Cath Lab Digest - March 2008 - (Page 50)

50 CATH LAB MANAGEMENT MARCH 2008 continued from previous page A cluttered cath lab counter that is hard to clear and clean. Q A The American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) guidelines recommend that clopidogrel should ideally be continued up to 12 months in all DES patients who are not at risk for bleeding. Why is it so important for DES patients to adhere to a regimen of dual anti-platelet therapy drugs? Shroff: The ACC/AHA/SCAI recommendations are based upon large metaanalyses and registry data that show that one of the most common causes of stent thrombosis — sub-acute or late stent thrombosis — is premature discontinuation of anti-platelet therapy. In general, why don’t patients take their anti-platelet medications? Shroff: There are several reasons. First of all, patients receive so much information while they are in the hospital, and they do not always leave with a good understanding of why they need to take each drug prescribed. In our experience, the most common time patients become non-compliant with their prescription is right after discharge. They either don’t get their prescription filled or they may simply forget to take it each day. Prescription drug costs are a major barrier to prescription compliance for many people, especially those on a fixed income or with a low income. We performed a pilot study at our Veteran’s hospital in which we found that 20 percent of patients were not taking their clopidogrel for the prescribed duration, even when the medication was free. I have to only imagine what those rates would be in the private sector for patients with little or no insurance. Furthermore, sometimes there is confusion among other health care providers about the importance of anti-platelet medication. For example, we have had several patients with stent thrombosis who stopped their Plavix™ because another physician instructed them to do so prior to a procedure or because the patient was having side effects. Q A Mark Long, RT, from Presbyterian setting up a tray in a relatively uncluttered lab. Q A Is the Stentplus program making a positive impact at your institutions? If so, how? Shroff: It’s definitely making a positive impact among our cardiology community. It augments and adds consistency to our patient-education process, and reinforces the quality aspect of the interventional program. For a long time, we associated quality with angiographic outcomes and immediate complications, but the long-term care sometimes was overlooked. The Stentplus Program sends the message that our patients are still under our care after they have left the hospital. The Joint Commission on the Accreditation of Healthcare Organizations routinely audits hospitals on quality of patient care. Does the Stentplus Program help to improve your cath lab’s quality of patient care? Kondos: Yes. As patients become more compliant with their medications, we are improving our quality of patient care. One of the quality indicators in the ACC/PCI registry is re-intervention, so this database will help us to quantify the impact of the Stentplus Program. What tools has the Stentplus Program provided to help your DES patients stay on the dual anti-platelet therapy that you prescribe for them? Kondos: The educational material is written at the appropriate level for our patients, who are not always in tune with medical terminology, so they can learn about their stent and the reason for its placement. The program includes a DVD that provides patient education about coronary artery disease, percutaneous coronary interventions and stenting, and the importance of anti-clotting medication. The DVD is now part of our in-house video program, so all patients view it prior to discharge. Patients can also take the continued on next page When there is a procedure is assigned to the cardiac cath room, select the appropriate carts and whisk them into the cath lab. At the end of the case, take the cart out and clean the room easily. At a minimum, have a sink and a countertop. Drug-dispensing equipment may be in the control room area. Design the room so no supplies can be stored in the cath lab. Dedicate or design a large central storage area and develop a cart system. When there is a procedure is assigned to the cardiac cath room, select the appropriate carts and whisk them into the cath lab. At the end of the case, take the cart out and clean the room easily. No continual source of contamination. With basic supplies on one cardiac cath cart, a crash cart, a basic interventional cart, a peripheral cart, a carotid cart, an a ASD cart, a PFO cart, you are ready to rock and roll. The key to the system is to have enough carts to keep you supplied throughout the day. Cleanup is quick and complete. The whole lab can be wiped down and the chances of cross-contamination are reduced. The staff restocking the cart do not require RN or technical training, and costs are reduced. Time is saved by not having to check the room for stock, and restocking by RN or technologists is not required. Now every room is standard, because every cart should be standard. There is more room in the cardiac cath lab to get around. Finally, the wipe-down and cleaning of the room should be quicker, easier and more effective in fighting infection. This is a winning situation! Staffing costs are reduced, inventory is better controlled, there is standardization of labs, lab efficiency is Q A Q A

Table of Contents Feed for the Digital Edition of Cath Lab Digest - March 2008

Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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