Steps For Implementing The New Practice

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters flittered around in my stomach, I had no idea what to expect. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

12 Lead Electrocardiogram (ECG) - There are typical changes to the normal pattern of the ECG in a heart attack. Patterns that occur include pathological Q waves and ST elevation (Koutoukidis, Stainton & Hughson 2013, p. 505). However, it is possible to have a normal ECG even if a patient has had a heart attack. The indicators for this test include: suspected myocardial infarction, suspected pulmonary embolism, perceived cardiac dysrhythmias, fainting or collapse, a third heart sound, fourth heart sound, a cardiac murmur or other findings to indicate structural heart disease. The

Evaluation is the final and often the most critical step in evidence based research and practice. Evaluation of evidence based practice follows a pathway beginning with the selection of the area for improvement, synthesizing the research into a process improvement activity and evaluating both the implementation of the process improvement as well and the outcomes of the intervention (Titler, 2008). To measure the results of process change in the management of heart failure patients a retrospective analysis will be conducted comparing the readmission rates of a pilot and control population over a 6-month period. The pilot population will be evaluated with the LACE index readmission risk assessment upon admission and subsequently receive the recommended interventions based on the risk stratification. In comparison, the control group will receive the current process of telephonic contact only. The pilot group will include patients over the age of 18 residing in zip-codes 45402 and 45403,

Early recognition of signs and symptoms and taking the right steps to identify, distinguish, and manage subtypes (STEMI and NSTEMI/UA) will improve Mr James outcomes (Bradley E.H., 2006)Recognizing the signs and symptoms such as chest pain or shortness of breath suggestive of an MI and obtaining an ECG as soon as possible (goal of less than 10 minutes following presentation of a patient) should be the standard of practice to manage this patient It has been demonstrated that reperfusion of the infarct-related artery in the very first hour (golden hour) of MI reduces mortality rates (Ayrik et al. 2006, Van de Werf et al. 2008). fact, every 30 minutes of delay time, the 1-year mortality risk increases by (DeLuca et al. 2004).According to triage and first assessment guidelines (Wrightet. al. 2011) Patients who complain of chest pain , pressure , tightness or heaviness require immediate assessment by the triage nurse and should be referred for further evaluation.

Patients experiencing chest pain require immediate assessment, including a twelve lead ECG within the time frame of ten minutes, will provide vital evidence of a cardiac, plueretic or musculoskeletal event (Acute Coronary Care Clinical care standards 2014).

Managed care organizations should develop an evaluation plan to examine the common vision developed by the partnering organizations and the priority SDOH identified. Establishing the evaluation plan at the outset is critical for: ensuring mutually agreed-upon baseline measures and benchmarks; the availability of data to assess identified goals and objectives; establishing milestone achievements; and creating timelines for interim and final evaluations. As the partnership progresses from program development to implementation, regularly evaluating these efforts is critical to ensure that the project stays on course to have its desired impact on SDOH. Evaluation metrics should be considered at all

I chose this team and this topic because I am a nurse who recently started working in a CCU. We take care of cardiac patients, and we have to closely monitor their heart rhythms. So, I would like to learn to better identify dysrhythmias, to improve competency assessments, and to better implement current evidence-based practices.

Compliance takes priority. Julie devised and maintains the emergency room physician log which lists the supervising physician for each day. The thorough charting and initial treatment plans exceed the requirements set by CMS. Physician chart reviews and reports are completed in a timely fashion. She researched the specific criteria for the newly determined coverage requirements for patients with congestive heart failure (CHF) whereby she initiated an easy-to- follow document for physicians to utilize for coverage criteria when a patient has a diagnosis of CHF. She seamlessly transitioned her program’s referrals from the ICD 9 codes to the ICD 10 diagnosis codes for pulmonary and cardiac rehabilitation this past year. In addition, she has the responsibility of tailoring all of the corporate policies and procedures to meet the needs of the program at Fannin Regional Hospital, as well as reviewing and revising these fifty-four policies annually.

