I work in the Cath lab and currently we are having a problem with one of the floor units being able to take our patients post heart cath procedure, due to either the patient being on an angiomax drip or having the sheath sutured into the groin. Angiomax is an anticoagulant that is given via IV during the hearth cath when patients are having stents placed. Usually the physicians will continue this medication until the bag is finished, which usually takes about 30 minutes to an hour. Some physicians will suture the lines into the groin and write orders to have them pulled 2 hours after the angiomax is finished infusing. The problems we are having right now is with this one unit not being able to take these patients back is that the patients are having to go too an ICU bed, which takes beds away from those patients that are in critical condition and need an icu bed/nurse to take care of them or we have to hold patients in the cath lab until the drip is finished or we are able to pulls lines ourselves. By holding patients in the cath lab we are pushing other procedures back which makes for not only upset physicians but upset patients because they have to wait so long. I chose Kotter’s 8-Step Change Model to implement a change.
Create Urgency: Holding patients in the cath lab or having to send them to an ICU post procedure to either finish the angiomax drip or pull lines is either tying up a procedure team or an ICU bed when these things could be done on a step down cardiac unit. Also leads to patient dissatisfaction scores.
Form a Powerful Coalition: Find people on the step down unit who are willing to learn how to pull lines and hold pressure and take an angiomax drip. Get people from the cath lab that are willing to teach these things to the step down unit. Also get the manager’s from both units involved and work together on developing a policy.
Create a Vision for Change: Explain to everyone the need for change, how it would benefit the hospital, staff and the patient. Ask everyone to start thinking about ideas and solutions
Communicate the Vision: Address nurses concerns and anxieties. Be willing to go out to the floor and help them when they have questions or concerns. Lead by example
Remove obstacles: Recognize and reward people for making change happen. Identify people who are resistant to change and help them understand why it is needed
Create Short-term wins: Set goals and analyze the potential pros and cons. Reward people for meeting their goals
Build on Change: Continue to look for improvements. With each success look at what went right and what you can improve on
Anchor the Changes: Talk about your progressions that you have made with the nurses and policies. Make sure that you continue to have the managers and hospitals support to make the changes that are needed
www.strategies-for-managing-change.com
Are there policies in place on these units for post cath patients in these situations? Developing a set policy/ protocol for the nurses to follow as well as maybe a super user group (3-5 nurses who do one on one training that can serve as a resource or can take the patients) for each area may also be helpful. Overall it looks like some great ideas and having the patients safety and satisfaction as well as the comfort of the staff in mind is great. Looks like you guys are well on your way to addressing and fixing the issue.
Communication is a key factor. Make known the concerns for the care of the post cath. patients and their lack of satisfaction of current process. Talk to the nurse managers, find out the overall concerns of the nurses. Get ideas from the units. Start developing a policy with guidance from the units and nurse managers involved. It’s refreshing to see a problem and act to correct it. Training and continued communication thru out this process to have a policy in place to benefit all involved. Well done!
I think that definitely is an issue that needs to be addressed. Taking up ICU beds for unnecessary patients is a huge problem. Especially right now with hospitals being full with all the flu and respiratory issues that are going around. I think that first the managers need to be on board and realize that this is an issue that can be improved upon. All members needs to sit down and formulate a plan that works for each unit. Then lastly there needs to be adequate amount of education for the nursing staff on each of the units. Great idea!