CCCN Abstracts S415

NP010PROCESS IMPROVEMENT: A MULTI-DISCIPLINARY APPROACHTO ADVANCE PATIENT CARE

V Rioux, S Reid

AHS/Mazankowski Alberta Heart Institute, Edmonton, AB

Establishing processes and standards of practice has proven tobe an effective method to elevate overall patient experience.The Canadian Cardiovascular Association has identified thathaving an efficient wait list is an indispensable element ofa functional health care system.With the ultimate goal of rising above the Canadian standard,a multidisciplinary Arrhythmia Services Team at the Mazan-kowski Alberta Heart Institute was established to look foropportunities and implement solutions. The key concernswere: a long wait list, disorganized work flow, lack of teamengagement and inadequate quality assurance.Through various Plan, Do, Study, Act (PDSA) cycles the teamimplemented a number of solutions. They revised procedurerequisitions challenging current wait time standards with welldefined patient priorities. Through following the patient'sjourney improvements were realized including standardizedequipment packs, case mix, redefining operating hours anddefined consent and start times. Most importantly, a standardof work was established providing the patient with an elevatedlevel of care.Since this work has begun the team has been able to decreaseinpatient urgent wait times from 7 days to 3 days. Thescheduled outpatient wait time has also seen a significantdecrease from 41 weeks to 16 weeks. Over a 2 year course, thepatient waiting list went from 256 patients in September 2010to 141 as of February 2013.By working in a collaborative environment the team was ableto decrease care delay and thereby improve patient safety andsatisfaction. The focal point is now to continue improving thequality of care delivered.

NP011CREATING A NEW CARE DELIVERY SYSTEM FORPATIENTS NEEDING AN IMPLANTABLE CARDIAC ELECTRICALDEVICE (ICED)

J Werry, J Reimer-Kent, S Lochan, D Di Lella, T Barra-Navratil,M Downey, L Boothby, S Karim, J Bonet, J LeMaitre

Fraser Health, Cardiac Services, Coquitlam, BC

A new care delivery system was developed to address thegrowing demand for timely access by both in-patients andout-patients for implantable cardiac electrical device (ICED)therapy. The need for change was based on the fact that theservice delivery model and clinical care model were non-standardized and fragmented. The situation was furtherexacerbated by budget and operational constraints such aslack of allocated operating room time, a shortage of

anesthesiologists, and difficulties transporting in-patients fromreferring sites to implanting sites within a large geographicalhealth authority.This initiative brought together well over 300 healthcareproviders and key stakeholders from multiple programs invarious forums and committees to develop a regional stan-dardized and integrated ICED service.Through commitment, perseverance, and multi-programcollaboration a 4 site ICED service delivery model wasdownsized to 2 sites, anaesthesia assistants were introducedand utilized for non-complicated pacemaker procedures, andstandardized pre- and post-procedure clinical practice toolswere developed.A post-implementation evaluation of the integration andacceptance of this new ICED service delivery model andclinical practice tools is planned. The results will be used tosupport future enhancements in phase 2 that is beingcurrently developed.This presentation will provide an overview of the findingsfrom the environmental scan and gap analysis and the cross-Canada survey results on ICED practices; the projectmanagement strategies used within the initiative; the new caredelivery system will be outlined; and the evaluation plan willbe highlighted.

NP012EMANCIPATORY EDUCATION: A GRASSROOTS STRATEGY TOENHANCE PEER-TO-PEER LEARNING

K Hedges, A Himbeault

Interior Health, Kelowna, BC

Research has identified that the lived experience of practicingnurses is challenged by feelings of loss of control, devaluation,fragmentation, and frustration. Strategies to ameliorate theseissues are to mitigate staff fragmentation, establish cohesive-ness, and empower nurses in their own learning whilehonoring professional and personal diversity (Kagan, Smith,Cowling, & Chinn, 2009).The purpose of this presentation is to describe a practical,visual tool that captures the teaching and learning done by themultidisciplinary team on a daily basis, thereby promotingpeer-to-peer education and empowerment.In an urban teaching hospital a grassroots strategy to supportthe ongoing educational needs of the cardiac surgery intensivecare unit (CSICU) was developed. The project was supportedby the administration and education staff.A grassroots education wall was created in a shared space inthe CSICU. Each month a central topic relating to clinicalpractice was posted and staff were encouraged to post infor-mation relating to the topic, requiring a low time investmentfor participation. The end result was a visual representation ofknowledge, demonstrating each professional's contribution tothe team. The information gained will be used to develop

S416 Canadian Journal of CardiologyVolume 29 2013

education and orientation tools. Further investigation isneeded on how to encourage participation in order to makethis a genuine tool for staff nurse empowerment.Session participants will learn about an innovative approachto peer-to-peer multidisciplinary learning that enhancescommunication both within and amongst disciplines.

