ACS Clinical Pathway

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ACS Clinical Pathway
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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 pathwaywill
  be written in medical ordersrefer 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 indicatedassumed 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 gt4 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, nurses 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 physicians 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 nurses 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.

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• GOOD LUCK!