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Cardiac Intensive Care UnitOperationalizing the Attending Nurse Role

Presented by Colleen Snydeman, RN, MSN

February 15, 2012

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CICU Relationship Based CareMary Koloroutis

Transition to Relationship Based Care Model Relationships are at the heart of all care Patient assignments that increase continuity Interdisciplinary team connections

“We know our patients by heart”

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CICU Attending Nurse RoleSetting the StageAccountability for patient / family continuity of care and progression of

plan Orient patient/family to MGH & CICU

Deliver Welcome packet Encourage journaling

Implement patient/family meetings within 24 hours (benchmark is 24-48 hours)

Redefine patient/family meetings Encourage and support patient / family participation on rounds

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CICU Attending Nurse RoleFacilitates the patient / family plan of care through

communication with Interdisciplinary Team Develops and revises patient care goals with

care team via interdisciplinary care team rounds 7:00 AM: Work Rounds with senior resident 8:30 AM: Interdisciplinary patient care rounds Daily: Patient specific rounds as needed Weekly: Interdisciplinary long term care rounds

Develop long term care flowsheet Communicates goals and plan of care to

patient / family

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CICU Attending Nurse Role

Facilitator of transition of care Attends 9:30 AM bed management meeting regarding

coordination/transfer of care Visits patient / family following transfer Speaks with nurse caring for patient Discharge follow up calls when indicated

Coordinates meetings with clinicians for timely decision making and connects nurses to optimize handoffs across continuum Attends Monday and Friday heart failure meetings Attends STEMI meetings Consults with Attending physicians as needed

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CICU Attending Nurse Role

Promotes clinical standards and patient / family relationship based care Active involvement in CICU Practice

Family presencing Evidence based practice Nurse sensitive indicators Hourly safety rounds Safe hand-offs Practice guidelines and

standards of care Nursing M&M rounds

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Navigator RoleCICU Attending Nurse will also function as

Navigator for MGH STEMI population Approx. 200 patients per year Oversee processes of care:

Patient progress admission-discharge Patient/family education Follow up discharge calls Communication across continuum of care

Contribute to innovative ideas for care redesign

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Attending Nurse Coverage Needs

Scenario 1 * Scenario 2 Scenario 3 Scenario 4

Days of Week

Mon - Fri Sun - Sat Mon - Fri Sun - Sat

Hrs /Day 8 8 12 12

Hrs/Wk 40 56 60 84

FTE 1.0 1.2 1.5 2.1

Ability to connect with familiesAbility to follow STEMI patients

* Start with Scenario 1: ongoing assessment and evaluation re: Attending Nurse workload Ability to connect with families Ability to follow STEMI patients Gaps over week-end shifts

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Next Steps Implement Attending Nurse role: March 19th Continuous evaluation of Attending Nurse hours of coverage Complete work related to Navigator role for STEMI patients

Develop system to identify MGH STEMI patients Define components of Navigator role Develop educational content required for Attending Nurse,

patients and families, MDs and others Communicate Navigator role Develop metrics to evaluate navigator role Tentative Go-Live for Navigator role April 23rd