better together: booking the or collaboratively
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CCCN Abstracts S373safe environment amenable to learning. A semi structurededucation guide starts the process, allowing for flexibility inlearning and to permit issues to arise from the group. Dis-cussion and problem solving are encouraged, with theeducator acting as facilitator, not lecturer.
The use of simulation strategies is an effective tool thatmay be transferred to any setting. In a large scale project tostandardize corporate practice this strategy has provenconsistently effective not only as an educational tool, but as aninformal evaluation method.NP025
VAPING: ARE E-CIGARETTES MORE THAN SMOKE ANDMIRRORS?D Fitch1, L Avery1, E Estrella-Holder2, M Kvern1, T Warner2,J Tam2
1Winnipeg Regional Health Authority, Winnipeg, MB, 2St. Boniface Hospital,Winnipeg, MB
Approximately 4.6 million adult Canadians are current smokers.Smoking is one of the most attributable risk factors leading tocardiovascular related diseases and premature death. The reduc-tion of the number of cigarettes smoked is a common strategyusedbyCanadians as a bridge to smoking cessation. There is confusionamong the public and professionals related to the safety and effi-cacy of e-cigarettes (EC) as a smoking cessation aid.
EC are devices that emit vaporized solutions. The essentialcomponents of EC include the battery, an atomizer, cartridgeswith or without nicotine, and other substances. Nicotine- deliv-ering EC devices are not approved for sale by Health Canada andmaynot bemarketed as a smoking cessation aid.There is a paucityof research to demonstrate either the safety or efficacy of EC as asmoking cessation aid. In addition, the variable nicotine levelsfound in EC may lead to compensatory smoking.
The purpose of this presentation is to highlight the currentCanadian policy and position related to EC as a smokingcessation aid and the evidence used to inform policy recom-mendations. Implications for nursing practice in relation tocounseling and evidence informed smoking cessation or harmreduction strategies will be presented.
Cardiovascular nurses play a pivotal role in health promo-tion and secondary prevention strategies related to tobacco use.In addition, practitioners require knowledge and awareness ofthe current state of evidence related to EC to enable the publicto make informed decisions regarding smoking cessation aids.NP026
BRIDGING THE GAP BETWEEN HOSPITAL AND HOME:OPENING A RAPID CARDIOLOGY ASSESSMENT CLINICM Galapin, S Michaud, D Bello-Aqui, J Ng Lee
Sunnybrook Health Sciences Centre, Toronto, ON
A pilot project for a Rapid Cardiology Assessment and HeartFailure Clinic was organized at Schulich Heart Centre,Sunnybrook Health Sciences Centre. The clinic aims toquickly review consultations so as to prevent hospitalizationand re-hospitalization of cardiology patients and to serve asbridge to outpatient care when patient is discharged to thecommunity. However, the clinic is not intended to replaceoutpatient cardiology care or assume long term care of car-diology patients.
The clinic receives referrals from: Emergency Department(ED), Cardiac Intensive Care Unit, Cardiology Ward, Gen-eral Internal Medicine (GIM) Ward, and Family Physiciansclinic within Sunnybrook Health Sciences Centre and itscatchment area.
Clinic criteria was developed to include: patients referredfrom ED with congestive heart failure not requiring urgentadmission, low-risk chest pain of coronary etiology, and ar-rhythmias that require urgent follow-up; rapid review of dis-charged patients as a bridge to their usual outpatient cardiologycare; GIM patients with cardiology diagnosis that requiresubspecialty expertise; and patients referred from family phy-sicians clinic as an option to an emergency room assessment.
Pilot project evaluation after three months of implementa-tion shows growth in clinic referrals and diversion of unnec-essary hospital admissions. Challenges identified includedtriage of referrals and medical manpower in the clinic.NP027
BETTER TOGETHER: BOOKING THE OR COLLABORATIVELYM Bellows, T Peters
Alberta Health Services, Edmonton, AB
An innovative approach was needed to reduce cardiac surgicalpostponements in a climate of finite operating room time,fiscal restraint and growing waitlist.
The cardiac surgical slate, booked by several SurgeonsOffices using an individualized approach, lacked an omni-scient perspective; one that is cognizant of case mix, procedurecomplexity and bed availability within the CardiovascularIntensive Care Unit and Cardiovascular Ward. Postponingsurgeries can cause undue physical and psychological stress topatients and families. To improve the patient experience andcare quality, a cost neutral, synergistic approach was applied.
