of HF. Pre diagnosis. Refer to the Heart Failure Clinic at VHK for Heart Failure (HF) - Primary Care Flow Charts Pre diagnosis Symptoms or signs suggestive of HF 12 lead ECG Normal examination and 12 lead ECG HF highly unlikely Abnormal 12 lead ECG HF Possible Arrange

More information

Sinclair Community College, Division of Allied Health Technologies

Sinclair Community College, Division of Allied Health Technologies Sinclair Community College, Division of Allied Health Technologies Health Promotion for Community Health Workers Cardiovascular disease, stroke, and cancer Class #9 Heart Failure (date) Course Objectives:

More information

DIXIE REGIONAL ACUTE REHABILITATION UNIT TEAM CONFERENCE and INDIVIDUALIZED OVERALL PLAN OF CARE SUMMARY

DIXIE REGIONAL ACUTE REHABILITATION UNIT TEAM CONFERENCE and INDIVIDUALIZED OVERALL PLAN OF CARE SUMMARY DIXIE REGIONAL ACUTE REHABILITATION UNIT TEAM CONFERENCE and INDIVIDUALIZED OVERALL PLAN OF CARE SUMMARY Conference Date: Rehab Admitting Diagnosis: Comorbid Conditions: Current Medical Prognosis: New

More information

Multiple Choice Questions

Multiple Choice Questions Multiple Choice Questions 25yo M presents without psychiatric or medical history, with complaint of tremor to the ER. He denies drinking alcohol but his friend at bedside takes you to the side and reports

More information

GASTRECTOMY. Date of Surgery. Please bring this booklet the day of your surgery. QHC#34

GASTRECTOMY. Date of Surgery. Please bring this booklet the day of your surgery. QHC#34 GASTRECTOMY Date of Surgery Please bring this booklet the day of your surgery. QHC#34 What is a Gastrectomy? A Gastrectomy is the surgical removal of all or part of the stomach. The stomach is the digestion

More information

Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:

Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician: Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: LEB Asthma Admit Phase, When to Initiate: LEB Asthma Admit Phase Non Categorized Add To Problem List Problem: Asthma

More information

Physician Orders ADULT: Asthma and Bronchitis Plan

Physician Orders ADULT: Asthma and Bronchitis Plan Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Asthma and Bronchitis Phase, When to Initiate: Asthma and Bronchitis Phase Non Categorized Problem: Asthma Problem:

More information

Quality Data on Core Measures

Quality Data on Core Measures Quality Data on Core Measures The Centers for Medicare and Medicaid (CMS) have developed several measurements to reflect the quality of care in hospitals. They include pneumonia, surgical care, heart failure

More information

1000 Lives Key Components of Reliable, Evidence-Based Chronic Heart Failure Care how do we compare?

1000 Lives Key Components of Reliable, Evidence-Based Chronic Heart Failure Care how do we compare? 1000 Lives Key Components of Reliable, Evidence-Based Chronic Heart Failure Care how do we compare? Dr Nerys Davies, GPST Ms B. Davies, Specialist Nurse (Heart Failure) Dr J. Taylor, Consultant Cardiologist

More information

SCVMC RESPIRATORY CARE PROCEDURE

SCVMC RESPIRATORY CARE PROCEDURE Page 1 of 8 Rev. - 11/99, 11/05, 4/11 R-NC - 08/99,08/00, 04/03,10/08,04/09, 07/11, 6/12 B7180-43 OBJECTIVE Continuous Nebulization allows for continuous, controlled drug delivery to the lung, avoiding

More information

Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan

Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Kidney Transplant Post Op Phase, When to Initiate: LEB Kidney Transplant Post Op Phase Admission/Transfer/Discharge

More information

AMI Talking Points. Provide appropriate treatment to Acute MI patients with these core measures:

AMI Talking Points. Provide appropriate treatment to Acute MI patients with these core measures: AMI Provide appropriate treatment to Acute MI patients with these core measures: Aspirin received within 24 hours of arrival or contraindication documented Primary PCI Received Within 90 Minutes of Hospital

