Looking after the heart

By Kimberley S. Jordan, RN | May 15, 2007

In January 2007, after a major renovation involving nearly 11,000 square feet of space, a state-of-the-art cardiovascular center opened at Jordan Hospital in Plymouth, Massachusetts. The opening of the new Cardiovascular Center at the nonprofit, 150-bed acute care hospital, which serves approximately 240,000 residents in 12 towns along the South Shore, marks an important healthcare milestone not only for area residents, but also for the Jordan Hospital staff.

More room, more technology, local care
"Jordan's patients," says Ann-Marie E. McDonough, RN, MSN, director of cardiovascular services, "now have access to the most up-to-date diagnostics and treatment for heart disease as well as arterial and venous disorders." The Cardiovascular Center complex includes a new cardiac catheterization lab, an area for endovascular procedures, and areas for EKG testing, stress testing, and echo labs. In addition, the new center has a reception suite where patients are welcomed, designated areas for physician consultation, and a preparation and a recovery suite.

Just as important as the expanded space is the new technology housed in the center. For instance, the cardiovascular department now has the Philips Allura Xper FD20 imaging device, an apparatus that uses the latest technology to diagnose and treat a wide range of cardiovascular conditions. "The hospital has also provided the department with a cardiovascular digital archiving CPACS system," says McDonough. "That system will allow the staff cardiologists immediate access to interpret noninvasive exams such as echocardiograms and EKGs online, anywhere they have Internet access."

A major advantage of the new facility is its ability to offer expanded services. For instance, the new area will expand the hospital's current provision of noninvasive studies such as echocardiology, stress testing, vascular imaging, vascular testing, and cardioversions. In addition, peripheral and renovascular disease are now included in the conditions that can be treated locally along with diagnostic cardiac catheterization. Thanks to a tertiary relationship with Boston Medical Center, interventional and invasive cardiologists from BMC travel to Jordan Hospital several days each week to perform cardiac catheterizations.

Eric Awtry, MD, is the medical director of the cardiac catheterization lab. He is also the director of education for the division of cardiology at Boston Medical Center. Awtry highlights the significance of the collaboration between the two centers when he says, "Linking a state-of-the-art community cardiovascular center with a nationally recognized cardiac center of excellence like Boston Medical Center means the Jordan community will enjoy convenient and timely access to the best cardiovascular care now and in the future."

Having this advanced care available locally allows Jordan patients to receive the individualized care they need while remaining close to home. This will reduce some of the physical, emotional, and financial strain on patients and their caregivers. It also will make it easier for a patient's existing healthcare providers to remain involved in the treatment plan, thereby minimizing anxiety and alleviating the burden of establishing a relationship with a new healthcare team.

A dedication to learning, a commitment to making a difference
Jordan Hospital has long been known for its commitment to the community. Opening the new Cardiovascular Care Center is a major step toward ensuring that area residents can continue to receive the most advanced treatment in their own community. And while the new facilities and state-of-the-art equipment are both key components in making that level of care available, Jordan Hospital recognizes that quality care does not happen without a dedicated and committed staff.

McDonough has been instrumental in making the newly available services a reality. As part of that effort, she has created and developed new positions, hired staff who are both qualified and motivated, and created a comprehensive educational program to help them develop new skills and maintain competency. For example, Michael Stevenson, PA-C, did an internship with the PAs at BMC, and McDonough is currently mentoring staff who will assume clinical management roles in their various departments. "The non-invasive RNs," McDonough says, "are currently learning both pre- and post-cath care with the interventional cardiology nurses at BMC."

In addition, McDonough has produced educational programs for staff in other areas of the hospital who will ultimately care for the patients undergoing the new procedures. She has also devoted considerable time to developing programs for community education with an emphasis on prevention. According to McDonough, "Patients are continually saying thank you for making advanced cardiac care available so close to home."

"McDonough has created and developed new positions, hired staff who are both qualified and motivated, and created a comprehensive educational program to help them develop new skills."

