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Developing the Nurse Coordinator Role. Disclosure Statement of Financial Interest I, Janine Carlson, DO NOT have any financial disclosures.

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Presentation on theme: "Developing the Nurse Coordinator Role. Disclosure Statement of Financial Interest I, Janine Carlson, DO NOT have any financial disclosures."— Presentation transcript:

1 Developing the Nurse Coordinator Role

2 Disclosure Statement of Financial Interest I, Janine Carlson, DO NOT have any financial disclosures.

3 TAVR Nurse Coordinator To facilitate seamless care from referral through follow up Primary Goal of the Role:

4 TAVR Nurse Coordinator Challenges in Development of the Role: Collaboration Coordination Continuity

5 Interventional cardiologists, CT surgeons Referring physician Hybrid OR staff CCU and cardiology floor nursing OT and PT Schedulers and authorizations Clinic staff Diagnostics labs staff Nurse Coordinator Echocardiographer Anesthesia Administration

6 Coordination of Patient Flow ReferralPatient ContactDiagnostic WorkupClinic visitAdditional Diagnostic TestsSchedulingPeri-ProcedurePost-Procedure

7 Referral Be Accessible Be Accessible Manage Expectations Manage Expectations Gather prior patient medical records Gather prior patient medical records Appropriateness of referral Appropriateness of referral Timelines Timelines Confirm a plan Confirm a plan Follow Up Follow Up AVA < 1.0 cm 2 Mean gradient > 40 mm Hg Or Jet velocity > 4 m/sec AVA < 1.0 cm 2 Mean gradient > 40 mm Hg Or Jet velocity > 4 m/sec

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9 Patient Contact Establish contact and build rapport Establish contact and build rapport Explain to the patient that they may be a TAVR candidate but further workup is required Explain to the patient that they may be a TAVR candidate but further workup is required Answer questions and dispel myths Answer questions and dispel myths Review timeline: manage unrealistic expectation Review timeline: manage unrealistic expectation Respect patient and family preferences Respect patient and family preferences Provide written information Provide written information

10 Diagnostic Workup Determine which screening tests need to be completed Determine which screening tests need to be completed Help coordinate insurance authorizations Help coordinate insurance authorizations Scheduling Scheduling Assist patient with navigating the institutions departments Assist patient with navigating the institutions departments

11 Pre-clinic Diagnostic Testing Transthoracic echocardiogram Transthoracic echocardiogram CT structural heart and CTA of abdomen and pelvis CT structural heart and CTA of abdomen and pelvis Minimum of spirometry with ABGs, full PFTs if underlying pulmonary disease Minimum of spirometry with ABGs, full PFTs if underlying pulmonary disease Lab work if none current Lab work if none current

12 Annotated Iliac CTA

13 Clinic Visit Perform frailty assessments Perform frailty assessments Facilitate a team approach…

14 Frailty Assessments 5 M W ALK T EST Exclusions (circle all that apply): o Clinically unstable o Severe neuropsychiatric impairment Non-ambulatory. If checked, specify reason: _____________________________________ Utilized walking aid? Yes / No FiveMWalk 1: __________ s/5m FiveMWalk 2: __________ s/5m FiveMWalk 3: __________ s/5m FiveMWalk AVG: ___________ s/5m Gait speed (circle one) Normal (avg 6 s/5m) Slow (avg > 6 s/5m) NOTES:_______________________________________ _____________________________________________ Activities of Daily Living /6 as per Katz Index (YES = 1, No = 0) Independent: Bathing: Yes No Dressing: Yes No Toileting: Yes No Transferring: Yes No Continence: Yes No Feeding: Yes No Total Score:_______/6 as per Katz Index

15 Clinic Visit Perform frailty assessments Perform frailty assessments Review diagnostic studies Review diagnostic studies Facilitate a team approach…

16 Clinic Workstation

17 Clinic Visit Perform frailty assessments Perform frailty assessments Review diagnostic studies Review diagnostic studies Determine operability vs. inoperability Determine operability vs. inoperability Make clinical decisions and treatment plans Make clinical decisions and treatment plans Patient and family education Patient and family education Send the patient home with a clear plan Send the patient home with a clear plan Follow up with the referring provider Follow up with the referring provider Facilitate a team approach…

18 Additional Diagnostic Tests Schedule cardiac cath with possible PCI or BAV Schedule cardiac cath with possible PCI or BAV Schedule TEE Schedule TEE As determined to be necessary in clinic visit…

19 Valve Sizing Valve Size to Annulus Diameter 23 mm or 26 mm valve The Edwards SAPIEN transcatheter heart valve accommodates an annular size range of 18 mm to 25 mm

20 Scheduling Upload all screening imaging to ValvePoint for manufacturer review Upload all screening imaging to ValvePoint for manufacturer review Notify out-patient cath coordinator, all physicians, admin assistants and supervisors Notify out-patient cath coordinator, all physicians, admin assistants and supervisors Notify valve company for clinical support during the case Notify valve company for clinical support during the case

21 Peri-Procedure Discuss what to expect Discuss what to expect Review advanced directives and code status Review advanced directives and code status Bright pink - REFUSES conversion Bright pink - REFUSES conversion Bright green - AGREES to conversion Bright green - AGREES to conversion Bright yellow - AGREES to emergency vascular repair Bright yellow - AGREES to emergency vascular repair Collect data for TVT Registry Collect data for TVT Registry Keep family up to date Keep family up to date Post-op daily rounding Post-op daily rounding

22 Post Procedure Set realistic expectations about recovery Symptoms Symptoms Quality of Life Quality of Life Functional status Functional status Meds Meds Resume care with primary cardiologist Resume care with primary cardiologist Weekly phone follow up until stable Weekly phone follow up until stable One month valve clinic follow up One month valve clinic follow up Follow up with referring physician

23 UC Davis TAVR Team

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25 Thank you Unity is strength…when there is teamwork and collaboration, wonderful things can be achieved. -Mattie Stepanek


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