More information

Difficult to Treat Hypertension

Difficult to Treat Hypertension Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic

More information

Congestive Heart Failure

Congestive Heart Failure Sheri Saluga Anatomy and Physiology II March 4, 2010 Congestive Heart Failure Scenario George is in congestive heart failure. Because of his condition, his ankles and feet appear to be swollen and he has

More information

CARE OF THE ADULT COPD PATIENT

CARE OF THE ADULT COPD PATIENT CARE OF THE ADULT COPD PATIENT Target Audience: The target audience for this clinical guideline is all MultiCare providers and staff including those associated with our Clinically Integrated Network. The

More information

COPD Management in LTC: Presented By: Jessica Denney RRT

COPD Management in LTC: Presented By: Jessica Denney RRT COPD Management in LTC: Presented By: Jessica Denney RRT Sponsored by Z & D Medical Services, Diamond Sponsor Seizing Opportunities to Provide Individualized Treatment and Device Selection for your COPD

More information

Objectives. Outline 4/3/2014

Objectives. Outline 4/3/2014 Jessica Litke PGY1 ISHP Spring Meeting April 12, 2014 Objectives Appreciate the significance of heart failure (HF) to a patient and to the health care system Understand 2013 ACCF/AHA guidelines for the

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Congestive Heart Failure Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014

More information

PT Goals - Certification or Supplemental Orders

PT Goals - Certification or Supplemental Orders General G01 PT Rehab potential excellent for stated goals C General G02 PT Rehab potential good for stated goals C General G03 PT Rehab potential fair for stated goals C General G04 PT Discharge when goals

More information

DRUG ALLERGIES WT: KG

DRUG ALLERGIES WT: KG DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24

More information

ICD Implantation Patient Information

ICD Implantation Patient Information Melbourne Heart Rhythm ICD Implantation Patient Information The Heart The heart is a pump responsible for maintaining blood supply to the body. It has four chambers. The two upper chambers (the right atrium

More information

Exhibit EP16.h University of Virginia Medical Center Clinical Decision Tool

Exhibit EP16.h University of Virginia Medical Center Clinical Decision Tool TITLE: Emergency Management for Suspicion of Cardiac Event PURPOSE: Increasingly, patients have multiple morbidities and are at risk of adverse events related or unrelated to the condition for which they

More information

Patient Group Direction for SALBUTAMOL INHALER (Version 02) Valid From 1 October September 2019

Patient Group Direction for SALBUTAMOL INHALER (Version 02) Valid From 1 October September 2019 Version Control This PGD has been agreed by the following organisations FCMS PDS Medical Doncaster CCG Lancashire CCGs including East Lancashire, Fylde and Wyre and North Lancashire CCGs Change history

More information

Heart Disease and Congestive Heart Failure

Heart Disease and Congestive Heart Failure Heart Disease and Congestive Heart Failure Heart failure affects nearly 5 million Americans. Roughly 550,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization

More information

When the heart job fails ~HEART FAILURE~

When the heart job fails ~HEART FAILURE~ HEART FAILURE Dr. BALINT, HAJNALKA Research/ Clinical Fellow Congenital Cardiac Centre for Adults University Health Network Peter Munk Cardiac Centre / Toronto General Hospital Toronto, ON, Canada Heart

More information

Prescribe appropriate immunizations for. Prescribe childhood immunization as per. Prescribe influenza vaccinations in high-risk

Prescribe appropriate immunizations for. Prescribe childhood immunization as per. Prescribe influenza vaccinations in high-risk Supplemental Digital Appendix 1 46 Health Care Problems and the Corresponding 59 Practice Indicators Expected of All Physicians Entering or in Practice Infectious and parasitic diseases Avoidable complications/death

