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  2. 2. SERVICE PROFILE DIRECTORATE: Emergency Care SPECIALITY: Cardiology BEDS: 7 Coronary Care 18 Cardiology Step-down 10 Chest Pain Assessment Unit STAFF Nursing: Ward Manager B22 Ann Roper Ward Manager CCU/CPAU Andrea Bell Cardiac Rehabilitation Nurses Chris Thompson Joan Armbruster Nurse Consultant Alun Roebuck Matron Gill Charlton Research Nurse Lisa Cowell 2 SP/12/05
  3. 3. Emergency Care Practitioners: X 10 Senior Staff Nurses: X5 Staff Nurses: X 35 Auxilary Nurses: X 15 Ward Clerks Dorothy Blench Jennifer Coulson 3 SP/12/05
  4. 4. LEAD NURSE** / LINK NURSE* Wound management Alison Gollan** Sandra Graham* / Zoe Kyle CHD Collaborative Sharon Park** Andrea Bell** PGD Neil Barry** / Margaret McGrath** Sharon Park* Educational Link Sharon Park** Budget Andrea Bell** Ann Roper* Lifting / Handling Annette Bainbridge** Madie Fox* Documentation Neil Barry** Annette Bainbridge* CPR Graham Pike** Kathryn Miller* Health Promotion Margaret McGrath** Ann McMahon* Research Chris More** Niki Day* Discharge Planning Chris More** Kerry Richardson * Audit Coordinator Helen Godfrey** Suzi Guerrero* / Sharon Park* Clinical Supervision Kathryn Miller** Angio Neil Barry** Niki Day* Health and Safety Frank Campbell ** Barbara Warren* Rehab Pat Blakelock** Eva Rontas 4 SP/12/05
  5. 5. SIA Sandra Cunningham** Darshini Naidoo* Holidays Sandra Cunningham** Denise Ward* Stock Management Sharon Buttle** Dawn Pennington* COSHH Frank Campbell** Pat Blakelock* Nutritional Link Annette Bainbridge** Barbara Warren* Diabetes Angela McDermott** Darshini Naidoo* Infection Control Sharon Buttle** Denise Ward*/ Sandra Graham* GRASP Graham Pike** Jan Whitwood* Clinical Governance Alison Gollan** Maureen Gallagher*/ Zoe Kyle Named Nurse Sharon Buttle** Essence of Care Jan Ayre**/ Ann Roper* Frank Campbell** Smoking Cessation Jan Ayre** Continence Margaret McGrath** Waste and Recycling Jan Ayre** Denise Ward* Pharmacy Sharon Buttle** Palliative Care Maureen Gallagher** Pressure Area Sharon Buttle** Troponin Link–wards Jan Ayre** Mandatory Training Jan Ayre** Dorothy Abuda* 5 SP/12/05
  6. 6. Medical Staff Cardiologists: Dr Pugh Dr Farrer Dr Junejo Dr Agrawal Dr Olszewski Dr McClure Registrar: Change every 6 - 12 months SHO: 1 based on CCU, B22 and CPAU Change every 3 months Allied Health Professionals Pharmacist Kirsten Shearer Dietician Anna Pickings Physiotherapist Christine Scott Occupational Therapist Tracey Rumfitt 6 SP/12/05
  7. 7. ACUTE CARDIOLOGY DEPARMENT PHILOSOPHY OF CARE The staff of the Acute Cardiology Department will endeavour to deliver the highest standard of nursing care to patients under their care. This will be achieved by creating an optimum environment in which skilled nurses using a recognised model of nursing will address issues of individual and holistic care without prejudice. Each Practitioner will be accountable for delivering nursing care that promotes and maintains the optimum health of individuals. Constantly seeking to improve quality of care and implementing evidence-based care. Continually updating skills to ensure the advancement of knowledge, skills and practice. Ultimately providing an effective and efficient Cardiology Service. 7 SP/12/05
