CME/CE – The Cardiac Cath Lab: Updating Best Practices

CME/CE – The Cardiac Cath Lab: Updating Best Practices
Author Information (click to view)

Srihari S. Naidu, MD, FACC, FSCAI, FAHA

Associate Professor of Medicine
SUNY Stony Brook School of Medicine
Director, Cardiac Catheterization Laboratory
Director, Interventional Cardiology Fellowship Program
Director, Hypertrophic Cardiomyopathy Treatment Center
Winthrop University Hospital

Srihari S. Naidu, MD, FACC, FSCAI, FAHA, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the latest update to the Society for Cardiovascular Angiography and Interventions’ expert consensus statement on best practices in the cardiac catheterization laboratory.

Method of Participation(click to view)

Release Date: 4/30/17
Expiration Date: 4/30/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at akhcme.com/akhcme/lessons/6.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Srihari S. Naidu, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.

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Srihari S. Naidu, MD, FACC, FSCAI, FAHA (click to view)

Srihari S. Naidu, MD, FACC, FSCAI, FAHA

Associate Professor of Medicine
SUNY Stony Brook School of Medicine
Director, Cardiac Catheterization Laboratory
Director, Interventional Cardiology Fellowship Program
Director, Hypertrophic Cardiomyopathy Treatment Center
Winthrop University Hospital

Srihari S. Naidu, MD, FACC, FSCAI, FAHA, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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The Society for Cardiovascular Angiography and Interventions has updated its recommendations for best practices in the cardiac catheterization laboratory. The document outlines important updates and details on how cardiac cath labs should operate.
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Several years ago, the Society for Cardiovascular Angiography and Interventions (SCAI) published an expert consensus statement on best practices in the cardiac catheterization laboratory (CCL) to provide clinicians with standards for pre-, intra-, and post-procedural evaluations and patient management. The document, released in 2012, offered important recommendations for taking a patient-centered approach to safety and quality in the CCL, a setting in which high throughput and increasing patient complexity demand optimal peri-procedural communication, clinical management, documentation, and protocols.

“In 2016, SCAI updated this consensus statement to better address process standardization in CCLs,” explains Srihari S. Naidu, MD, FACC, FSCAI, FAHA, who was lead author of the 2016 update as well as the 2012 paper. “Many CCLs had been working under only local regulation and policies. Over the past several years, there has been increasing interest among interventional cardiologists for a comprehensive document that outlines the details on how CCLs should operate.” He adds that it is important to tailor directives to the percutaneous setting in order to assure quality, optimize patient safety, and maintain efficiency.

A Helpful Update

The 2016 update from SCAI, published in Catheterization and Cardiovascular Interventions, outlines best practices in the CCL with a set of evidence-based, agreed-upon recommendations that were developed by expert interventional cardiologists. The update was designed to improve patient and physician satisfaction by offering pre-, intra-, and post-procedure recommendations to ensure the highest quality of care and improve patient outcomes.

An important component to the SCAI update is an updated pre-procedure checklist for cardiac catheterizations. The checklist provides nurses, technicians, physician extenders, and physicians with a set of questions to review with patients before they undergo these procedures. “The checklist notes that all members of the procedural team must be present for a ‘time out’ before the procedure takes place, immediately before vascular access is obtained,” says Dr. Naidu.

The physician taking ultimate responsibility for the procedure should lead the time out and ensure that each of the following items is announced:

  1. The patient’s name and medical record number.
  2. The precise procedure to be performed.
  3. Confirmation that the equipment needed is available or alternatives are available, including intended stent type for PCI or cath-possible patients.
  4. The patient’s allergies and pre-medication, if appropriate.
  5. Any special laboratory or medical conditions the patient may have.
  6. Confirmation that informed consent was signed, witnessed, and present.

“The SCAI update also provides clinicians with techniques on how CCLs can improve function through effective governance and management strategies,” Dr. Naidu says. In addition, the document outlines specific strategies that CCLs can employ to provide the highest value of care.

 

Treatment Information

When SCAI released its previous recommendations in 2012, the document did not cover information regarding the recent support for using radial access procedures. “The SCAI update now includes best practices on when radial access is appropriate and factors that CCLs should take when considering using this treatment approach,” says Dr. Naidu. “The update also provides clinicians with new evidence on medications that have been brought to market since the last consensus document was published, including information on when to use certain drugs and the appropriate dosage amounts of these medications.”

 

Maintaining Industry Relationships

Recommendations on maintaining appropriate industry relationships are a new addition in the SCAI update. “This is a hot-button topic,” Dr. Naidu says. “SCAI recommends that industry’s role in individual CCLs should be consistent with policies set by the hospital and/or director.” Industry should not have “hands-on” equipment in the CCL, except for defined educational purposes or device preparation. In addition, it is recommended that industry always provide information and advice that is in the best interest of patients, regardless of other considerations.

The SCAI update to the expert consensus statement also cross-references other SCAI reports and documents, reflecting the direction in which the profession of interventional cardiology is heading. “These recommendations are patient-centric and strive to enhance patient satisfaction,” says Dr. Naidu (Table). “The document also specifically addresses cost containment strategies that should be implemented when managing all patients in the CCL.”

The measures outlined in the SCAI document are critical to patient safety, laboratory efficiency, and patient and referring physician satisfaction. Healthcare systems should provide resources through adequate staffing, equipment, and information technology—including physician extenders where appropriate—to ensure that the performance of these practices are effective and that they be reviewed from time to time.

Readings & Resources (click to view)

Naidu SS, Aronow HD, Box LC, et al. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2016 Apr 24 [Epub ahead of print]. Available at: http://www.scai.org/Assets/d85693c6-2c9d-4937-ae68-06dc9c1385ff/635977899021470000/cci-26551-2016-05-02-pdf.

Naidu SS, Rao SV, Blankenship J, et al. Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2012;80:456-464.

Harold JG, Bass TA, Bashore TM, et al. ACCF/AHA/SCAI 2013 Update of the clinical competence statement on coronary artery interventional procedures: A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures). J Am Coll Cardiol. 2013;62:357-396.

Rao SV, Tremmel JA, Gilchrist IC, et al. Best practices for transradial angiography and intervention: a

consensus statement from the Society for Cardiovascular Angiography and Intervention’s transradial working group. Cathet Cardiovasc Interv. 2014;83:228-236.

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