More information

Presentation, symptoms and signs of heart failure

Presentation, symptoms and signs of heart failure 3 Presentation, symptoms and signs of heart failure What will I learn? In this section you will learn: Who is at risk of heart failure The symptoms of heart failure The signs of heart failure The importance

More information

Referral Forms for TYVASO and REMODULIN

Referral Forms for TYVASO and REMODULIN Referral Forms for TYVASO and REMODULIN HOW TO GET STARTED Tyvaso and Remodulin are available only through select Specialty Pharmacy Services (SPS) providers. Follow these 5 simple steps to complete each

More information

2012 Core Measures. Acute Myocardial Infarction (AMI)

2012 Core Measures. Acute Myocardial Infarction (AMI) 2012 Core Measures Acute Myocardial Infarction (AMI) Aspirin at Arrival Aspirin Prescribed at Discharge Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for left ventricular

More information

HQO s Episode of Care for Chronic Obstructive Pulmonary Disease

HQO s Episode of Care for Chronic Obstructive Pulmonary Disease HQO s Episode of Care for Chronic Obstructive Pulmonary Disease Dr. Chaim Bell, MD PhD FRCPC Ontario Hospital Association Webcast October 23, 2013 Objectives 1. Describe the rationale and methodology for

More information

Angiogram and angioplasty

Angiogram and angioplasty Angiogram and angioplasty The femoral arteries run from the groin to the thigh, delivering blood to your legs. When there is a narrowing or blockage in these arteries, the blood supply to the legs is reduced,

More information

Heart & Vascular Health

Heart & Vascular Health CLINICAL PATHWAY Heart & Vascular Health Syncope Clinical Pathway Syncope Clinical Pathway Table of Contents (tap to jump to page) INTRODUCTION 1 Scope of this Pathway 2 Pathway Contacts 2 CLINICAL PATHWAY

More information

Pulmonary Rehabilitation. Palmetto GBA, Jurisdiction 11 MAC Provider Outreach and Education

Pulmonary Rehabilitation. Palmetto GBA, Jurisdiction 11 MAC Provider Outreach and Education Pulmonary Rehabilitation Palmetto GBA, Jurisdiction 11 MAC Provider Outreach and Education Pulmonary Rehabilitation Pulmonary Rehabilitation is a multi-disciplinary program of care for patients with chronic

More information

OB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General

OB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General OB Well Baby Nursery Admission (Term) [3040000234] For specialty focused order sets for your patient, refer to: 3040000424 Neonatal Circumcision Order Set 3040000522 Neonatal Herpes Viral Order Set 3040000524

More information

Reducing the Risk of Deep Vein Thrombosis (DVT) whilst in hospital and following your discharge home

Reducing the Risk of Deep Vein Thrombosis (DVT) whilst in hospital and following your discharge home Reducing the Risk of Deep Vein Thrombosis (DVT) whilst in hospital and following your discharge home 1 Part of: South Tyneside and Sunderland Healthcare Group Introduction This leaflet explains what Deep

More information

NHS QIS National Measurement of Audit Acute Coronary Syndrome

NHS QIS National Measurement of Audit Acute Coronary Syndrome NHS QIS National Measurement of Audit Acute Coronary Syndrome Things have changed based on the experience and feedback from the first cycle of measurement and, for the better we think! The Acute Coronary

More information

CLINICAL PATHWAY. Acute Medicine. Chronic Obstructive Pulmonary Disease

CLINICAL PATHWAY. Acute Medicine. Chronic Obstructive Pulmonary Disease CLINICAL PATHWAY Acute Medicine Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Table of Contents (tap to jump to page) INTRODUCTION 1 Scope of this Pathway 1 Pathway Contacts

More information

THORACIC SURGERY CHECKLIST Please review this checklist prior to surgery

THORACIC SURGERY CHECKLIST Please review this checklist prior to surgery THORACIC SURGERY CHECKLIST Please review this checklist prior to surgery Clearance: Prior to surgery you will need surgical clearance from your Primary Care Physician and/ or Cardiologist, if recommended.

