Cath Lab Digest - December 2007 - (Page 23) 23 Vendors are not allowed to circulate cases or participate in direct patient care. How is staff competency evaluated? All employees must maintain required certifications in their specialty. Evaluations are set up to occur at the same time of year for all employees. Our lab also uses a peer-assigned competency check-off system to demonstrate our knowledge and performance of what we do on a daily basis. The director then reviews these competencies and schedules individual interviews with each employee. In 2006, Eisenhower became a certified Chest Pain Center by the Society of Chest Pain Centers (Columbus, OH, www.scpcp.org). In October 2007, the County of Riverside appointed Eisenhower Medical Center as one of the designated STEMI Receiving Centers, as a result of our meeting the standards set by the Society of Chest Pain Centers for timely treatment of patients with acute MI. This relationship with ambulance services will increase the number of STEMI patients admitted via our emergency room for immediate angioplasty. Our door-to-balloon time is continually improving in order to meet and exceed the benchmarks set for maintaining our certification. In the peripheral arena, we are actively increasing our patient load with the ABI Screening program mentioned earlier. This program is in conjunction with FoxHollow Technologies. How are new employees oriented and trained at your facility? We have a core competency program that all new hires must complete within a probationary period to be successful. Long-term employees mentor new hires for the period of time necessary to complete competencies and to be able to participate in the on-call schedule. The mentor process is adjusted to the experience of the new hire with a reasonable expectation timeline for performance. All employees in the cath lab must meet minimum qualifications in order to be hired. RNs must have BLS and ACLS. CVTs must be certified and have RCIS and ACLS. RTs must have California state licensure; preference is a national registry accreditation and BLS. The clerical support staff must also have BLS. What type of continuing education opportunity is provided to staff members? Our cath lab team formed a lunchtime education program where we invite industry representatives to give us accredited inservices. We also have hospital tuition and expense reimbursement available for outside local and national education programs. How do you handle vendor visits to your lab? Vendors must book specific dates via our clerical staff. They are limited to a specific number of visits per month. Only one vendor per day can be in the lab. All vendors must register with Materials Management to receive a name badge. Vendors may not enter the control room or patient area without physician approval. Does your lab have a clinical ladder? To date, our lab does not have a clinical ladder for the technologists. There is a hospital-wide clinical ladder for the RNs. Does your lab utilize alternative therapies? In the past, guided imagery was trialed with patients using a CD. We found that the best “therapies” are a smile, kind words of reassurance, respect, listening, appropriate pain medication and sedation, and professionalism. These simple acts put patients at ease. How does your lab handle call time for staff members? There must be at least one RN and one RT on the three-person call team. The third person can be an RN, RT or RCIS. The cath lab has coverage twentyfour hours, seven days a week. Call begins at end of scheduled cases with a three-person team. Call is scheduled in advance. It is often traded and bartered for! Weekend call works out to be every third weekend. Since we have a four-day work week (ten-hour shifts), we periodically get four-day weekends. Staff member Cheli Shea, RN, has undertaken the challenge of making our schedules. She does an excellent job in juggling all of our requests while covering the needs of our lab. We appreciate her effort! What time period are call team members expected to arrive to the lab after being paged? In compliance with our Society for Chest Pain Center certification, we must meet a benchmark of ninety minutes or less for door-to-balloon time. We are required to arrive in cath lab within twenty minutes after being paged. Prior to paging cath lab, the goal is for early detection (in the field) of acute MI, and beginning measures to establish coronary blood flow as soon as possible. A paramedic uses a 12-lead EKG to assess a patient in the field. The ER physician interprets the initial 12-lead, the vitals, available history, possible contraindications, etc. Based on the judgment of the ER physician, the cath lab team may be paged prior to the cardiologist assessing the patient. There is not a cardiologist on site 24/7. The ER physician continues with the appropriate emergency algorithm. This process saves minutes for the valuable myocardium. It is vital to the life of our patient that each cath lab and ED team member involved is playing their role full-out, 100% of the time. We each make a difference in the outcome of our patients. Do you have flextime or multiple shifts? We have an informal flextime for slow days. It works well for us and is fair and equitable. Team members communicate with each other with respect to schedule desires. We have found that working tenhour shifts, four days a week gives our team the greatest flexibility in lab case coverage and in meeting individual needs for time off. Does your cath lab do electives on weekends and or holidays? The emergency call back team is used for non-emergent inpatient cases after hours, weekends, and holidays. Our physicians are our main patient referral bases and it is important to foster good relations by trying to accommodate their scheduling requests. It also serves the hospital by not holding an inpatient bed an extra day solely for scheduling a cath procedure during regular hours. Hospital occupancy is 80-90%, depending on seasonal fluctuations, and available bed space is of utmost importance in serving our community. Has your lab undergone a Joint Commission inspection in the past three years? Our cath lab has passed The Joint Commission inspection in the last three years. The best advice is to keep everything Joint Commission-ready all year. This can become a habit. It also eliminates the drama associated with inspection preparation. Where is your lab located in relation to the operating room (OR), emergency room (ER), and radiology department? Eisenhower Medical Center in Rancho Mirage, California. In compliance with our Society for Chest Pain Center certification, we must meet a benchmark of ninety minutes or less for door-to-balloon time. We are required to arrive in cath lab within twenty minutes after being paged. http://www.scpcp.org
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