CLINICAL PATHWAY: ELOS: 1 Day

Hôtel-Dieu Grace PERMANENT PACEMAKER INSERTION Date Approved: November 2002

Hospital
Date Revised: September 2006 V.3
DATE: DATE: DATE: DATE: DATE:
EVENT Pre-AdmissionClinic Pre-Op O.R. DAY
POST-OP TELEMETRY POST-OP DAY #1
Intraoperative PACU
Outcomes/Goals -verbalizes an understanding of -prepared for surgery -minimal anxiety -minimal anxiety -stable vital signs - stable cardiac rhythm
the operative process and at -OR checklist completed - reasonable pain control - reasonable pain control -stable cardiac rhythm - ready to manage care at
home care -maintenance of body temperature -maintenance of body temperature -cardiologist/internist/intensivist home or CCAC arranged
-free from injury, infection -free from injury, infection notified of admission
-hemodynamically stable -hemodynamically stable
-respiratory status stable -respiratory status stable
- meets PACU discharge criteria
Assessment & -complete Day of Event -patient to change into - interview patient, review chart in - monitor vital signs/rhythm -vital signs - Pacemaker Technician to do
Intervention Summary gown holding area - complete PACU Record -check incision/dressing threshold testing
-develop Plan of Care -vital signs recorded - verify patient, surgery - arm in sling post procedure as -F.H.P. assessment Q4-8 h - If rhythm stable discontinue
-review anaesthesia -start IV - ensure CCU/X-ray tech called to ordered -icepack to incision monitor
questionnaire -review Day of Event OR -monitor – document rhythm Q
-notify Pacemaker Clinic (ext. Summary - provide reassurance to shift
3215) -complete OR chart patient/family
-notify OR of any pertinent -OR checklist completed - monitor vital signs/rhythm
information (ie, latex allergy, MH) -ensure patient has voided - complete Perioperative Flow
pre-operatively Sheet
-inpatients – move chest - defibrillator cart in room
leads to back - quick combo pads (prn)
Diagnostics/ - 12 lead ECG -ensure results are on chart Duplex scan or ultrasound prn - CXR in PACU - ECG early in a.m.
Laboratory - CBC, SMA7
- PTT, INR if on
anticoagulants/aspirin
Consults -ensure medical referral history -cardiologist/internist/ -notify cardiologist on call if any -notify cardiologist on call if any -notify cardiologist on call if any -notify cardiologist on call if any
is on chart intensivist arrythmias arrythmias arrythmias arrythmias
identified as needed
Nutrition N/A -NPO -NPO -NPO -NPO X 2 h then DAT - DAT
-IV until stable Æ I.V.C. - remove I.V.C.

Activity N/A -ambulate/stretcher to OR - ensure patient’s bed goes to OR -assist to move with roller post-op -arm in sling - AAT
- to OR by bed if inpatient -AAT – limit shoulder/arm
movement (if new leads)
Medications -obtain accurate history of -note any medications taken -antibiotic as ordered -antibiotic as ordered -analgesic as needed - analgesic as needed
medications taken including or given on OR chart -analgesic as needed -analgesic as needed
allergies -IV antibiotic if ordered - local with IV anaesthetic standby
-check with surgeon re:
anticoagulants/aspirin before
surgery
 CLINICAL PATHWAY: PERMANENT PACEMAKER INSERTION
DATE: DATE: DATE: DATE: DATE:
EVENT Pre-Admission Pre-Op O.R. Day
Clinic POST-OP TELEMETRY POST-OP DAY #1
Intraoperative PACU
Teaching -start Education Record -reinforce teaching done in -OR process pre- -post-op exercises -give Education Booklet & review key points - reinforce all teaching – wound care, activity and pain
-review pamphlet- n Patient PAC anaesthesia -review Patient Pathway control measures
Pathway -answer any questions -ensure patient gets Pacemaker I.D. Card - review Education Booklet
o “Important Things to -inform of time frame in OR - Education Record completed
Remember The Day of Your
Surgery”
-instruct to take specific meds at
least 2 hours before surgery
-review wound care, activity
level, pain control measures
Discharge -ensure PAC form indicates -transfer to PACU -transfer to Telemetry - Pacemaker Clinic follow-up appointment arranged
Planning Telemetry post-op -surgeon reassures family - Ensure suture removal appointment is arranged
-usually patient stays overnight members post procedure - CCAC if required
-identify any special needs, - Script given to patient
CCAC
-ensure patient makes plans for
ride home day after surgery
Progressing on Y N : Y N : Y N : Y N : Y N : D Y N : D
Path Y N : E Y N : E
(Yes or No) Y N : N Y N : N
Variances
A. Patient / Family A. _____________ A. _____________ A. _____________ A. _____________ A. _____________ A. _____________
1. Patient Condition
2. Patient/family
decision
3. Patient/family
availability B. ______________ B. ______________ B. ______________ B. ______________ B. ______________ B. ______________

B. Provider
4. Decision by
provider
5. Physician order
6. Response time of C. ______________ C. ______________ C. ______________ C. ______________ C. ______________ C. ______________
provider

C. Facility
7. Bed/appointment
time availability
8. Information/data
availability
9. Resource D. ______________ D. ______________ D. ______________ D. ______________ D. ______________ D. ______________
(supplies/equipment)

D. External
10. Placement/home
care availability
11. Transportation E. ______________ E. ______________ E. ______________ E. ______________ E. ______________ E. ______________
availability

E. Other

***RETURN TO CLINICAL PATHWAY COORDINATOR ON DISCHARGE*** Form # 4-2143