  8. 8. Hours of Duty Whilst on placement Student Nurses will be allocated a Mentor, and will work with their Mentor during a variety of shifts across a 24 hour period. By working days, nights, and weekends it will allow quality time to be spent with their Mentor, providing great opportunities for learning, to ensure all aspects of Cardiology Care are experienced. Learning during the placement is the Student’s responsibility; their Mentor will facilitate this learning to help them achieve the objectives set. Any problems or recurring issues experienced by the Student Nurse should be expressed to their Mentor or Ward Manager during the placement so they can be resolved before the end of the placement. Hopefully, this will create an atmosphere conducive to learning, and make the experience an enjoyable one. Early 7.30 am - 4.15 pm Early half day 7.30 am - 1pm Late 12.30 pm - 8.30 pm Reverse half day 3 pm - 8.30 pm Thirteen Hour 7.30 am - 8.30 pm Night Duty 8.15 pm - 7.45 am Referrals / Admissions • Direct admissions from Ambulance Service • GP Direct • Accident and Emergency Department • Clinical Decisions Unit • Admission Wards 8 SP/12/05
  9. 9. • Any other ward or patient area within CHS Ward Rounds At least twice daily on CPAU by the Cardiologist on call. Daily on CCU: Monday Dr Farrer Tuesday Dr Pugh Wednesday Registrar Thursday Consultant Cardiologist of the week Friday Dr Junejo B22: Tuesday Dr Pugh Thursday All Cardiologists Friday Dr Junejo 9 SP/12/05
  10. 10. GLOSSARY OF ABBREVIATION USED WITHIN ACUTE CARDIOLOGY DEPARTMENT ACS Acute Coronary Syndrome IV Intra Venous AF Atrial Fibrilation LBBB Left Bundle Branch Block Ant MI Anterior Myocardial Infarction LVF Left Ventricular Failure Ant-Lat Anterior Lateral Myocardial MI Myocardial Infarction Infarction APTT Activated Partial Thromboplastin MSU Mid Stream Urine Time AV Atrio-Ventricular MSW Medical Social Worker BP Blood Pressure NAD No Abnormality Detected BM Boeehringer Mannheim NBM Nil By Mouth Mellitus (Blood Glucose) NIDDM Non-Insulin Dependent Diabetes CABG Coronary Artery Bypass Graft NPU Not Passed Urine CCU Coronary Care Unit NSAID Non-Steroidal Anti Inflammatry Drug CE’s Cardiac Enzymes OT Occupational Therapist CHB Complete Heart Block PAWP PulmonaryArtery Wedge Pressure CO Cardiac Output PE Pulmonary Embolism COPD Chronic Obstructive Pulmonary PEA Pulseless Electrical Activity Disease CPAU Chest Pain Assessment Unit Post MI Posterior Myocardial Infarction CPR Cardio-Pulmonary Resuscitation PU Passed Urine CVP Central Venous Pressure PVD Peripheral Vascular Disease C&S Culture and Sensitivity Px Prescribed CXR Chest X-ray RBBB Right Bunble Branch Block DC Direct Current SVT Supra-Ventricular Tachycardia DU Duodenal Ulcer Sync Synchronised ECG Electrocardiograph TNK Teneceplase ECHO Echocardiogram U/A Unstable Angina ETT Exercise Tolerance Test U&E’s Urea and Creatinine FBG Fasting Blood Glucose VE Ventricular Ectopics FWT Full Ward Test VF Ventricular Fibrillation GTN Glycerine Tri Nitrate VT Ventricular Tachycardia HR Heart Rate V/R Ventricular Rate Inf MI Inferior Myocardial Infarction VSD Ventricular Septal Defect Inf-Lat Inferio-Lateral WPW Wolff-Parkinson-White MI Myocardial Infarction IM Intra Muscular 10 SP/12/05
  11. 11. LEARNING OPPORTUNITIES Frequent physiological conditions • MI • Angina • Heart Failure • Arrythmias • Cardiomyopathy • Pericarditis • Endocarditis • Cardiogenic Shock Clinical Procedures • Insertion of Central Venous Pressure Line • Insertion of Temporary Pacing Wire • Pericardiocentesis • Insertion of Intra Aortic Balloon Pump • Synchronised Cardioversion • CPAP 11 SP/12/05
  12. 12. Diagnostic Tests • Cardiac Enzyme Troponin T • Exercise Tolerance Test • Echo • Angiography • Myocardial Perfusion Scan • Cardiomemo • 24 Hour Tape Journals, Books etc A selection of Cardiac Journals can be found in the Research Office on B22 Selected titles of recent Cardiology Books are available - see Sr Bell / Roper 12 SP/12/05
