Integrated Review For Post Percutaneous Coronary Intervention

It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P., a 60-

In their study, they found many factors that contribute to participation and some that, surprisingly, did not play a role. The researchers followed 266 patients who underwent coronary artery bypass graft (CABG) or left heart valve surgery. One third of the patients who were referred never began the program initially. Of those who began the program, 40% did not complete the CR; this rate is comparable to other findings. One of the primary reasons for elective discharge was being overweight. Overweight patients were almost twice as likely to not complete the program. Additionally it was found that patients who did not complete the CR were more likely to be prescribed antidepressant medications. This, however, may not be due entirely to a lack of completion as the rate of post-CABG depression is 20%. Lastly, being single is a risk factor for poor attendance. The same study also outlined a number of factors that did not end up affecting participation. Age was found to be negligible for completion, as well as differences between males and females. Additionally, being a smoker did not have an effect in completing the program. Furthermore, it was found that patients who underwent major surgery, such as CABG, were actually more likely to participate in programs compared to those who underwent minimally or non-invasive procedures. Patients who do not participate in

We live in the wealthiest nation in the history of the world and practice our profession in an era of unprecedented technological capability. In cardiovascular medicine, we can diagnose and treat heart disease with innovative approaches unimaginable to the previous generation of physicians. However, as a wealthy nation with a technologically advanced health care system, history will judge us not by our scientific progress, but by how we treat the weakest and most vulnerable amongst us. By this critical measure of

Today, I split my time shadowing between Dr. Qaiser Shafiq, a non-invasive cardiologist, and Dr. Ehab Eltahaway, an interventional cardiologist, both of the University of Toledo Medical Center. I shadowed Dr. Shafiq at the inpatient care center. Inpatients are patients that are admitted and stay at a hospital until discharged. Dr. Shafiq was "rounding" - checking on patients that aren't his but making sure they are healthy. I saw four patients with Dr. Shafiq, although none of them were very significant, other than asking questions about how they were and if they had any concerns. Interventional cardiology is a catheter based treatment. Doctors use a CAT scan to look at the heart and blood vessels. Dr. Eltahawy's patient was healthy, until they found a blood vessel lesion.

Many organizations have developed practice guidelines for a myriad of clinical scenarios which include the use of specific drugs or classes of medications, typically in a step-wise pattern. These “Best Practice” guidelines are built on evidence based criteria and systematic reviews. It has been shown that these clinical guidelines, with their list of essential medications, improve the quality of care and lead to better outcomes, but have not been shown to reduce costs.4,5 The practice of medicine has moved dramatically towards the use of these guidelines in recent years. For example, best practices for diabetic care recommends that all patients be placed on an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) for prevention of diabetic nephropathy and a statin for prevention of coronary artery disease. However, each patient’s insurance may cover a different medication in this class

Every year, up to 249,000 BSIs occur within hospitals in the US. Apparently, 32.2% of these BSIs do occur in the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013)The apparent bias in prevalence of BSIs within the ICUs is associated with the increased utilization of the CVCs within these units since they deal with a majority of critical care situations.

Risk factors for RSIs are greater with varying situations and barriers which often lead to inaccurate counts. Because RSIs can lead to death, the Institute of Medicine produced a report in 1999 that was an "ethical call to arms" for "never" events (Stawicki S. P. et al, 2013). At this time the institute challenged all facilities to establish safety guidelines to help minimize complications that were deemed preventable (Stawicki S. P. et al, 2013). RSIs were at the top of the list for risk.

The purpose of this paper is to discuss a new best practice, the necessary steps for implementing the new practice, and support this change in practice with current literature. Heart disease is the leading cause of death in the United States. Evidence-based clinical practice guidelines regarding patients with ST-segment elevation myocardial infarction (STEMI) seek to reduce variation in practice and improve outcomes for this patient population (O 'Gara et al., 2013). Current evidence-based practice includes immediate reperfusion therapy to the involved coronary artery in this patient population. However, it is often challenging for emergency department nurses to implement the initial steps of this evidence-based practice, which includes obtaining a 12-lead electrocardiogram within ten minutes of arrival, as some patients present with symptoms other than chest pain, or atypical symptoms. For instance, atypical presentations include shortness of breath, altered mental status, upper extremity pain, upper back pain, generalized weakness, and abdominal pain (Glickman et al., 2012). Ultimately, this results in delays of reperfusion therapy.

