COFFS/ CLARENCE NETWORK

M.R.N.

NAME:

OTHER NAMES:

D.O.B. SEX: M / F

(Affix patient identification label)

SPECIMEN INITIAL REGISTER - ALL users of pathway to register

Initial Print Name Desig. Initial Print Name Desig.

Documentation of Clinical Pathways:

The Clinical Pathway is to remain with the patient’s observation/medication charts and is to be utilised in conjunction with the ward

rounds/ handover and case conferences.

ALWAYS ASSESS WHETHER AN INTERVENTION IS APPROPRIATE FOR THE INDIVIDUAL PATIENT.

THE CLINICAL PATH DOES NOT TAKE THE PLACE OF THE PHYSICIAN’S ORDER.

This Clinical Pathway is designed for use by a multidisciplinary team to plan patient care.

EMERGENCY DEPARTMENT TO WARD HANDOVER CHECKLIST

PRESENTING PROBLEMS: Admission time:

Cardiac Diagnosis: Thrombolysis time:

Cardiac history:

General History:

Risk factors: Diabetes Hypertension Obesity Heart Disease Respiratory Disease Family History Hyperlipidemia

Alcohol Smoking current / ceased when: □ Depression/ Anxiety □ Social Isolation

CURRENT INVESTIGATIONS: Estimated Weight:

Admission ECG: Chest X-Ray:

Troponin on admission:: Peak:

Angiogram: Date: LV LAD RCA Cx Other:

Interventional Cardiology: Primary – Procedure: BGL:

Sestamibi/ Thallium Scan: Exercise Stress Test::

ECHO: Other:

DRAFT

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Tick yes (Y) or no (N); or tick variance (V) on pathway AND complete variance form on last sheet of clinical pathway

ADMISSION TO CCU /HDU

OR AFTER 6 HOURS IN ED

Tick √

Correct box

DAY 2 Tick √

Correct box

DATE / / Y N V / / Y N V

Outcomes Confirm diagnosis

Haemo dynamically stable

Treatment discussed with patient

Patient pain free

Haemo dynamically stable

Treatment discussed with patient

Patient pain free

Assessments Cardiac monitor

Physical assessment

Vital signs Q2-4 hourly PRN

Circulation observation

Femoral site

Rhythm strips: once a shift (8th hourly)

Record incidence of chest pain

Cardiac monitor

Physical assessment

Vital signs Q-4 hourly PRN

Rhythm strips: once a shift (8th hourly)

Circulation observation

Femoral site

Medications Analgesia

ACE inhibitors

Beta Blockers IVI PO

Anticoagulation IVI PO

Nitrates IVI PO TOP

Oxygen

Aspirin

Lipid lowering agents

ACE inhibitors

Beta Blockers IVI PO

Anticoagulation IVI PO

Nitrates IVI PO TOP

Oxygen

Aspirin

Lipid lowering agents

Pharmacist review

Investigations and Lab Tests

Repeat Troponins

Other

UEC/ APTT

Serial ECG

ECHO

ECG in am

UEC / APTT

Fasting cholesterol / triglycerides level

ECHO

Intravenous Therapy

IV cannula site (s)

Date for review:

IV cannula site(s)

Date for review:

Diet and Fluid Restrictions

Healthy Heart Diet Healthy Heart Diet

Output Urinalysis on arrival

Fluid Balance Chart (FBC)

Days since BNO

FBC

Activity Complete bed rest

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+ (circle)

Sit out of bed for ½ hour (assist sponge)

ROM exercise in bed and chair

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+(circle)

Pressure Area Care

Pressure area score (according to scale)

Action required…………………………….

Pressure area score (according to scale)

Action required………………………….

Patient Education

Inform patient to report chest pain

Discuss pathway with patient and family

Discuss medications in use

Given educational material re heart disease

Referrals/Consults

Inform Cardiac Rehab team

Other – specify …………………………..

Cardiac Rehab team

Other – specify …………………………..

Discharge Planning

Monitor D/C checklist Monitor D/C checklist

Specific Patient Issues

Sign and print name

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COFFS/ CLARENCE NETWORK

M.R.N.

NAME:

OTHER NAMES:

D.O.B. SEX: M / F

(Affix patient identification label)

Tick yes (Y) or no (N); or tick variance (V) on pathway AND complete variance form on last sheet of clinical pathway

DAY 3

If UAP Diagnosis go to day 4 of Pathway

Tick √

Correct box

DAY 4 Tick √

Correct box

DATE / / Y N V / / Y N V

Outcomes Angiogram within 48 hours of admission

Patient aware of risk factors

Patient aware of new medicines

Patient able to walk 5 minutes BD

Discharge Plan established

Patient remains pain free

Assessments Cardiac monitor/ Telemetry

Physical assessment

Vital signs QID, PRN

Circulation observation

Femoral site

Rhythm strips: once a shift (8th hourly)

Cease Telemetry

Physical Assessment

Vital signs QID, PRN

Medications ACE inhibitors

Beta Blockers IVI PO

Anticoagulation IVI PO

Nitrates IVI PO TOP

Oxygen

Aspirin Clopidogrel

Lipid lowering agents

ACE inhibitors

Beta Blockers

Anticoagulation

Nitrates

Oxygen

Aspirin Clopidogrel

Lipid lowering agents

Investigations and Lab Tests

Pathology as ordered

ECG in am

ECHO (if not already attended)

EST

Pathology as ordered

ECG in am

ECHO (if not already attended)

EST

Intravenous Therapy

IV cannula site(s)

Date for review:

Review need for cannula

Diet Healthy Heart Diet Healthy Heart Diet

Output Days since BNO Days since BNO

Activity Assisted sponge or supervised shower

Post C/Cath protocol re: bed rest, obs etc

Sit out of bed as tolerated

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+ (circle)

Shower self

5 minutes walk around ward BD

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+(circle)

Pressure Area Care

Pressure area score (according to scale)

Action required…………………………….

