P613Nurse-led pre-admission clinics for percutaneous coronary intervention (PCI) patients are beneficial and are positively evaluated by patients

Abstract

Background: The nurse-led pre-admission clinic for patients undergoing elective PCI and angiogram +/- PCI, was established in 2009. Appointments take place 1-4 weeks prior to admission. Purpose: Attendance at the clinic prepares patients physically and psychologically for the procedure and also identifies patients who are not fit for admission. This optimises bed usage and reduces length of stay and cancellations. Method: During the two hour appointment, patients are examined by a clinical nurse specialist/nurse consultant who takes a full medical history, examines the patient, completes all the relevant documentation and records an ECG. The procedure is discussed with the patient and risks/benefits explained. Patients are seen by the cardiology pharmacist who takes a full medication history and ensures the patient is prescribed dual antiplatelet therapy prior to admission. The pharmacist, who is a non-medical prescriber, also optimises and advises on other medication (including management of anticoagulation) where necessary. Height, weight, blood pressure measurements, blood tests and screening for MRSA are carried out by a healthcare support worker. Any abnormal findings from the clinic are highlighted and a management plan formulated. Discussion with the medical team regarding patient management takes place if required. Data is prospectively entered into a database and a retrospective analysis was carried out on all patients seen in 2016. Patient experience of attending the clinic was audited for a two-month period using a purpose made questionnaire. Results: A total of 940 patients were reviewed in the clinic in 2016. Three patients were found to be MRSA positive. A further 29 patients (3.09%) had their admission deferred or cancelled. Reasons included -; 5 patients with significant anaemia; 4 patients who declined to have the procedure; 3 patients requiring further cardiology review in clinic; 2 patients referred for CT angiogram; 2 patients with Staphylococcus aureus wound infections; 1 patient with a recent CVA, 1 patient with a recent GI bleed and 1 patient with an allergy to Lidocaine. An additional 511 patients (54.36%) had an abnormal blood test which would need to be addressed during admission. 87 patients (9.26%)were identified as having impaired renal function which required pre-hydration. 157 patient experience questionnaires were sent to patients with a return rate of 54.78%. 100% of the patients were happy to attend the appointment and were satisfied with the information they received in the clinic. 95.35% found the preadmission appointment useful and 94.18% felt there was adequate time to discuss any concerns they had. Conclusion: Nurse-led pre-admission clinics facilitate optimum preparation for patients being admitted for PCI. A small but significant number of patients are identified with problems which could compromise patient safety if they had been admitted. Patient experience of attending such clinics is positive.