I need to ask the vast, smart ED nurses here...do any of you have a dedicated STEMI protocol sheet?
I had a STEMI arrive via ambulance. I notified the Doc prior to arrival, grabbed out STEMI med box and got to work. The time frame from door to cath lab was within time limits, but the process itself for the primary nurse (me) was less than smooth. I had the ER doc and cardiologist giving verbal commands continuously, while I gave the meds and scribbled cryptic notes to document later. The problem is, we don't have time later. I got another nurse to help give medications and help me while I began to furiously scribble the orders onto my documentation and the physician's order form since none of the doctors did.
At some point, the cardiologist flung the consent form somewhere in my pile of mess on the counter. About 20 minutes later the cath lab Rns showed up to take the patient. In that time, the other nurse and I had started another IV, gave ASA, nitro, benadryl, metoprolol, heparin, tridil, morphine, placed a foley, multiple ECGs, V/S, called a family member for the patient, and did most of the documentation.
I gave the ER doc the physician's order sheet to sign which he asked, "You want me to blindly sign off on this?" At which point I said, "Yes, you will. They were all verbal orders that you and the cardiologist asked for. Sign it."
I was copying the documentation while the patient was whisked away. I had to go to the cath lab in order to give them everything, plus they didn't take (or get the patient's signature yet) on the consent.
The cardiologist asked why I had not gotten the consent yet. So, I had to go to the patient to have the person sign it. Then a cath lab nurse was rather rude when she asked why I had not copied all of the lab results. Well, they are all on the computer now. Look them up. She was sitting in front of the computer berating me for not having time to check the labs and copy them for her.
Later, they called and reported me to my charge nurse for the labs. I'm thinking this is going to become an issue.
I spoke to the ER Doc after this was all said and done and we agreed that we should have a standard protocol that ER nurses could follow based on what the ER and cardiologists want pre-cath. Reduce the redundant and voluminous paperwork that the ER nurse does not have time to do in this time sensitive situation.
My response to this whole situation is to start to research the development of this type of sheet since my ER doesn't have it and we really should.
So a long story to ask, how does your ED deal with STEMIs?
We have a Cath Alert packet that contains all the paperwork you'll need for a STEMI. There is a standard order sheet that includes blank spaces for information such as time of onset of symptoms, time of arrival in the ED, time of arrival of the ED physician, time of EKG done in the ED, time of arrival of the cardiologist, time of arrival in the cath lab, etc. All you do is write down the time in the appropriate blank and initial it. The standard meds are on the sheet, with check boxes the doc can either check, or the nurse can check when they get the v.o. The consent form is also in the packet. Also, we have STEMI kits in the Pyxis, so all you have to do is make one selection to get all the potential drugs you might need. When the radio call comes in, you just grab the packet, grab a STEMI kit from the Pyxis, and take it to the room and get the room ready. It's really a great streamlined process. I think my record from ED door to cath lab is 12 minutes. Really, the only thing that slows the process down is the time it takes to assemble the cath lab team and get the cath lab ready.
Oh, and you still have to write a narrative note (we do paper charting), but I usually wait until after I've accompanied the patient to the cath lab, and finish up my charting while the cath team gets started. Sometimes, if things aren't really crazy in the ED, I can stick around long enough to see the intervention.
Last edit by Anna Flaxis on Apr 14, '12