At this center, 'staff' training means everyone
At this center, 'staff' training means everyone
Even valets learn who to call for chest pain patients
[Editor's note: This is the first part of a two-part series on staff training at the chest pain center at Oregon Health & Science University Hospital. In this issue, we tell you about training for the valet, patient access service clerk, and triage nurses. In next month's issue, we'll tell you how they enhanced their care for ST-segment elevation myocardial infarction (STEMI) and how atomic clocks were purchased to synchronize door-to-balloon times.]
Your ED might not be blessed with valet service, but if it was, would it occur to you to train valets in how to respond when chest pain patients arrive?
One leader at Oregon Health & Science University (OHSU) Hospital did.
Mary Spiering, RN, MN, CNS, clinical nurse specialist for the cardiac service line, "was in the ED all the time," training not only the valets, but also the patient access service clerk and the triage nurses. Spiering began with the valets, because "that's where the patient enters the system. They have to know who to call," she says.
In talking with the valets, she learned that they often spent a good deal of time looking for a nurse. "I asked if they had a cell phone and they did, so we put the charge nurse's phone number in," says Spiering.
The next person the patient sees is the patient access service clerk. "We put together a poster that hangs right in front of their station that says, 'Look for these signs,' and we list things like shortness of breath or jaw pain, and we have a picture of a jaw showing where the pain could occur," says Spiering. If patients exhibit those problems, the patient access service clerks are to call the triage nurse. Several posters on other clinical topics are rotated in.
The triage nurses required education as well in issues such as 12-lead EKGs and acute coronary syndrome, she says. In addition to talking with them personally, Spiering employed an online cardiac education program named imPULSE from Apex Innovations (www.apexinnovations.com/imPULSE.php). Administrators in the hospital's Division of Cardiology approved a three-year contract for training 1,000 nurses. The cost is proprietary, says Spiering.
Another import step involved getting the staff to recognize a "STEMI activation" for ST-segment elevation myocardial infarction. "We put together a STEMI process improvement group that included ED docs and cardiologists, who sat at the same table," Spiering recalls. During those discussions, a cardiologist noted that STEMI activations were not getting called. An ED physician responded, "I just thought we were supposed to call the cath lab. That was an 'Aha' moment," says Spiering. "We realized that we all had to be speaking the same language, and we needed to make sure the nurses knew that language, too."
Barrier: No EKG in triage
Equipment was another issue that had to be addressed in order for the facility to continue improving its performance. "We wanted chest pain patients to receive an EKG within five minutes, or half the national standard," says Spiering. "We looked at the barriers to achieving this, and one was the fact that there was no EKG machine in triage."
Robert Norton, MD, an ED attending physician, says, "Having the machine at triage allows us to do the EKG as soon as the patient checks in and meets certain chief complaints, such as chest pain or shortness of breath." This system allows providers to start the process earlier, he says. "As soon as the EKG is done, it's brought to one of the attendings by a CNA to review immediately, and if there is evidence of STEMI, the patient is brought back immediately to the cath lab," Norton adds.
Following her penchant for reminders, Spiering had a STEMI activation checklist placed on the side of the EKG cart, listing "everything you're supposed to do with a STEMI." [Copies of the checklist and other forms are available.] Spiering met with the staff to whittle down the list to "the least amount of work the ED has to do to get the patient ready for the cath lab — the things they absolutely need to do," she explains.
[Editor's note: This is the first part of a two-part series on staff training at the chest pain center at Oregon Health & Science University Hospital. In this issue, we tell you about training for the valet, patient access service clerk, and triage nurses. In next month's issue, we'll tell you how they enhanced their care for ST-segment elevation myocardial infarction (STEMI) and how atomic clocks were purchased to synchronize door-to-balloon times.]Subscribe Now for Access
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