  13. 13. LEARNING OPPORTUNITIES KEY ELEMENT INTERPERSONAL SKILLS LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONNEL / DEPARTMENT Use of the telephone: Ward clerk / ward staff Answering calls Making calls Ring back etc Bleep system Use of computer to obtain: Ward clerk / ward staff Patient investigation results Patient information Talking to: Ward manager / Clinical Lead Patients Registered / Auxiliary nurse Relatives Doctors, Multi-disciplinary team Doctors Other nurses including specialist nurses Multi-disciplinary team referrals Registered nurses / OT / Physio / Social worker / Specialist nurses Ancillary staff Domestics MDT meetings Registered nurses Doctors ward round Doctors / registered nurses / pharmacists Consultant ward rounds Booking transport Ward clerk / Ambulance control / Hospital transport Dept Facilitating investigations Registered nurses / Doctors / ward clerk Nurses handovers Registered nurses Managerial structure in Trust Ward manager Team working Observation of role Patient transfer in Trust Patient / relative / registered nurse / bed Patient transfer outside the Trust manager / porter / ambulance crew. KEY ELEMENT 13 SP/12/05
  14. 14. CLINICAL SKILLS LEARNING OPPORTUNITIES RESOURCE / RELAVANT PERSONNEL / DEPARTMENT CORE SKILLS: Patient hygiene Registered / auxiliary nurse / occupational therapist Mouth care Registered / auxiliary nurse Hair / nail care Skin care Pressure care prevention (Braden Scale) Recording of physiological observations: Registered / auxiliary nurse / Doctor Blood Pressure Temp, Pulse, Resps Weight Blood Glucose Registered nurse / Diabetic nurse specialist Urine Output Registered / auxiliary nurse Maintaining accurate charts Giving medications - Registered nurse / Pharmacist / Doctor Oral Intramuscular Subcutaneous Intravenous Rectal Intravenous infusions Registered nurse / Infection control nurse Cannulation / Care of venflons Medical devices - Registered nurse / Medical electronics Infusion pumps Syringe drivers Phlebotomy / venepuncture Registered nurse / Phlebotomists / path lab Administration of blood / blood products Registered nurse Aseptic techniques, i.e. dressings Registered nurse Risk assessment Registered nurse Nutritional intake BMI Falls assessment Moving and handling Registered nurse / Physiotherapist / Moving 14 SP/12/05
  15. 15. Use of aids and Handling Advisor Hoists Infection Control Registered / Auxiliary nurse / Control of Isolation of patients Infection nurse Catheter insertion and care Registered nurse Test urine Registered Auxiliary / nurse Central venous pressure lines Registered nurse Patient safety Registered nurse Checking equipment Registered nurse / Medical electronics / works dept Preparation for investigations Registered nurse / Doctor Consent Information Invasive radiology Registered nurse / Radiology nurse / Non-invasive radiology Doctor SPECIALIST SKILLS Nurse Thrombolysis Emergency Care Practitioner (ECP) Temporary Pacing wires Registered nurse / Doctor Synchronised Cardioversion Registered nurse / Nurse Consultant Pericardiocentesis Registered nurse / Doctor Intra Aortic Balloon Pump Registered nurse / Nurse Consultant CPAP Registered nurse / Nurse Consultant Investigations: Cardiac enzymes - Troponin T Registered nurse Exercise Tolerance Test Registered nurse / Doctor / ECG Dept Echocardiography Registered nurse / Doctor / ECG Dept Angiography Registered nurse / Angiography nurse Myocardial Perfusion Scan Registered nurse / Medical Physics nurse / Doctor Cardiomemo Registered nurse / ECG Dept 24 hour tape Registered nurse / ECG Dept KEY ELEMENT 15 SP/12/05