The Cardiovascular Surgery Collaborative Booking Teamwas born. A strategic alliance of Nurse Navigators, UnitManagers, Surgeons Administrative Assistants, and CardiacOperating Room (OR) and Zone Program Nurse Managersmeet weekly to plan the next weeks slate. This Team dis-cusses and makes adjustments to the draft slate, planning forcomplex cases, potential unplanned emergencies and patientflow. Bringing stakeholders together and fostering shared de-cision making, decreased postponements due to no bedsfrom 4.5% to 0.6%. Added benefits of the collaborative teamapproach include building relationships with adult congenitalpatients and families prior to surgery and increased ORutilization.
S374 Canadian Journal of CardiologyVolume 30 2014As a result of this constructive way to increase communica-tion and collaboration among members of the adult cardiacsurgical program, the paediatric cardiac surgical program hasinitiated a similar group dedicated to the same purpose. Advo-cating for patients and families is at the heart of what we do andwe are better able to do so by enhancing nursing relationships.NP028
STRATEGIES TO IMPROVE SELF-MANAGEMENT IN HEARTFAILURE PATIENTSM Toback
AHS/FMC, Calgary, AB
BACKGROUND: Heart failure is one of the most common causesof hospitalization, hospital readmission and death. Approxi-mately half of heart failure patients are rehospitalized within 6months of discharge, and almost two thirds of these patients arereadmitted because of a deterioration of a previously diagnosedheart condition. Patients with heart failure are also associatedwith a complex network of health care providers, for example,multiple coexisting diagnoses which cause polypharmacy,require care frommany specialist clinicians, adjust medicationsand behavior according to changes in their symptoms, and alsomaintain a restricted diet and exercise regime. Therefore, thepatient plays a crucial role in the management of heart failuredisease; however, self-care is a challenge for most heart failurepatients without robust and supportive strategies.AIM: To review the available studies on heart failure self-management. Increasing evidence suggests self-management isan important role of educational, behavioral and psychosocialstrategies to improve patient outcomes. The results of thisstudy can be used to design the national standards for heartfailure self-management education.METHODS: A literature review in PubMed was performed, inthe search of the available studies for the period 1999 to 2014.The European Journal of Heart Failure and the up-to-datewebsite were included.CONCLUSION: Improved self-management results in increasedcompliance, promotes quality of life, improves clinical out-comes, and reduces hospital readmissions thereby decreasinghospitalization costs.NP029
NURSES INITIAL PERCEPTIONS OF ANINTERPROFESSIONAL EARLY WARNING SIGNS PROTOCOLFOR PREVENTION OF FAILURE TO RESCUE: PART OF ACOLLABORATIVE HOSPITAL-BASED QUALITYIMPROVEMENT PROJECTY Liu1, V Wrzesien2, M McQuirter1, M Sergerie1
1McGill University Health Centre, Montral, QC, 2 Jewish General Hospital,Montral, QC
Failure to rescue has long been recognized and continues to bean area of concern within the health care system. Accordingly, auniversity-affiliated hospital network based in Quebec, hasdeveloped an institutional protocol to act primarily on earlysigns of patient deterioration and streamlining the responsewhen these signs occur. The goals are preventing in-hospitalcardiac arrests, decreasing intensive care admissions, andimproving patient outcomes. A quality improvement projectwas developed to ensure successful implementation practices ofthe protocol across the institution. The knowledge to actionprocess was used to guide the evaluation of the early warningsign (EWS) protocol implementation. A written survey wasconducted with nurses on two medical units as part of thisprocess to evaluate the understanding, acceptance, internali-zation and impact of the EWS protocol on their practice. Aconvenience sampling of 37 nurses completed the surveyfollowing an educational workshop about EWS. The resultssuggest that nurses had ambivalent opinions and repliedneutrally to statements that addressed the nurse-physiciancommunication and relationship. Concerns regarding staffingand heavy workload, a fear of crying wolf, and the cohe-siveness between nurse-physician collaboration were voiced aspossible limitations. Strengths of this protocol included highrates of agreement among nurses regarding the protocolsbelievability, understandability, ease of implementation, buy-in and compatibility. For instance, 82.3% of participatingnurses agreed that the EWS protocol was compatible with theircurrent practice, knowledge and beliefs. Interventions to in-crease interprofessional collaboration the EWS protocol areindicated for its successful ongoing deployment across the in-stitution.NP030
SMOKING CESSATION FOLLOWING DIAGNOSIS OF MILDTO MODERATE CORONARY ARTERY DISEASER Rana, D Lightburn, L Zavitz
St. Pauls Hospital, Vancouver, BC
Smoking is the single most important modifiable risk factorthat one can