Working to improve people's lives
Collaboration between the staff at Jordan and the staff at BMC is essential to ensuring continuity of care. Part of that responsibility rests on Stevenson's shoulders. In addition to obtaining patients' histories and ordering labs, medications, and tests that may be required prior to the catheterization procedure, Stevenson is Jordan's on-site physician extender for the invasive cardiologists at BMC. After Jordan's staff cardiologists screen patients and determine their condition is medically appropriate for the lab's existing capabilities, Stevenson reviews the information and relates it to the BMC physicians. He also monitors the patients after the procedure and identifies and manages any complications.

"I'm anxious to be part of a project that has such relevancy to our patients' everyday lives," Stevenson says. "Once we receive interventional privileges in the cath lab, we will be able to change people's lives in huge ways via angioplasty, stents, and/or bypasses. Providing a service [that] improves the everyday lives of our patients is both gratifying and part of our responsibility as healthcare practitioners."

"I'm anxious to be part of a project that has such relevancy to our patients' everyday lives."

Monica Morelli, RN, is known as the "patient person" and serves as Cardiovascular Center's primary patient advocate. Her duties include prepping patients for their procedure, making sure the time-out protocol is followed, administering moderate sedation, and monitoring vital signs. She also is responsible for communicating with patient families to explain procedures and to give updates about the patient's condition.

In addition, as an RN she often functions as the "recorder" for a case. The recorder is responsible for noting various blood-pressure readings and measurements related to the heart's functionality. That data is then used to make a final diagnosis of the patient's condition. The recording process also captures information that Morelli submits to McDonough for mandatory reporting to state and national regulatory agencies.

Cynthia Martin, RT, CVIT, scrubs in on cases and directly assists the physician. She also operates the imaging equipment and is responsible for processing all of the films that are taken during the procedure. As a radiology technologist, she can also "record" procedures utilizing the cardiovascular information system (CVIS). In addition, McDonough relies on Martin to monitor radiation exposure for all patients and staff. "I love my job," Martin says, "and find it rewarding to be a part of bringing these services to the communities served by Jordan Hospital."

Connecting with the community
As the manager of cardiopulmonary rehabilitation, Kristin Alvarenga, who is a master's prepared exercise physiologist, oversees the provision of cardiopulmonary rehabilitation services on an outpatient basis. Her department, which consists of two RNs and representatives from social services, pharmacy, and dietary, also delivers educational outreach programs for the community. "I am brainstorming with Ann-Marie McDonough and Dr. Eric Johnson (the medical director of Jordan's cardiac rehab program) about developing a prevention program for people in the community with risk factors for cardiac disease, such as diabetes and smoking." Alvarenga adds that two nurses, Cheryl Gomes and Joanne Wenhold, are also involved in the process. "The program will include structured, monitored exercise as well as an educational component and should be available in the very near future."

Since diabetes and cardiac disease often travel hand in hand, education in these areas is vital and can make a tremendous difference in patients' lives. Lois Hutton, RN, CDE, is the manager and coordinator of the diabetes education program. She provides diabetes and prediabetes education, as well as dietary consultation for cholesterol and management of hypertension. Citing the importance of accurate information, Hutton says, "Adherence is not usually the issue with people who receive education. In the 1990s, research showed that good blood-glucose control lowered the risk of complications. Our goal is to enable the patients to get to their target goals for blood glucose, cholesterol, and blood pressure in order to prevent or postpone these complications." In her approach to education, Hutton points out that the patient is the team leader, with the PCP, RN, and registered dietitian as support people. She also emphasizes the importance of achieving good blood-glucose control before patients develop cardiac disease.

In January 2005, after a three-year preparation, Jordan Hospital received Magnet designation. It is the first hospital on the South Shore and the third in Massachusetts to have achieved this recognition. Positive patient outcomes are the objective at Jordan Hospital, and providing facilities such as the Cardiovascular Center and recruiting, supporting, and retaining competent, dedicated individuals who can provide quality care are key components in achieving that goal.

This is the first of a two-part series on the new Cardiovascular Center at Jordan Hospital. In the next installment, Kim Jordan, who is a freelance writer and a nurse who works on a telemetry unit at Jordan Hospital, will describe the patient rehabilitation and education programs.