WHAT YOU NEED TO KNOW ABOUT

8 NORTH

Orientation to Cardiology

Overview

Floor LayoutWho is on the Cardiology FloorProcess

AMOR Medication Reconciliation Assessment Drug Therapy Problems Care Plan Follow-Up Pharmacy Suggestion Documentation

Common Conditions

Floor Layout

North Side Hallway (rooms: 00 - 32)

South Side Hallway (rooms: 34 - 53)

stairs

elevators

service elevators

patient lounge

reception

patient charts (AM)

charge nurses

fish bowl

PCI room

Who is on the Cardiology Floor

Charge Nurse x 2NursesPSWsDoctors (Surgeons, Specialists, Hospitalists, Family

Doctors)Social WorkerRehabilitation Services (OT & PT)Dieticianetc.

Process: AMOR

AMOR: Admission Medication Order RecordPatient are usually admitted to Cardiology with a

completed AMOR

Can be completed using: patient/caregiver verbal list patient’s medication vials, blister packs, prescription receipts,

etc. long-term care medication administration record patient transfer record pharmacy list

Not always an accurate representation of patient’s medications

Process: AMOR

Process: Medication Reconciliation

Obtain Medication List from Community Pharmacy Check if pharmacy name

listed on AMOR If yes, check patient chart If no, ask patient

If required, call pharmacy to obtain medication list Be sure to have:

Patient’s name & DOB Cardiology fax number

Review Pharmacy List in comparison to AMOR (if available)

Read ‘Notes’ and ‘Other Reports’ to obtain information regarding the visit, patient history, etc. in MEDITECH

Discuss home medications with the patient

Process: Medication Reconciliation

Complete Pharmacy Communication as Process Immediately If medication requires clarification to AMOR

e.g., wrong dose, wrong frequency If patient not taking medication listed on AMOR

e.g., patient not taking at home, has not filled in some time

Process: Medication Reconciliation

Complete Pharmacy Communication for Physician Review If medication missing from AMOR

e.g., on community pharmacy list, additional vitamins & supplements

Process: Assessment

Assess patient’s medical history and reason for visit Are all patient conditions being managed with drug therapy?

Is the patient receiving evidence-based medications? Indicated, Safe, Effective, Convenient/Able to Adhere Post-MI: ASA, Clopidogrel, Beta-blocker, ACE inhibitor, Statin Atrial Fibrillation: CHADS2 & HAS-BLED risk scores

If not receiving all evidence-based medications Is there a reason the medication may not be indicated for this

patient? assess kidney function, blood pressure, heart rate, hemoglobin

Evaluate available options for drug therapy in the context of this patient

Process: Drug Therapy Problems

Identify Drug Therapy Problems

drug not indicated

dose too high

dose too low

ineffective drug therapy

adverse drug reaction

additional drug therapy required

patient non-adherence

Process: Care Plan

Determine what actions should be taken to resolve the Drug Therapy Problem e.g., Initiate, Discontinue, Change dose

Consider the timing of the intervention When is it appropriate to make these changes?

e.g., now, after a procedure, when blood pressure stabilizes

Has the MRP rounded on the patient yet? (many round in the AM)

Process: Follow-Up

Determine what follow-up is necessary for the patient and the medications e.g., Blood sugar, Kidney function, Hemoglobin, Side effects

Decide on the frequency of follow-up /when to follow-up next e.g., Daily, In two days, Weekly

Process: Pharmacy Suggestion

If the plan is indicated at this time Write a Pharmacy Suggestion on a Pharmacy Communication

form for Physician Review Include reasoning behind suggestion, appropriate dose, route &

frequency

Bring all Pharmacy Suggestions to the attention of the charge nurse responsible for the patient

Attach the Pharmacy Communication form to the front of the chart

The MRP will review the Pharmacy Suggestion & if agrees will sign the Pharmacy Communication form Otherwise the MRP may write a different order or

therapy may remain unchanged

Process: Documentation

Be sure to document this process as an ‘Intervention’ in the patient’s file on MEDITECH Pharmacy > Pharmacist Desktop > My List > Add Interventions > Patient > Enter

Type: • OTH – other

o Medication reconciliation

o Hyperglycemia

• TPS – TPA/Streptokinaseo Warfarin/Coumadin

Status:• A – active• C – complete

Process: Documentation

Once the General Information is filled in click ‘Text’

Be sure to include the date & your initials e.g.,

JUL8: Medication reconciliation complete as per the patient and Shoppers Drug Mart Long Lake Road (705-522-3030).

The patient was admitted with… history of… …-SB

Common Conditions

Hypertension

Acute Coronary Syndromes (ACS) Unstable Angina/Non-ST Segment Elevation Myocardial

Infarction (UA/NSTEMI) ST Segment Elevation Myocardial Infarction (STEMI) Post-MI

Congestive Heart Failure (CHF)

Atrial Fibrillation

Diabetes & Stress Hyperglycemia

COPD Exacerbations

Infections

Enjoy Cardiology