Note: this following symbol mean 9 = Met X = not met N/A = not applicable

Day 1: EMERGENCY DEPARTMENT / OPD

ER / OPD Day 1 : CCU

1.Assessment

y Emergency or OPD assessment

Fast tract chest pain
y Fast-tract
y V/S with O2 sat. (Record initial BP
in both arms)

1.Assessment

2.Investigation

y EKG 12 Leads stat and with chest

pain
y Blood for save specimen 3 tubes
(EDTA, Clot blood and PTT)

2.Investigation

3.Intervention

y EKG and O2saturation monitoring

y MONA
y IV fluid as order
y Consult Cardiologist stat in case
y of STEMI
y Activate Cath lab in case of primary
PCI
Implement
Pre/ Post cath order
y

3.Intervention

4.Nutrition
5.Activity &
Rehabilitation

y NPO
y Absolute Bed Rest

4.Nutrition
5.Activity &
Rehabilitation

6.PFE

y Explain plan of care and treatment

to patient and family

6.PFE

7.Discharge
plan

y Transfer To
Cath lab for urgent Cath
CCU
y From Cath lab tranfer to CCU

7.Discharge
plan

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F/M-02.1-HEART-021 Rev.0 (21/11/2011)

D E N

y IPD assessment
y Pain assessment
y V/S on admission then every 1 hr
y Assess for thrombolytic contraindication
y Record Intake and output every 8 hrs
y Lab as order
y CXR : Portable
y Obtain EKG with all episodes of chest
y pain and following pain relief.
y Echocardiogram
y Coronary angiogram
y EKG and O2saturation monitoring
y Oxygen therapy maintain O2sat > 94%
y IV Fluid as order
y Clopidogrel
y Heparin/ LMWH
y GP IIb/IIIa (High risk, PCI)
y Nitroglycerine
y Uptitrates b-blocker
y ACIE/ ARB if LVEF < 40%
y Review Patient's own medications
y Referfusion PCI Thrombolytic
y Bleeding precautions with stool quaiacs
if on anticoagulants
y If recurrent pain , consider cath or recath
y NPO until seen by cardiology Attending
y Bedrest until sheaths out or if hemodynamic
unstable
y Otherwise bedside commode.
y Orient to surroundings , equipment , testing
y Explain and give patient copy of patient
ppathwayy and PI
y Assessment for Discharge planning to
establish need for home services or interim
replacement
y See progress note / Physician orders for
reflection pathway integration

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Note: this following symbol mean 9 = Met X = not met N/A = not applicable
Day 2 : CCU .
D E N Day 3 :
.

1.Assessment

2.Investigation

3.Intervention

4.Nutrition

5.Activity &
Rehabilitation
6.PFE
7.Discharge
plan

y Smoking Assessment
y V/S and O2 sat. every 1-2 hrs and
with episodes of chest pain
y Record I/O every 8 hr
y Daily weight by 7.00 am
y Cardiac monitor
y Echocardiogram (If not done Day 1)
y Consider whether stress test
appropriate and what type to done
Obtain
EKG with all episodes of
y
chest pain and following pain relief.
y D/C Oxygen if chest pain free and
O2sat > 94% on Room air
y IV Fluid or IV saline lock
y ACIE/ ARB if LVEF < 40%
y Clopidogrel
y Nitroglycerine
y Uptitrates b-blocker
y Heparin/ LMWH
y Bleeding precautions with stool
quaiacs if on anticoagulants
y Nutrition consult for cardiac prudent
diet teaching
Low
chol. and low salt diet
y
(No concentrated sweets)
y Consult PT consult for Phase I
cardiac Rehab
y Progress activity per Phase I
cardiac Rehab
y Reinforce patient pathway
y Discuss cardiac medications their
use and actions
y Transfer to ward if pain free
hemodinamically and electrically
stable
y Establish discharge plan :

* PCI patient who is revascularized and

hemodinamicallyy stable without significant
g
comorbidities target Day 3-4 discharge
with no additional non invasive testing.
* All other patient target : Day 4-5
discharge (If stable)

D E N

1.Assessment

y V/S and O2 sat. every 4 hrs and with

episodes of chest pain
y Record I/O every 8 hr

2.Investigation

y Cardiac monitor
y Labs : per patient need
y Obtain EKG with all episodes of chest pain
and following pain relief.

3.Intervention

y IV saline lock
y b-blocker
y ACIE/ ARB
y Lipid lowering agent
y Bleeding precautions with stool quaiacs
if on anticoagulants

4.Nutrition

y Cardiac diet teaching by Nutritionist

y Low chol. and low salt diet
(No concentrated sweets)

5.Activity &
Rehabilitation

y Progressive ambulation per Phase I

cardiac rehab (Target 200 ft.)

6.PFE

y Discuss cardiac medications their use

and actions.
For
y active smokers, reevaluate patient s
response to discussion of smoking cessation
and response to not smoking in hospital
Give
patient information document
y
y Confirm discharge plans and services with
team.
p will be obtained,,
y Confirm how pprescription
how patient will get home and contact
appropriate resources if need facilitate this.
y See progress note/ Physician orders for
reflection pathway integration

7.Discharge
plan

y See progress note/ Physician orders

for reflection pathway integration

RN signature

F/M-02.1-HEART-021 Rev.0 (21/11/2011)

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Note: this following symbol mean 9 = Met X = not met N/A = not applicable
Day 4 :
1.Assessment

2.Investigation

3.Intervention

.
y
y
y
y
y
y
y

4.Nutrition

y
y

5.Activity &
Rehabilitation

y
y

6.PFE

y
y

7.Discharge
plan

V/S and O2 sat. every 4 hrs and with

episodes of chest pain
Record I/O every 8 hr
Cardiac monitor
Labs : per patient need
Obtain EKG with all episodes of
chest pain and following pain relief.
IV saline lock
Meds : chest pain protocol. Consider
Once daily dosing of appropriate
agent
Bleeding precautions with stool
quaiacs if on anticoagulants
Diet teaching by Nutritionist
Low chol. and low salt diet
(No concentrated sweets)
Cleared by PT for discharge
Progressive ambulation per Phase I
cardiac rehab
Continue risk factor modification
teaching
Review discharge instruction :
Compleate ACS patient
perception survey

May D/C if 48 hrs sine last episode of

chest pain, no dysrhythymias and
no CHF
See progress note/ Physician orders
for reflection pathway integration

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F/M-02.1-HEART-021 Rev.0 (21/11/2011)

D E N Day Disharge

D E N

1.Assessment

V/S and O2 sat. every 4 hrs

2.Investigation

y
y

Notify cardiologist if RA sat less than 95%

Labs : per patient need

3.Intervention

y
y

4.Nutrition

5.Activity &
Rehabilitation
6.PFE

7.Discharge
plan

IV saline lock
Meds : chest pain protocol. Consider
Once daily dosing of appropriate
agent
y Bleeding precautions with stool
quaiacs if on anticoagulants
y Diet teaching by Nutritionist
y Low chol. and low salt diet
Cleared by PT for discharge
Progressive ambulation per Phase I
cardiac rehab
y Review discharge instruction :
Compleate ACS patient
perception survey

y
y

See progress note/ Physician orders

for reflection pathway integration

RN signature

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