  16. 16. HEALTH DEVELOPMENT OPPORTUNITIES LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONNEL / DEPARTMENT Healthy lifestyle strategies in relation to: Smoking cessation Smoking cessation advisor / pharmacist Alcoholic Liver Disease Dietician / Gastroenterology nurse Bowel disorders Dietician / Upper GI nurse Cancer Macmillan nurse / Hospice Obesity Dietician / Practice nurse Diabetes Dietician / Diabetic nurse specialist Eating for a healthy heart Dietician / Registered nurse / rehab nurse Drug and alcohol abuse Drug and alcohol team Promotion of exercise Physiotherapist Stroke rehabilitation Stroke unit / Physio / OT Healthy heart CHD nurse / Heart failure specialist nurse Pulmonary rehabilitation Respiratory specialist nurse Health education and health promotion Health Promotion Unit literature City Hospitals Web site Internet Models of health promotion/ education Specialist nurse clinics Discussion with mentor Interface between hospital and community HAZ care Health Promotion Unit Specialist nurses CHD Community nurse Counselling Macmillan nurse specialists Hospice Clinical psychology KEY ELEMENT 16 SP/12/05
  17. 17. MANAGEMENT OF CARE LEARNING OPPORTUNITIES RESOURCE / RELEVANT PERSONNEL / DEPARTMENT Use of nursing model Registered nurse Philosophy of care Registered nurse Documentation used Registered nurse Chest Pain Assessment Emergency Care Practitioner Nursing process: Assessment - Who assesses? Registered nurse How is assessment carried out / open or Sources of information closed questions? Patient, relatives, doctor, pharmacist, notes, What is assessed? district nurses, specialist nurses Where does it take place? Planning - Care plans Registered nurse Risk assessment tools Registered nurse / Link nurses Care pathways Registered nurse / specialist nurses Multi-disciplinary plan / working MDT Discharge planning Discharge liaison nurse Referrals to other agencies - Registered nurse OT Physio Social worker District nurse Discharge liaison Specialist nurses Critical Care Outreach nurse Macmillan nurse Hospice Relevant departments Implementation / Evaluation - 17 SP/12/05
  18. 18. Ward rounds Registered nurse / Doctors MDT Registered nurse Documentation Registered nurse Standards Registered nurse Protocols Registered nurse Policies Registered nurse Patient Group Directions Registered nurse Communication / patient / relatives Registered nurse Time management Registered nurse Planning priorities Registered nurse Dealing with difficult situations Registered nurse Deceased patients Registered nurse / Doctor Patient property / Valuables Registered nurse / General office Self discharge Registered nurse / Doctor Religious needs / arranging priest / Registered nurse / hospital chaplain / priest communication etc 18 SP/12/05
  19. 19. KEY ELEMENT ORGANISATIONAL AND MANAGERIAL ISSUES LEARNING OPPORTUNITIES RESOURCE / RELVANT PERSONNEL /DEPARTMENT Managing a team: Organisational skills Registered nurse / team leaders / manager Delegation skills Registered nurse / team leaders / manager Prioritising skills Registered nurse / team leaders / manager Time management Registered nurse / team leaders / manager Leadership Registered nurse / team leaders / manager Off duty Team leaders / manager Managing patient workload Registered nurse / team leaders / manager Quality Registered nurse / team leaders / manager Standards of care Registered nurse / team leaders / manager Implementing change Registered nurse / team leaders / manager Giving information to: Staff Registered nurse / team leaders / manager Doctors Registered nurse / team leaders / manager Patients Registered nurse / team leaders / manager Relatives Registered nurse / team leaders / manager Multi-disciplinary team members Registered nurse / team leaders / manager Other departments Registered nurse / team leaders / manager Resources: Stock control Registered nurse / Pharmacist / stores Drugs Registered nurse / Pharmacist TSSU Registered nurse / TSSU Materials management Registered nurse / stores Non - stock Registered nurse / stores Stationary Registered nurse / ward clerk / stores Establishment / skill mix Ward manager Budget control Ward manager Managing risk: Policies and procedures Registered nurse Equipment safety checks Health and safety officer / electronics Quality control Health and safety officer and link nurse 19 SP/12/05