More information

1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 26 Caring for Clients with Coronary Heart Disease and Dysrhythmias Coronary Heart Disease (CHD) Leading

More information

Apical Bullectomy Surgery

Apical Bullectomy Surgery Apical Bullectomy Surgery UHN Information for patients and families Read this booklet to learn: how to prepare for your surgery what to expect while in hospital what to expect after you return home who

More information

SUMMARY. Research hypotheses:

SUMMARY. Research hypotheses: SUMMARY Nephrotic syndrome is one of the most, chronic kidney disease in Egypt. The estimated incidence of nephrotric syndrome ranges between 2-7 childhood cases per 100,000 children per year. Childhood

More information

Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms. Module 4

Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms. Module 4 Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms Module 4 Taking Charge of HEART FAILURE Contents Important Information 3 Taking Charge of Heart Failure 4 Following Your Treatment

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE

More information

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1)

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1) Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department with suspected stroke or transient ischemic attack must have an immediate clinical evaluation

More information

ADULT ASTHMA GUIDE SUMMARY. This summary provides busy health professionals with key guidance for assessing and treating adult asthma.

ADULT ASTHMA GUIDE SUMMARY. This summary provides busy health professionals with key guidance for assessing and treating adult asthma. ADULT ASTHMA GUIDE SUMMARY This summary provides busy health professionals with key guidance for assessing and treating adult asthma. Its source document Asthma and Respiratory Foundation NZ Adult Asthma

More information

Interprofessional Scenario #4. Scenario Description

Interprofessional Scenario #4. Scenario Description Interprofessional Scenario #4 Scenario Description John Sim is a 40 year old post op patient who was presented in emergency three days ago with nausea, vomiting and severe abdominal pain. Mr Sim was admitted

More information

Educational Goals and Objectives for Rotations on: Cardio Inpatient

Educational Goals and Objectives for Rotations on: Cardio Inpatient Educational Goals and Objectives for Rotations on: Cardio Inpatient Residents will rotate through cardiology inpatient rotations to: Develop skills to evaluate and manage patients with diseases of the

More information

Varicose Vein Surgery. Varicose Vein Surgery

Varicose Vein Surgery. Varicose Vein Surgery What Are Varicose Veins? Varicose veins are veins under the skin of the legs which have become widened, bulging and twisted. They are very common and do not cause medical problems in most people. Normally

More information

Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan

Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital

More information

What to expect when having a pacemaker implantation

What to expect when having a pacemaker implantation What to expect when having a pacemaker implantation Cardiology Department Patient information leaflet What is a pacemaker? A pacemaker is a small metal device which contains an electronic circuit and a

More information

Treating your abdominal aortic aneurysm by open repair (surgery)

Treating your abdominal aortic aneurysm by open repair (surgery) Patient information Abdominal aortic aneurysm open surgery Treating your abdominal aortic aneurysm by open repair (surgery) Introduction This leaflet tells you about open repair of abdominal aortic aneurysm,

More information

Appendix 2017UEMS031

Appendix 2017UEMS031 Appendix 2017UEMS031 PREVENTION Clinical checklist This checklist should be completed for each person with dementia. Keep this chart with the person s corresponding paperwork. General symptoms Include

More information

Medical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011

Medical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College

More information

POST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT

POST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS

More information

Managing Exacerbations of COPD (Version 3.0)

Managing Exacerbations of COPD (Version 3.0) Managing Exacerbations of COPD (Version 3.0) Guideline Readership This guideline is intended for use in patients with a confirmed diagnosis of a chronic obstructive pulmonary disease (COPD) exacerbation.

More information

Our Commitment to Quality and Patient Safety Core Measures

Our Commitment to Quality and Patient Safety Core Measures Calvert Memorial Hospital is committed to our community, with a focus on patient-centered care. High quality and safe patient care is not our goal, it is our priority. That means delivering the best possible

More information