NP013ST. PAUL'S HOSPITAL HEART FUNCTION CLINIC PATHWAY: ANINTRODUCTION

N Esbak1, F Ranjbaran2, A Kaan1

1PHC, Vancouver, BC, 2VCH, Vancouver, BC

The heart function clinic (HFC) at St. Paul's Hospital is oneof Canada's largest heart failure services. Current literaturesupports the use of standardized pathways as an effectivemethod in improving consistent quality of care by identifyingand measuring patients’ improvements and outcomes. TheHFC pathway was launched in June 2011 with the hopes ofreducing unnecessary costs, facilitating timely discharges, andreducing wait lists. In this abstract we will discuss thecomponents of the pathway.The clinic pathway brought together referrals and informationrequired by cardiologists, nurses, nurse practitioners, andclerks. The standard track of the 9-month pathway containsall information with regards to the necessary investigations,self-management teaching, and optimization of heart failuretherapy for each individual patient. The pathway is dividedinto three phases. Phase one consists of patient enrolment andindividualized planning of patient care. Phase two containsinformation with regards to active treatment of patientsincluding education and optimization of heart failure medi-cations. Phase three involves a review of patients’ progressthroughout the 9-months period and examination of patient'ssuitability for discharge.The standardized pathway can be a useful tool in identi-fying patients who do not make the expected progressthereby allowing for appropriate interventions. Thispathway was implemented at the HFC with the hopes ofensuring quality and continuity of care for patients,decreasing documentation overlap for staff, and improvingoverall outcomes. A review of the pathway is warranted toassess the effectiveness in generating appropriate and timelydischarges.

NP014POST OPERATIVE DELIRIUM AND STERNAL DEHISCENCE INCARDIAC SURGERY: A RETROSPECTIVE STUDY

K Remo1,2, M Mackay2, R Rana2

1Providence Health, Vancouver, BC, 2SPH, Vancouver, BC

Post-operative delirium in the cardiac surgical population isassociated with rising incidence rates of sternal woundcomplications such as sternal dehiscence. A review of liter-ature shows sternal wound dehiscence heightens the risk ofsternal wound infection (0.3-8%), re-sternotomies,lengthens hospital stay and increases morbidity/mortality(10-40%). Determinants of delirium in this populationinclude age, co-morbidities, and prior incidence of cere-brovascular strokes.This three year retrospective study using chart review ina single-centre quaternary hospital, aims show causationbetween delirium and sternal dehiscence. The immediategoal of the study is to decrease the incidence rates ofsternal dehiscence by ensuring the early indicators ofdelirium are recognized, assessed and managed post-oper-atively.

NP015EVIDENCE BASED PRACTICE FOR REMOVAL OF CHESTTUBES

S Desrosiers1, R Dhir1, M Nicholas2

1St. Paul's Hospital, Vancouver, BC, 2Royal Columbian Hospital, NewWestminster, BC

All patients immediately post open heart surgery havemediastinal or pleural chest tubes. One of patient's worstand most painful memories has been that of having theirchest tubes removed; this then led to a practice changeseveral years ago of nurses removing chest tubes. In mostCardiac Surgery Intensive Care Units (CSICU) the criticalcare nurse is expected to remove chest tubes when specificcriteria have been met. There are three CSICU's in thelower mainland of BC. Each of these units has a specificand unique protocol as to how to do this procedure. Thequestion raised is why does every unit do this proceduredifferently?The unit specific protocols will be compared and contrasted,and then a literature review will be completed to assess forbest practice guidelines. This review will look at issues ofwhen to pull the chest tubes, how to pull them, if there aredifferences in insertion techniques that would alter removalstrategies, should it be one at a time or all at once, paincontrol issues and then post removal care such as dressingsand chest x-rays.The goal is to create an evidence based protocol for theremoval of chest tubes with the most optimal outcome thatcan be disseminated to the various CSICUs, and potentiallypublished. If the literature review does not provide adequateinformation it could lead to potential research around bestpractice guidelines for chest tube removal in the post-operativeperiod.