1. WHAT YOU NEED TO KNOW ABOUT 8 NORTH Orientation to Cardiology

2. Overview Floor Layout Who is on the Cardiology Floor Process  AMOR  Medication Reconciliation  Assessment  Drug Therapy Problems  Care Plan  Follow-Up  Pharmacy Suggestion  Documentation Common Conditions

3. Floor Layout North Side Hallway (rooms: 00 - 32) South Side Hallway (rooms: 34 - 53) stairs elevators service elevators patient lounge reception patient charts (AM) charge nurses fish bowl PCI room

4. Who is on the Cardiology Floor Charge Nurse x 2 Nurses PSWs Doctors (Surgeons, Specialists, Hospitalists, Family Doctors) Social Worker Rehabilitation Services (OT & PT) Dietician etc.

5. Process: AMOR AMOR: Admission Medication Order Record Patient are usually admitted to Cardiology with a completed AMOR  Can be completed using:  patient/caregiver verbal list  patient’s medication vials, blister packs, prescription receipts, etc.  long-term care medication administration record  patient transfer record  pharmacy list  Not always an accurate representation of patient’s medications

6. Process: AMOR

7. Process: Medication Reconciliation Obtain Medication List from Community Pharmacy  Check if pharmacy name listed on AMOR  If yes, check patient chart  If no, ask patient  If required, call pharmacy to obtain medication list  Be sure to have: Patient’s name & DOB Cardiology fax number Review Pharmacy List in comparison to AMOR (if available) Read ‘Notes’ and ‘Other Reports’ to obtain information regarding the visit, patient history, etc. in MEDITECH Discuss home medications with the patient

8. Process: Medication Reconciliation Complete Pharmacy Communication as Process Immediately  If medication requires clarification to AMOR  e.g., wrong dose, wrong frequency  If patient not taking medication listed on AMOR  e.g., patient not taking at home, has not filled in some time

9. Process: Medication Reconciliation Complete Pharmacy Communication for Physician Review  If medication missing from AMOR  e.g., on community pharmacy list, additional vitamins & supplements

10. Process: Assessment Assess patient’s medical history and reason for visit  Are all patient conditions being managed with drug therapy?  Is the patient receiving evidence-based medications?  Indicated, Safe, Effective, Convenient/Able to Adhere  Post-MI: ASA, Clopidogrel, Beta-blocker, ACE inhibitor, Statin  Atrial Fibrillation: CHADS2 & HAS-BLED risk scores  If not receiving all evidence-based medications  Is there a reason the medication may not be indicated for this patient? assess kidney function, blood pressure, heart rate, hemoglobin  Evaluate available options for drug therapy in the context of this patient

11. Process: Drug Therapy Problems Identify Drug Therapy Problems  drug not indicated  dose too high  dose too low  ineffective drug therapy  adverse drug reaction  additional drug therapy required  patient non-adherence

12. Process: Care Plan Determine what actions should be taken to resolve the Drug Therapy Problem  e.g., Initiate, Discontinue, Change dose Consider the timing of the intervention  When is it appropriate to make these changes?  e.g., now, after a procedure, when blood pressure stabilizes  Has the MRP rounded on the patient yet? (many round in the AM)

13. Process: Follow-Up Determine what follow-up is necessary for the patient and the medications  e.g., Blood sugar, Kidney function, Hemoglobin, Side effects Decide on the frequency of follow-up /when to follow-up next  e.g., Daily, In two days, Weekly

14. Process: Pharmacy Suggestion If the plan is indicated at this time  Write a Pharmacy Suggestion on a Pharmacy Communication form  for Physician Review  Include reasoning behind suggestion, appropriate dose, route & frequency Bring all Pharmacy Suggestions to the attention of the charge nurse responsible for the patient Attach the Pharmacy Communication form to the front of the chart The MRP will review the Pharmacy Suggestion & if agrees will sign the Pharmacy Communication form  Otherwise the MRP may write a different order or therapy may remain unchanged

15. Process: Documentation Be sure to document this process as an ‘Intervention’ in the patient’s file on MEDITECH  Pharmacy > Pharmacist Desktop > My List > Add  Interventions > Patient > Enter Type: OTH – other o Medication reconciliation o Hyperglycemia TPS – TPA/Streptokinase o Warfarin/Coumadin Status: A – active C – complete

16. Process: Documentation Once the General Information is filled in click ‘Text’ Be sure to include the date & your initials  e.g., JUL8: Medication reconciliation complete as per the patient and Shoppers Drug Mart Long Lake Road (705-522-3030). The patient was admitted with… history of… … -SB

17. Common Conditions Hypertension Acute Coronary Syndromes (ACS)  Unstable Angina/Non-ST Segment Elevation Myocardial Infarction (UA/NSTEMI)  ST Segment Elevation Myocardial Infarction (STEMI)  Post-MI Congestive Heart Failure (CHF) Atrial Fibrillation Diabetes & Stress Hyperglycemia COPD Exacerbations Infections

18. Enjoy Cardiology