1. NSTEMI Pathway Education for Nurses

2. Objectives Demonstrate an understanding of the NSTEMI clinical pathway. Understand the importance of early and consistent education throughout hospital stay. Demonstrate the knowledge of the educational material and where to access the material. Understand the discharge criteria including follow-up appointment and supply of medications for home.

3. What is the NSTEMI Pathway An evidence based, streamlined approach to NSTEMI patient management starting when a patient enters the system through the ED and continues to post discharge. The focus is on early treatment and diagnosis including: troponins, medications, interventions if necessary, and focused education. Each patient that meets the criteria for an NSTEMI will be placed on the clinical pathway through the acute admission. The Cardio Chest Pain/ MI Admission Power Plan MD 5712 has been optimized to support the pathway roll out. – Pathway NSTEMI will be checked on the order set. It will also appear in the problem list in power chart. The orders and educational materials for these patients are standardized.

4. Cardio Chest Pain/MI Admission Power Plan MD 5712 Revisions

5. What is my role as the nurse in this pathway? Early and consistent education! Patient advisors made it clear: – Too much information is provided in a short period of time – Patients need time to understand and accept the diagnosis of a heart attack – Major lifestyle changes are hard to comprehend in the acute hospital stay – Patients want to know the essentials to keep them safe upon discharge Focus is on providing the essentials of diagnosis, procedures, medications, and follow up with secondary prevention. Cardiac rehab will reinforce lifestyle changes such as: – Weight loss – Dietary Changes – Smoking Cessation – Lifestyle Modifications

6. NSTEMI Clinical Pathway

7. What is my role as the nurse in this pathway? You will know if your patient is on the NSTEMI pathway by: – Checking off the order to place the patient on the pathway – Checking the Problems/Diagnosis List – Checking the Non-categorized orders for NSTEMI pathway Provide the education listed under Psychosocial Support/Education on the NSTEMI Clinical Pathway Form for each day. Document the education you provide as well as the patient comprehension of the teaching on the back of the Supplemental Plan of Care-Ineffective Tissue Perfusion Cardiopulmonary Percutaneous Intervention. Eventually this flowsheet will be available in I-View. Partner with Pharmacy and Case Management to obtain new AMI medications prior to discharge where applicable.

8. NSTEMI Pathway Education Tip Sheet

9. Discharge Criteria Patient verbalizes an understanding of: – Symptoms of a heart attack – When to call a physician – When to call 911 – Medication regimen and able to teach back Has a scheduled appointment with Cardiologist/NP within 7 days – Call the Cardiologist’s office to schedule an appointment if not already done. Input the appointment into the discharge paperwork through Depart.

10. Discharge Criteria-Adding an Appointment to Discharge through Depart

13. Discharging with Medications If the patient chooses to use CCHS’s pharmacy: – RN sends Pharmacy Discharge Program Form (“Purple Sheet”) to Pharmacy – RN Confirms meds are ready for pick up at pharmacy Patient can have family member obtain meds from pharmacy OR Upon discharge, RN can direct escort to take patient to pharmacy for med pick up If the patient wishes to use their own pharmacy or CCHS pharmacy is closed: – Case Management and RN should partner to ensure scripts are sent to pharmacy and patient can bridge the gap between discharge and prescription pick up. – Inpatient pharmacy is able to bridge medications with a physician’s order.

14. NSTEMI Pathway Discharge Medication Workflow

16. Thank you! The pathways will help us to streamline and provide consistent, patient focused care to a critical patient population. – It will promote efficient use of resources that reduces unnecessary variation and costs of care. – It maximizes the value of care and treatment by formally integrating best practices and evidence based guidelines to support team based care delivery. We will continue to learn and adapt the pathways as needed to support continual process improvements. Your feedback is welcome!