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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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Who?

  • Pts with Acute Ischemic Heart Disease now described as having ACS


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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


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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


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ACS Clinical Pathway

  • Designed to provide optimal patient care for this group of patients


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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


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Components

  • 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)


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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


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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


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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


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Using the Pathway

  • The physician orders should indicate pt is ordered on the ACS clinical pathway


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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


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Using the Pathway

  • When documenting on the pathway, it is not necessary to document findings elsewhere in the chart


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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


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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


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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


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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


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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


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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


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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


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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.