Time is tissue is how Fred Duran, RN, BSN, describes the approach he and his RN colleagues take toward rapid, effective cardiovascular care at Glendale Adventist Medical Center in Glendale, Calif.
In February 2014, GAMC received its re-accreditation as a chest pain center, the result of more than 18 months of exacting work and streamlining processes for patients with chest pain.
The biggest component of the success, Duran said, was working with other departments such as the ED and ICU, to streamline the whole process and cut down minutes. Every step of the way, we timed our efforts, Duran said.
Between 300 and 400 RNs at GAMC are involved in the chest pain center, said Chest Pain Center Coordinator Gina Shepherd, RN, MSN, CNOR, CCPC. They work throughout the facility, including the ED, cath lab, CCU and telemetry units.
Glendale Adventist Medical Center was not alone in its journey for accreditation.In 2013, 261 chest pain centers in the U.S. were accredited by the Society of Cardiovascular Patient Care, said Donna L. Hunn, RN, MAN, MSc, ANP-C, the organizations accreditation clinical manager.
More and more facilities are seeking accreditation because were a process-based organization, she said. She acknowledged the accreditation process is a lot of work, but that the overwhelming theme afterward is that everyone is glad they did it.
What it takes
Acquiring accreditation at Glendale required rigorous practice, training, paperwork and repeated timing of processes. The bottom line is when a patient has an MI or an [obstructed]vessel nothing is more important than getting the patient on the table [in the cath lab]to open the vessel, Duran said.
Patients with a suspected ST segment elevation myocardial infraction must be treated within strict time guidelines. Shepherd and the chest pain center RNs created policies throughout the facility and worked to refine the process of getting every patient treated in the required time frame. Duran also emphasized cross-training of personnel among various units to provide better timed outcomes.
We had to identify gaps in our systems and improve our processes to enhance the care, Shepherd said. For example, the protocols and algorithms from the Society of Cardiovascular Patient Care required that a patient with chest pain receive an aspirin on arrival, have their EKG read within 10 minutes of arriving at the hospital door and be re-perfused within 90 minutes of arrival. Meeting these parameters is even more difficult when a patient is being transported by ambulance, where the clock starts ticking before the patient comes through the hospital doors, Duran added.
Providing 24-hour coverage, the RNs work in teams with interventional cardiologists and cardiovascular technicians. Duran noted this approach injects another challenge: Policy says we have to be within 30 minutes of the hospital while on call. When we get a patient, every one of us [on the team]has to drop everything were doing and rush to the hospital.
Karen R. Brandt, RN, MSN, FNP-C, vice president, ancillary services, commends the RNs of the chest pain center. RNs play a major role in the care of chest pain patients, she said. She believes they are a key element in identifying, gathering, and coordinating all of the pieces needed for the physicians and entire care team to give the life-saving treatment.
Tips when anticipating chest pain center accreditation
Tips for nurses anticipating chest pain center accreditation:
– Welcome, rather than resist, change. Shepherd said nurses found it difficult to adjust to new systems due to specialized protocols.
– Take advantage of the training to hone your skills and deliver even better patient care. Chest pain center RNs are ACLS certified; all attend an eight-hour class initially, then refresh with online training each year.
– Seek early and consistent collaboration with others, especially physicians, through meetings and written agreements.
Other RNs who helped gain accreditation
According to a hospital spokesperson, the following Glendale Adventists nurses participated in the Chest Pain Center accreditation:
Lucy Chang, RN, Maria David, RN,Yi Sen, RN, Susamma Oonnooney,RN, Jennifer Washington, RN, Vetta Mankarios, RN, Robert Brown, RN, Lani Collins, RN, Randa Shamaa, RN, Ellen Obregon, RN, Sergey Gantman, RN, Wendy Talend, RN, Janice Williamson, RN, Rachel Wairimu, RN, Lana Rhodes, MSN, RN, ACNP, Lee Allen, RN, and Jodi Gillians, RN.