Cath Lab Digest - April 2008 - (Page 24)

SPOTLIGHT APRIL monthly staff meeting at which one of our cardiologists or interventional radiologists will lecture us on a topical subject. Also, our vendors are excellent sources of information. How do you handle vendor visits? Vendor visits are usually by appointment, but if they are restocking consignment items (e.g., stents) then they usually come once a week. We may have more than one vendor representative per day, but they cannot be from competing companies. All must wear appropriate hospital-issued identification. Some of our vendors are ex-cath lab personnel and have been invaluable for educational purposes. How is staff competency evaluated? Staff competency is evaluated by our manager on an annual basis. Some competencies are required by the hospital, also on an annual basis, and are covered in our yearly safety fair; others, specific to our lab, are done by a ‘super-user’. The charge RN, the medical director or a person from the hospital laboratory can also do proficiency testing. Does your lab have a clinical ladder? The RN and RT clinical ladders are a negotiated contact between Kaiser Permanente, United Health Workers and the California Nurses Association. The steps and pay scales are for any RN or RT working in the northern California region, not specifically in the cath lab. Does your lab utilize any alternative therapies? We have recently started a guided imagery program for our patients. Our cardiac cath lab director, John Kennedy, MD, with Lance Benedict, Cardiac RNP, have written a guided imagery program, “Healing Your Heart from Inside Out,” which is specifically for cardiac patients. Many studies show that it can be used to reduce anxiety, pain, enhance patient participation, improve quality and patient/family satisfaction, as well as reduce length of stay. This program is a pilot for Kaiser Permanente. It has required the input and cooperation of staff from the cath lab, the telemetry floor, and ICU. Hopefully, with the data acquired, it may be instituted in other Kaiser Permanente labs. We believe that we are the only lab in the country using a guided imagery program specifically tailored to cardiac cases. How does your lab handle call time for staff members? Is there a particular mix of credentials needed for each call team? Call time is shared equally among the staff. Our call team consists for 4 staff members, where at least 1 is an RT and at least 2 are RNs. Spare shifts are allocated on a seniority basis. We always have 2 RNs circulating and an RT scrubbed in, and the monitor person can be either a RT or RN. Within what time period are call team members expected to arrive to the lab after being paged? We are expected to arrive within 30 minutes of being paged, but most of the time we are there within 20 minutes. We are fortunate to have several staff members who live close to the hospital who can open the lab and start the set up soon after the page. Is an attending cardiologist always onsite? If not, what is their expectation to arrive after being paged? During office hours the cardiologists are on site. They, too, are expected to be at the facility within 20-30 minutes when paged emergently during after hours. Do you have flex time or multiple shifts? The lab hours are 6:30am to 5:00pm. Our standby team is available after 4:30pm for any urgent or emergent cases needing to be completed. Does your cath lab do electives on weekends and or holidays? At this time we do not perform electives on weekends and holidays, only emergent cases. Has your lab has undergone a Joint Commission inspection in the past three years? Do you have any recommendations or advice for labs which are about to undergo this inspection? Joint Commission visited our facility in November 2007 and recertified Kaiser Permanente San Rafael Medical Center for 3 more years. In preparation for our survey, our facility has provided frequent in-services and patient safety awareness training. All of our safety tasks are audited, and a “timeout” line has been added to our charting system, to be checked for every patient. We make a concerted effort to be ready at all times, and work as if an inspection is imminent all year round. What trends do you see emerging in the practice of invasive cardiology? We have most recently seen a reduction in diagnostic cardiac caths, possibly related to the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. Many members are electing to trial medications and exercise prior to any invasive procedure. Though COURAGE looked at stable angina patients, which is not the population we traditionally service, it is having an impact on patient decision-making. We have also seen a reduction in the number of diagnostic caths with the addition of the 64-slice CT scanner. Our lab has seen an increase in the range and scope of IR procedures as new techniques develop. Please tell the readers what you consider unique or innovative about your cath lab and its staff. Our ability to perform emergent interventional cardiac caths without cardiac surgical backup on site is a somewhat new innovation in treatment, though possibly not unique. Our heart alert system, where paramedics can call in STEMIs from the field, we believe is unique. Also unique is our dual-use lab and cross-trained staff. The most unique element in our lab is the mix of our staff and their ‘can do’ attitude to the department. Each one of us, without exception, ‘owns’ the lab and is truly committed to having the very best working environment and commitment to excellence that can be provided. No one in our lab had cardiac cath experience. We started a new and unrecognized lab from literally nothing — not only the physical lab, but the very systems and paperwork that enable it to work — a daunting challenge, to say the least. The electronic charting system instituted in our lab at the beginning was new and untried, not only to us, but the entire Kaiser Permanente system. After trialing and streamlining in our facility, this system is now being instituted in all Kaiser Permanente cath lab facilities systemwide. ‘Change’ is almost an everyday word in our lab, and, by virtue of having a small staff, can be implemented, embraced, encouraged and adapted to with minimal interruption to the daily lab workflow. Even during the writing of this article, a number of revisions were required due to changes that had occurred in our lab. We are all totally committed to the success of our lab, from lab staff to upper management. Is there a problem or challenge your lab has faced that you’d like to share? Along with the myriad problems faced by our staff in establishing a new lab from the ground up, the biggest ongoing challenge is the ability to move patients out of our small recovery area to beds within the hospital. Often, due to census and staffing constraints, we are unable to move patients to other areas for recovery. This immediately impacts our workflow due to our limited capacity to hold patients. With collaboration from hospital management, PACU, telemetry, and medical floors, we are usually able to secure beds for recovery at the start of the day, although of course circumstances may change. Our facility’s ‘Commitment to Excellence’ shows in the lengths that other areas will strive to go to in order to accommodate our patients. What’s special about your city or general regional area in comparison to the rest of the U.S.? How does it affect your “cath lab culture”? The area that our patient population is drawn from is mainly Marin county, but also from Contra Costa county and Sonoma county. The lab is located centrally in Marin. Marin is one of the most affluent counties in the U.S., and has a high standard of living. Its residents are also generally well informed concerning health issues. The Golden Gate Bridge is 10 miles south of us, and we have a (relatively) easy drive to all the attractions of the Bay Area. North of us are the famous wineries of Napa and Sonoma counties. All in all, a great place to live! The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight: 1. Do you require your clinical staff members to take the registry exam for the Registered Cardiovascular Invasive Specialist (RCIS)? At this time, there is no requirement to have our staff to take this certification. This year we as a facility will be strongly encouraging our staff to become RCIS certified. 2. Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP, or regional organizations? Not at this time. We do read Cath Lab Digest! ■ The author can be contacted at pialt@comcast.net

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

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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