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ACS Clinical Pathway. Who?. Pts with Acute Ischemic Heart Disease now described as having ACS. ACS - Definition. Umbrella term, encompasses the full spectrum of disease manifestations associated with ischemic heart disease: Unstable angina Non ST segment elevation MI

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  • Pts with Acute Ischemic Heart Disease now described as having ACS
acs definition
ACS - Definition
  • Umbrella term, encompasses the full spectrum of disease manifestations associated with ischemic heart disease:
          • Unstable angina
          • Non ST segment elevation MI
          • ST segment elevation MI
acs definition4
ACS - Definition
  • More accurately reflects the diagnostic uncertainty that exists on presentation to hospital
  • Emphasizes urgent nature of problem & its location
  • Provides a starting point for a series of decisions providing rapid determination of the optimal treatment and dx
acs clinical pathway5
ACS Clinical Pathway
  • Designed to provide optimal patient care for this group of patients
using the pathway
Using the Pathway
  • Replace the Acute MI pathway
  • Based on 2002 ACC/AHA Clinical Guidelines for UA, NSTEMI & STEMI
  • Goal: provide best practice for pts
  • Consults
  • Tests
  • Assessments/Treatments
  • Mobility/Safety
  • Nutrition
  • Psychosocial support
  • Pt Education
  • Discharge Planning
  • (Medications are not listed on the pathway…will be written in medical orders…refer to standard orders sheet)
using the pathway8
Using the Pathway
  • ACS Clinical Pathway documentation includes:
      • Physician Pre-Printed Order Sheets
      • Clinical Pathway
      • Patient/Family Information
      • Case History
      • Clinical Flow Sheet/part of documentation
      • Patient Discharge Information ACS
forms available
Forms Available
  • ACS Pathway
  • Pt Information Sheet
  • GAP Tool
  • Orders (admission, CCU, levels, Cath, PCI, transfer to levels)
  • Protocols Chest Pain (CCU, levels), O2 protocol
  • Flow Sheet
using the pathway10
Using the Pathway
  • On admission to HI all patients will start the clinical pathway
  • Start on the day of admission column
  • Includes all pts transferred from other hospitals
  • Ensures that all tests, consults and assessments will be done
using the pathway11
Using the Pathway
  • The physician orders should indicate pt is ordered on the ACS clinical pathway
using the pathway12
Using the Pathway
  • Charting by exception
  • Only deviations to the plan are charted
  • Initial & time where indicated…assumed that standards of care have been met and provided unless otherwise indicated
using the pathway13
Using the Pathway
  • When documenting on the pathway, it is not necessary to document findings elsewhere in the chart
using the pathway14
Using the Pathway
  • Consists of 4 days
  • If pt stay is >4 days, Day 4 may be repeated
  • Intervention day is to be used when pts go for cath/PCI
using the pathway15
Using the Pathway
  • Dates are entered on top of the pathway to indicate Day 1, Day2, etc…
  • Communicate to next shift by circling undone/incomplete care & putting an arrow to the next day
using the pathway16
Using the Pathway
  • Problem list completion required with the use of the pathway
  • Reminder on pathway to complete the initiation/review/update of the problem list
using the pathway17
Using the Pathway
  • Assessment of variance is done on outcome section of pathway
  • Pt progress and variances are documented on the pathway, nurse’s notes and medical notes
using the pathway18
Using the Pathway
  • Interdisciplinary team in consultation with attending physician will determine if a specific pt care would be better managed off the pathway
  • A physician’s order is required to discontinue the pathway
  • Previous system of documentation resume when a patient is taken off the pathway
using the pathway19
Using the Pathway
  • Staff are required to sign at the end of each shift in the RN signature box on pathway
  • Info that needs to be documented, not found on pathway, entered in nurse’s progress notes
using the pathway20
Using the Pathway
  • Discharge day must be completed, documenting that pt has script, d/c letter, teaching and any other plans
  • GAP tool will indicate the meds the pt will take on discharge
using the pathway21
Using the Pathway
  • On discharge ALL ACS pts will have the Patient Discharge Information ACS completed and signed by BOTH the nurse and the patient.