Pressure area score (according to scale)

Action required………………………….

Patient Education

Discuss pathway with patient and family

Given educational material re heart disease

Educate re: discharge management

Dietary education

Referrals/Consults

Cardiac Rehab team

Other – specify …………………………..

Cardiac Rehab team

Other – specify …………………………..

Discharge Planning

Monitor D/C checklist Monitor D/C checklist

Specific Patient Issues

Sign and print name

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COFFS / CLARENCE NETWORK

M.R.N.

NAME:

OTHER NAMES:

D.O.B. SEX: M / F

(Affix patient identification label)

Tick yes (Y) or no (N); or tick variance (V) on pathway AND complete variance form on last sheet of clinical pathway

DAY 5Tick √

Correct boxDAY 6

Tick √

Correct box

DATE / / Y N V / / Y N V

Outcomes Patient understands risk factor

Discharge plan confirmed

Patient has understanding of medications and is confident with use

Patient is self caring

Patient has received Cardiac Rehabilitation Education and is aware of follow up

Patient has understanding of medications and is confident with use

Patient is discharged

Assessments Physical assessment

Vital signs QID, PRN

Vital signs BD

Medications ACE inhibitors

Beta Blockers

Anticoagulation

Nitrates

Aspirin Clopidogrel

Lipid lowering agents

Pharmacist review

ACE inhibitors

Beta Blockers

Anticoagulation

Nitrates

Aspirin Clopidogrel

Lipid lowering agents

Pharmacist review

Investigations and Lab Tests

ECG in am

EST

EST

Intravenous Therapy

nil Ensure IVC is removed

Diet Healthy Heart Diet Healthy Heart Diet

Output Days since BNO Days since BNO

Activity Self caring with ADL’s

10 minutes walk around ward BD

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+ (circle)

Self caring

Patient Activity and Mobilization Program Stage 1 2 3 4 5 6 (circle)

Mobility Score ° ° ° ° (circle)

Falls Assessment Score 0 1 2 3+(circle)

Patient Education

Given educational material re heart disease

Educate re: discharge management

Educate re: discharge management

Review discharge medications with patient and family

Referrals/Consults

Cardiac Rehab team

Other – specify …………………………..

Discharge Planning

Monitor D/C checklist Complete discharge form

Specific Patient Issues

Sign and print name

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COFFS/ CLARENCE NETWORK

M.R.N.

NAME:

OTHER NAMES:

D.O.B. SEX: M / F

(Affix patient identification label)

Tick yes (Y) or no (N); or tick variance (V) on pathway AND complete variance form on last sheet of clinical pathway

DAY 7 Tick √

Correct box

DAY 8 Tick √

Correct box

DATE / / Y N V / / Y N V

Outcomes

Assessments

Medications

Investigations and Lab Tests

Intravenous Therapy

Diet

Output

Activity

Pressure Area Care

Patient Education

Referrals/Consults

Discharge Planning

Specific Patient Issues

Sign and print name

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COFFS/ CLARENCE NETWORK

M.R.N.

NAME:

OTHER NAMES:

D.O.B. SEX: M / F

(Affix patient identification label)

AIM: To identify those factors which affect Length of Stay

INSTRUCTIONS: Enter the Variance Code from the table below eg. if there is a variance noted in the patient'sclinical pathway due to transport availability enter D1

Date of Admission Date of Discharge LOS (days)

/ / / /

DATE DAY OFSTAY

VARIANCECODE

EXPLANATION OFVARIANCE CODE ACTION TAKEN SIGNED

GENERIC VARIANCE SOURCE CODE(Please tick all variances that occurred during this admission)

A. PATIENT

1. Pressure Care2. Post op / procedure complication3. Infection4. Co-existing morbidities5. Severity of Disease6. Mobilisation – late7. Delay in drain removal

8. Delay in suture/clips removal9. Unplanned return to OT10. Unplanned return to ICU11. Non compliance with treatment 12. Other13. Taken off pathway

B. CLINICAL

1. Delay in medical consultation2. Delay in allied health consultation3. Delay in consultation due to ADO/Public Holiday/Weekend4. Inadequate discharge planning5. Non-attendance at pre-admission clinic6. Other

C. HOSPITAL

1. Delay in test results2. Delay in OT/procedure3. Cancellation of procedure4. Delay in patient transfer to ward from ED5. Other

D. COMMUNITY / FAMILY

1. Delay in availability of transport2. Delay in availability of rehabilitation bed3. Delay in availability of nursing home bed4. Delay in availability of private hospital bed5. Delay in availability of community services6. Delay in early availability of discharge options7. Delay in availability of home oxygen8. Other

Adopted and revised from “Clinical Pathway for Myocardial Infarction” St. Vincent’s and Mater Health Sydney NSW

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