Located in the Gagnon Cardiovascular Institute at Morristown (N.J.) Medical Center is the MMC and Overlook Medical Center cardiac cath and electrophysiology labs, which provide perioperative care for patients who require cardiac testing or treatment.
Nurses, radiology technologists and certified cardiovascular invasive specialists care for patients who need cardiac catheterization, angioplasty, patent foramen ovale and atrial septic defect repair, electrophysiology studies, ablation, device implants, cardioversion or transesophageal echocardiogram. Equipped with a cardiac access unit and a rapid treatment unit, the labs generally discharge patients between four and 23 hours, depending on the procedure performed. More than 8,000 procedures were performed in 2010 in the EP and cath labs.
Patient-centered focusFrom left, Karen Meyer, chief RCIS; Beena Thomas, senior RCIS; and Ginelle Walker-Way, RN, manager of the cath and EP labs, are members of the leadership team.
Critical to nursing care is patient and family education before and after procedures. “We know that with the concentrated stay of 23 hours, we need to emphasize the seriousness of heart disease with our patients and what they need to do,” said Nancy Levy, RN, BSN, MPA, CNML, manager of the cardiac access unit. “Staff reinforces education by explaining the procedure that patients had done and why it was needed. As nurses discuss the role lifestyle has in developing heart disease they provide patients with written materials for them to have as reference upon discharge. Patients may be referred to our cardiac outpatient rehabilitation department, and there they can use the staff expertise as well as support from patients who have been through what they are experiencing,” Levy said.
The facility’s integrative medicine department offers therapies such as therapeutic touch, Reiki, massage and acupressure, particularly for patients who are immobilized postoperatively. “We have collaborated with integrative medicine to help our patients’ postprocedure experience be a more comfortable one,” said Stephanie Bartleson, RN, MSN, CCRN, clinical coordinator. “And in this ongoing effort, they continue to collect data related to these services.”
As a member of multiple registries, the cath lab and cardiology data department work together to make changes in patient care based on data they collect. “For example, we observed an increase in postprocedure bleeding in the older population, particularly with women,” said Ginelle Walker-Way, RN, BSN, MAS, MBA, lab manager. The team reviewed the data with the medical director and removed the heparin from the procedure table, she said.
“This action shifted the responsibility to the circulating nurse, who now communicates with the physician about the recommended weight-based dosing for the patient,” Walker-Way said. “We are now significantly below the national benchmark for access-site bleeding postprocedure.”
One of 40 sites nationwide, MMC was selected to participate in CoreValve clinical trials, which evaluates the treatment of aortic stenosis with transcatheter aortic valve implantation. This valve repair is performed from a percutaneous approach, rather than through surgery. “The cardiac team has implanted [valves in] 14 patients so far this year,” Walker-Way said. “We have a collaborative team whose skill and experience are needed for these high-risk patients.”
View a photo gallery of the Morristown and Overlook cardiac cath and EP labs at www.Nurse.com/gallery/AtlanticLabs.