Contemporary Treatment Options for Pulmonary Embolism

Purpose: Provide RNs education on the classifications of PEs and new catheter directed treatment options. Significance: PE remains a common and lethal entity PE is the 3rd leading cause of cardiovascular death in hospitalized patients (60,000-1000,000 per year) 150,000-250,000 PE related hospitalizations per year RNs must be knowledgeable of the classifications of PEs and catheter directed therapies to promote positive patient outcomes Prior to catheter directed therapies, submassive PEs had a mortality rate up to 20% at 3 months and were traditionally treated with IV heparin, or oral anticoagulant therapyhttps://digitalcommons.centracare.com/nursing_posters/1139/thumbnail.jp

Recognition of Nonconclusive Seizures in Patients After Cardiac Arrest Using

Background: Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest. Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring ordered STAT. Neurodiagnostic technologists who apply EEG monitoring are not available 24/7. Conclusions/Implications: While the rapid EEG recording may have limitations compared to continuous recordings for diagnostic purposes, it has immediate feedback for monitoring of nonconvulsive status epilepticus. Continuous EEG monitoring can take 45 minutes to set up and much longer to obtain diagnosis of status epilepticus. Continuous EEGs have broader diagnostic capabilities, however, are not monitored continuously by neurology providers, which could delay the identification of seizure activity. Recommendations: Continue immediate placement of rapid EEG if technologists are not available within one hour. Continue to replace rapid EEG with continuous EEG when technologist becomes available. Explore improved capabilities for more timely reading and diagnosis of continuous EEG.https://digitalcommons.centracare.com/nursing_posters/1159/thumbnail.jp

It\u27s Time to Break Old Habits: Admitting STEMIs to the Telemetry Unit

Beginning December 2020 uncomplicated ST-Elevated MI patients will be admitted directly to Telemetry following intervention instead of CICU. June 2020: Review and develop evidence- based exclusion criteria for admission to Telemetry June 2020: Create a process for communication between the nursing supervisor, cath lab, Telemetry Unit and CICU for patient placement Fall 2020: Meeting with Telemetry and CICU charge nurse, nursing supervisor and cath lab RN to discuss communication process Dec 2020: Begin tracking STEMI patients Unit admitted to (Telemetry or CICU/ICU) Requiring transfer to CICU/ICU from Telemetryhttps://digitalcommons.centracare.com/nursing_posters/1120/thumbnail.jp

Clinical Nurse Specialists: A Rare Breed

What is a CNS?: A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) with graduate level education in nursing. CNSs are prepared to provided leadership, consultation, and clinical expertise for patients and their families, nurses, and systems. Have the autonomy to diagnose and treat based on advanced clinical assessment like other APRNs (Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists). CNS work in all areas of healthcare like clinics, emergency departments, hospital units, entire healthcare systems, or even as independent practitioners/contractors.https://digitalcommons.centracare.com/nursing_posters/1152/thumbnail.jp

Improving Bedside ECG Monitoring in Telemetry

To improve accuracy of bedside ECG (EASI lead) monitoring through accurate placement of electrodes and proper skin preparation.https://digitalcommons.centracare.com/nursing_posters/1061/thumbnail.jp

Safe Intra-Hospital Transport of Adult Patients on Non-Critical care Units

Plan: Between 2021 and 2022, two non-critical adult patients returning from the imaging department after an invasive procedure developed increased oxygen needs, which ended in death for on patient and a transfer to critical care for the other. No formal guidelines exist for the intra-hospital transport by unlicensed personnel may be absent. An intra-hospital transport checklist was developed for non-critical care patients leaving the unit for procedures in the imaging department. Do: A RN Pre-Invasive Procedure Transport Safety Checklist was created by a telemetry RN (MSN student, Greta Titus) and CNS, Teresa Jahn The checklist was designed to answer questions to determine a patient\u27s hemodynamic and respiratory stability prior to transport by an unlicensed person The checklist is to be completed prior to transport on all patients leaving the unit for a procedure in the imaging department (i.e. paracentesis, thoracentesis, biopsy, etc.) If one of the questions answered is yes , the next step is to prompt a huddle with Resource RN or Charge RN to identify f a patient is safe for transport without a RN. The why for the change was presented by Greta Titus during the November 2022 CentraCare Heart and Vascular Center Clinical (CCHVC) Practice meeting Staff were also notified of this change during Telemetry daily huddles and weekly updates The trial started on Telemetry beginning 11/1/2022 Follow up on the progress of the practice change was presented by CCHVC CNS during Telemetry Education Days in January-February 2023https://digitalcommons.centracare.com/nursing_posters/1161/thumbnail.jp

Implementation of Proper Lead Selection Based on ECG Practice Standards in Hospitalized Patients

Ensure adult patients in a 36 bed Telemetry Unit and 14 bed Cardiac Intensive Care Unit (CICU) with the diagnosis of STEMI and NSTEMI are being monitored in the appropriate leads to detect acute or silent ischemia and arrhythmias.https://digitalcommons.centracare.com/nursing_posters/1109/thumbnail.jp

A Multidisciplinary Approach to Reduce Complications from Blind Small Bore Feeding Tube (SBFT) Insertion

Between 2019 and 2021, six lung perforations related to blind placement of SBFTs. A multidisciplinary team reviewed current methods of placing SBFTs and the feasibility of each: Fluoroscopy 2 Step X-Ray Capnography Electromagnetic visualization Capnography was selected as a safe and cost-effective way to attempt to identify insertion location in real time. Four team members were selected and trained to insert SBFT using capnography Each placement attempt and outcome of placement was tracked Outcomes were identified as successful or unsuccessful Any adverse events were to be trackedhttps://digitalcommons.centracare.com/nursing_posters/1122/thumbnail.jp

Clinical Research: Evaluation of Healing Touch\u27s Effect on Coronary Artery Bypass Grafting (CABG) Recovery, a Randomized Study

This study is assessing the efficacy of Healing Touch on patients receiving Coronary Artery Bypass Grafting at St. Cloud Hospital. A single previous research study determined Healing Touch, when added to standard nursing care, can significantly reduce anxiety and length of stay in patients undergoing CABG procedures.https://digitalcommons.centracare.com/nursing_posters/1087/thumbnail.jp

Beacon Journey: Improving Patient Outcomes: Reducing Adverse Drug Events Using an Inter-Professional Team Approach

Literature states that the use of sedation regimens that include routine reversal of benzodiazepines or narcotic agents are not recommded. An inter-professional team concurred that planned reversals would no longer be the standard of practice for patients post post-procedural sedation. An inter-professional team analyzed the use of reversal agents, reviewed literature related to sedation and analgesia by non-anesthesiologists, and proposed recommendations for practice changes.https://digitalcommons.centracare.com/nursing_posters/1056/thumbnail.jp