According to the American Heart Association, over the past 20 years, hospital admissions for AF have increased by 66%, eliciting a flood of treatment options such as medication regimes, cardioversion and catheter ablation.
The complexity of treatment and myriad post-procedure complications may cause some heart-pounding for critical care clinicians, but the Hospital of the University of Pennsylvania (HUP), Philadelphia, and Sentara Heart Hospital (SHH), Norfolk, VA, have gone above and beyond to prepare their teams for any and all patient types - especially AF sufferers.
Providers caring for AF patients are busy, even from the moment of admission. Patients admitted to HUP for an ablation procedure have been NPO since midnight, according to Gail Delfin, MSN, RN, CCNS, CCRN, and clinicians must negotiate with the different departments to ensure they get the necessary tests done effectively and efficiently.
The most important work, however, comes post-procedure. Providers have to carefully monitor their patients and know how to identify a real problem. Linda Hoke, PhD, RN, CCNS, ACNS-BC, CCRN, noted several complications such as chest pains, hypotension that may indicate cardiac tamponade, retroperitoneal hemorrhage and groin complications. But above all, Delfin, Hoke and Audrey Douglas-Cooke, MS, RN, associate nurse executive at SHH, emphasized the biggest concern - stroke.
"It is so important for clinicians to be aware of what they are monitoring and what they are looking for because, for instance, when someone is having a stroke, it's not always the 'down on one side stroke,' it's that they just cannot move their hand right or they have some numbness or tingling," Hoke explained. "It's really hard to tell the difference between that and what happened in the procedure."
At HUP, which offers ablation for pulmonary vein isolation from the left atrium, the education starts from day one, as newly hired clinicians have to successfully care for several AF patients before coming off of orientation. After orientation, they actively pursue a better understanding of their patients' needs.
"Our providers are required to be at rounds with the team, and that's a great on-site learning experience," Hoke said.
Even with rigorous orientation and ongoing education providers could use some help keeping the complex care procedures in mind at all times. In collaboration with the nurse practitioners and doctors, Hoke implemented a post-ablation patient care guideline, which includes information such as patient needs pre-ablation and what to look for - vital signs, monitoring and complications - post-procedure.
"It was definitely something that was needed," Hoke said. "It really has improved care, collaboration and teamwork."
For patients unable to maintain sinus rhythm through traditional treatments, SHH is participating in the Dual Epicardial Endocardial Persistent AF Study (Staged DEEP) feasibility trial - a collaborative procedure where, working through tiny chest incisions, the cardiothoracic surgeon creates lines of block on the outside of the atrium and, during the same hospital stay, the electrophysiologist tests the surgical lines and completes additional ablation lines using tiny catheters.
As with all of their trials, SHH brought in experts to work with staff during mandatory in-services related to the DEEP trial - education that reinforced their annual competency training.
"We are seeing a population of patients who are participating in the trial who previously did not have any other options," Douglas-Cooke explained. "Our providers have been educated to pay attention to details because these patients are very sick.
"The clinicians know these patients have failed medical management treatment, cardioversion or a routine catheter ablation," Douglas-Cooke continued. "But the wonderful thing about this trial is how nice it is for these patients to go get their DEEP trial and come back in a normal sinus rhythm. I cannot tell you the joy these patients feel when they are being wheeled out the door 24 hours later not feeling as though their heart is jumping out of their chest."
Whether caring for routine ablation patients or those participating in the DEEP feasibility trial, team leaders know well-educated clinicians are what make all the difference to their AF patients.
"I feel this way about all types of care, but I think for these patients, vigilance basically is what keeps them safe," Delfin said. "If something goes wrong, the provider is the first one to detect it and the first one to intervene. Teaching clinicians about vigilance is really key to the success for an uncomplicated atrial fibrillation ablation."
Rebecca Hepp is assistant editor at ADVANCE.