Some lifestyle-related conditions and decisions increase the likelihood of a person having heart disease. Some examples are diabetes, overweight and obesity, poor diet, lack of physical activity and excessive consumption of alcohol. High blood pressure, low-density lipoprotein (BAD) cholesterol, and smoking are key risk factors for heart disease. LBD is considered to be "bad" cholesterol because having high levels can lead to accumulation in the arteries, which can cause heart disease and stroke. If you lower your blood pressure and cholesterol, and if you do not smoke, you will reduce your chances of having heart disease. Now, in case of emergency, angioplasty which is the best treatment needs to get done. In this case we need to kake in consideration that not all hospitals are capable to made the process, so we need to be aware of our options. After the angioplasty you should take a daily medication, which will help your heart adapt to the implanted stents and they will not close again, a phenomenon known as restenosis, his medication should not be forgotten any day in order to minimize future

Because SSI rates for healthcare facilities are made public, patients are able to gain knowledge of how well their facility SSI prevention practices work. “It is moving fast and furiously because consumers are pleased with the progress that has been made in reducing central line infections,” says Linda Greene, MPS, RN, CIC, director, infection prevention, Rochester General Health System, Rochester, New York. The public now expects the same transparency for SSIs” (Patterson, P., 2011) .Facilities that participate in Medicare must report their SSI for certain procedures; the list of procedures to report continues to grow as patients’ demand for listed procedures grow. ” SSI data will be reported through the National Healthcare Safety Network (NHSN) managed by the Centers for Disease Control and Prevention (CDC), a secure, web-based surveillance system for reporting data on infections and other events. The data can then be used for analysis, facility comparisons, and quality improvement.” (Patterson, P., 2011) Hospitals will, and should, continuously search for new ways to increase their quality of care. Having a great overall rating for a low number of incidences of SSIs can only boost their ratings.

Since its inception, The American Heart Association has conducted several events and has taken several successful initiatives to educate the public and healthcare professionals towards raising awareness regarding health issues and risk factors. The organization has further conducted several events to educate healthcare professionals regarding best practices in healthcare as well. An example of this is the Spotlight Series conducted by the AHA. This series, working since 2008, entails free and case-centric presentations with an objective of enlightening healthcare providers regarding evidence-based practices. The audience for these presentations consisted of physicians, interns, “cardiologists”, “pharmacists”, “nurses”, etc., who work closely

This paper will address ‘door to electrocardiogram’ times for acute coronary syndrome patients presenting to the emergency department, utilizing quality improvement competencies created by the Quality and Safety Education for Nurses Institute (2014) to improve patient care. The American College of Cardiology supports quality improvement by developing national registries and clinical practice guidelines. An analysis of my organization’s ‘door to electrocardiogram’ data from January 2014 to June 2016, identifies an opportunity to implement process improvements. Following a discussion of the data regarding this measure, I will discuss the implementation of a process change, a second solution to address the issue, and the valuable lessons learned while conducting this process improvement project.

For the hospital, there is a lower risk than the reference population. The indicator measures in-hospital deaths per every 1000 hospital discharges with a principal diagnosis of acute myocardial infarction for patients above 18 year of age. This measure excludes all obstetric discharges and any transfers to other hospitals. The numerator is the number of deaths and the denominator is the number of discharges with a ICD-9 code for AMI.

An extensive study conducted in 2006 by a team of medical researchers sought to establish predictors of vascular complications for patients who have undergone diagnostic cardiac catheterization (CC) and/or percutaneous coronary intervention (PCI). Noting that The American College of Cardiology has set a benchmark rate for vascular complications of "no more than 1% for diagnostic CC and 3% for PCI," the purpose of the study was "to provide baseline data on the number and type of vascular complications post CC and PCI experienced at this institution and the significance of risk predictors for these complications" (Dumont et al., 2006). By utilizing a "retrospective, descriptive, and correlational study of 11,119 patients who underwent CC and/or PCI, with femoral artery access, in the years 2001 to 2003" (Dumont et al., 2006), the researchers concluded that an increased risk for vascular complications applied to female patients over the age of 70, who have a history of renal failure and underwent a PCI procedure.

As previously mentioned, cardiovascular disease has developed to become the major cause of deaths across the world. A cohort study and evidence-based management study was developed to identify the major causes of the disease, analyze key steps, including current medications used to address the disease, and identify ways for mitigating is proliferation. The study was based