Initiation of Cardiac Monitoring on a Blood and Marrow Transplant Unit: An Educational Plan to Provide Continuity of Care for Patients

Karen Harden MS, RN, AOCNS, Katy Gudritz MS, RN, Carol Kristofik, MBA, BSN, RN7 West Blood and Marrow Transplant Unit, University of Michigan, Ann Arbor, MI

Education Methods ResultsPurposeImplementation of cardiac monitoring on the Blood and Marrow Transplant (BMT) unit to provide continuity for patients and consistency in patient care.

References

Policy DevelopmentIt was essential to develop a concise policy to guide our care and education as we progressed. We benchmarked other Blood and Marrow Transplant units in institutions around the nation to gather information on how cardiac monitoring was being used with transplant patients. We identified common arrhythmias and determined which cardiac agents would be acceptable. Our philosophy throughout the project was to start slow and build up to adding additional drugs once we considered the need of our patients and realized the increased skill of our nurses.

Learning program requirements for all staff:3 day ECG class provided by hospital critical care orientation team1:1 and group learning sessions provided for staff as neededCardiac rhythm strip interpretation exam – Must pass with 80% success.Bucket of practice strips for ongoing practiceCardiac book and on-line practice strips Reading EKGs for practice4 hour unit-based class

Review presentation of cardiac rhythms Play “Cardiac Monitoring Jeopardy”Hands-on sessions with cardiac monitorCase Scenarios of cardiac arrhythmias in simulation lab with mannequin. Hands-on demonstration of CIC (Central Information Center)

Care of patients on the cardiac monitor with every shift rhythm interpretationDouble checks of all cardiac strips by an experienced rapid response team member.

Background

Nurse ExperienceAlthough we have a team of highly experienced BMT nurses, the majority had no experience in managing cardiac monitoring and reading cardiac rhythm strips. We developed an extensive educational program for existing nurses and will continue to provide this education in the current orientation program.

Total of 70 nurses passed through our programNurses are independently caring for patients with cardiac monitors.Zero patient transfers to telemetry unitsContinued support by RRT for rhythm interpretationContinued cardiac orientation program for new BMT nurses to educate about cardiac issues with BMT patients.

Cardiac Monitoring Jeopardy

Use your Calipers

Lethal Weapon

You’ve got

Rhythm3rd Class

Whatcha gonna

do?$100 $100 $100 $100 $100

$200 $200 $200 $200 $200

$300 $300 $300 $300 $300

$400 $400 $400 $400 $400

$500 $500 $500 $500 $500

Cleveland Clinic. (1995-2010). What is Atrial Fibrillation. Retrieved fhttp://my.clevelandclinic.org/heart/atrial_fibrillation/afib.aspxBayer plx. (2008). Thrombosis Advisor. Retrieved from http://www.thrombosisadviser.co.uk/scripts/pages/en/current-treatments/current-approaches-to-antithromobotic-therapy/stroke-prevention-in-af/index.phpMayo Clinic. (2009-2010). Atrial Fibrillation. Retrieved from http://www.mayoclinic.org/atrial-fibrillation/symptoms.htmlNational Heart Lung and Blood Institute diseases and condition index. (2010). Atrial Fibrillation. Retrieved from http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_signs.html