Most the patients being seen at Bakersfield Heart Hospital has cardiovascular problems. We have groups of great physicians and by far one of the best physicians in Kern County. There are many instances of successful stories in prevention of stroke and the door-to-balloon minutes, and thus saves many lives. Our organization has same belief as the American Nurse Association code of ethics. “The Code of Ethics for Nurses was developed as guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession (ANA, n.d). Therefore, American Nurses Association and American Heart Association are the external method of dissemination of the propose evidence-based practices of bedside reporting. Bakersfield Heart Hospital’s mission is the same as the American Heart Association. These are as follows: the patient involvement in their hospital care, collection of the hospital’s stroke-treatment performance data, hospital team performance data and use of data to assess and continually improve quality of care for stroke patients. Therefore, these organizations should be notified and report any progress or changes of the bedside reporting. These organization may have some helpful tips or recommendations to better implementation of the bedside reporting. The communication strategies are to provide updates on the progress of the bedside reporting, power points that will include the data analysis of bedside reporting, and when possible, the organization can join the ANA team so that the success and articles of bedside reporting can be published or posted to the official website of the American Nurses Association and for others to utilize. Lastly, webinar meeting can be obtained so that these organizations are continuously being involved in the success of the bedside

Chest pain is a frequent cause of emergency department presentation. Many times, chest pain can be an indicator of myocardial infarction. Yearly, about 600,000 people die of heart disease in the United States, with a total of about 700,000 having a myocardial infarction. The leading source of death for both men and women is heart disease ("Heart disease facts," 2014). Managing the challenging clinical problems of those presenting with chest pain can be demanding. While clinical judgment is imperative in managing these patients, rapid treatment protocols to evaluate risk

Evidence-based practice is classically defined as the integration of best research evidence with clinical expertise to facilitate clinical decision making. I believe the phrase, “This is how we have always done it” has no place in patient care. Previously our best practices were based on evidence from incomplete or inconclusive research. Healthcare delivery in the critical care setting requires thoughtfulness and deliberate action. I learned this lesson during rounds as the AG-AGNP of the mixed medical/surgical ICU at Massachusetts General Hospital. While quickly reviewing the patient’s systems I mentioned the MAP goal of 65. The attending politely interrupted and asked why? My mind raced for an answer and I began to explain our goals for perfusion. While he assured me I was not incorrect, he helped provide insight on the risk of arbitrary values. I later developed a more thoughtful perfusion goal tailored to the individual patient.

This report acknowledges the current good practice strategies that are utilized by a support group, with an illustration of different concepts and theories that will support; social and personal values, attitudes and ideology related to health and social care. This good practice guide will explore the importance of understanding the legislations and how it influences those within the organisation. Jhay’s Support Group is a service for young people aged 16-25 who has a learning.

Providing care for post percutaneous coronary intervention (PCI) patients has evolved and the guidelines and protocols have been heavily influenced by research and evidence based practice (EBP). Unfortunately, coronary heart disease has become a major issue for the health status of Americans across the lifespan. According to the CDC, “About 610,000 people die of heart disease in the United States (U.S.) every year – that’s 1 in every 4 deaths.” In addition, treating coronary heart disease patients has negatively impacted the economic status of U.S. healthcare. Therefore, to manage

This study was completed to determine the effectiveness of the current guidelines for the treatment of a myocardial infarction. “Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI” is about the door-to-ballon time that has become a performance measure in the treatment of MI’s, the recommended door-to-ballon time is 90 minutes or less. This title clearly states what the article is about, the abstract is also broken down to include what is detailed in greater depth in the body of this article.

I improved application of professional knowledge during my preceptorship. I always remembered that the focus of my professional practice are my clients and their needs. I planned care with the patient and used best practices to recommend plan of care. I discussed the comfort and pain management with the client and recommended to adjust daily routine ,transfer and pain medication to minimize the patients discomfort. I used knowledge base to rule out possible causes of tachycardia such as drug interaction, anemia, unexpected blood flow changes, possible blood loss?. I assessed the patients for signs of weakness, dizziness and peripheral edema .I also measured the patients VS,Resp,LOC,Spo2.. I checked the patient’s history for cardiac issues,