  20. 20. Environment checks Domestic supervisor Infection Control Control of infection sister Moving and Handling Moving and handling co-ordinator COSHH Link nurse Health and Safety Link nurse Emergency situations: Cardiac arrest Registered nurse / arrest team Fast bleep system Registered nurse / switchboard Violent incidents Registered nurse / Security officer Fire Registered nurse / Fire officer Bed alerts Registered nurse / Bed manager Patient falls Registered nurse / health and safety officer Staff Developments: Clinical supervision Registered nurse Reflective practice Registered nurse 20 SP/12/05
  21. 21. KEY ELEMENT PATHOPHYSIOLOGICAL PROCESSES LEARNING OPPRTUNITIES RESOURCE /RELEVANT PERSONNEL / DEPARTMENT Infection: Inflammatory process Registered nurse / Doctor / Pharmacist / Source books / articles Nature spread Treatment Immunological factors: Antigens Registered nurse / Doctor / Pharmacist / Autoantigens books / articles Suppression of immune system Drugs Disorders Disturbances in water and electrolyte balance: Normal electrolyte balance Registered nurse / Doctor / Pharmacist / Reading and understanding blood results Renal team / books / articles Dehydration Water excess (ADH) Acidosis Oncology: Epidemiology Registered nurse / Doctor / Pharmacist / Aetiology books / articles / Macmillan nurse / Pathology Hospice Treatments chemotherapy, radiotherapy, Chemotherapy unit / Radiotherapy dept Drugs 21 SP/12/05
  22. 22. Cardiovascular system: Anatomy and physiology Registered nurse / ECP / Doctor / ECG / Conduction system and ECG books / articles Investigations Registered / Angiography nurse Treatments Registered / ECP / Doctor Myocardial infarction Registered / ECP / Rehab nurse Angina Registered / ECP / Doctor Heart failure, CCF, LVF Heart Failure nurse Cardiac arrest Registered nurse / Doctor Hypertension Registered nurse / Doctor Cardiac Arrhythmias Registered nurse / Doctor Cardiogenic shock Registered nurse / Doctor Drugs Registered nurse / Doctor / Pharmacist Respiratory system: Anatomy and physiology Registered / Respiratory nurse / Doctor Investigations Pulmonary technician Infections Doctor / Pharmacist Treatments Chest infections COPD Asthma Emphysema Fibrosis Drugs Nebulisers, inhalers, oxygen therapy Liver and Biliary system: Anatomy and physiology Registered nurse / Doctor / GI nurse / Jaundice Endoscopy unit Tumours Macmillan nurse Alcoholic liver disease Drug and alcohol unit Nutrition Dietician Treatments Kidney and Genitourinary system: Anatomy and physiology Registered nurse / Doctor / Continence Infections nurse / Radiology Drugs Investigations Testing urine Pyelonephritis Fluid balance 22 SP/12/05
  23. 23. Diseases of the blood: Blood formation and destruction process Registered nurse / Doctor / books / articles Red blood cells Haematology unit White blood cells Platelets Anaemia's Blood transfusions Malignant disorders Lymphomas Leukaemia's Myeloma Haemorrhage Thrombosis Endocrine and Metabolic disease: Diabetes mellitus Registered nurse / Doctor / Diabetic nurse / Thyroid problems Endocrine nurse / Pharmacist Long term use of steroids Pituitary problems Nervous system: Epilepsy Registered nurse / Doctor / Pharmacist Tumours Headaches CVA Stroke unit / Specialist nurse Infections Control of Infection nurse Connective tissue, joints, bones: Arthritis Registered nurse / Doctor / Pharmacist / Lupus Specialist nurse / Physio / books / articles Osteoarthritis Osteoporosis How bones heal Infection Acute poisoning: Causes Registered nurse / Doctor / Pharmacist / Treatments Poison unit Drugs 23 SP/12/05
  24. 24. 24 SP/12/05