Email Discussion Group: January 2008

Under Discussion: EP Lab Work Schedule Our EP lab will be going to 8-hour shifts, 5 days a week in a couple of months. This is a decision that is widely unpopular with our nurses and techs. I am wondering if any other EP labs work 8-hour shifts (all 7-3:30) 5 days a week, and if so, what has been your experience with this scheduling format? Any pros, cons, suggestions? Lee Henry, RN (To reply to this question, please type Work Schedule in your subject line.) We consider ourselves 8-hour shifts Monday through Friday, but we cannot leave until all cases are completed for each day. Rarely is our day only 8 hours, hence, overtime every day. We have no second shift, nor any replacements, so it is the same four staff members (two RNs, two techs) that complete each day, no matter how long it takes. Having someone call us "8-hour shifts" just makes us laugh. anonymous Our cath lab likes the 10-hour shifts for scheduling. Our EP lab does 8-hour shifts because there are not enough trained people in EP to be able to do 10-hour shifts and allow someone time off for doctor appointments, vacations, birthdays, or whatever. EP has to borrow from the cath lab for personnel. EP has more desire for time off than a 10-hour schedule. Dana St. John, RN We work 10-hour shifts because of the busy caseload here. About two or three nurses work 6:30-4:30, two nurses work 7:00-5:00, one nurse works 7:30-5:30, and two work 8:00-Late (whenever). We typically schedule 6 to 8 nurses a day. We used to work 8-hour shifts (6:30-2:30) and the Late nurses working 8:00-Late. This schedule caused enough overtime to cause administration to finally listen to us and change to a 10-hour shift. This type of shift also caused procedures to be put off until the next day, which we all know doesn't work anymore because of length of stay issues. I think that depending on the volume, 8-hour shifts don't belong in a procedural area. We need to be able to accommodate the patients who need these procedures 10-14 hours a day, not only 8 hours. name withheld by request I am not sure what you are asking/what the real issue is here (the hours the lab is open or the scheduling of the staff), but the hours for our lab have always been 0700-1530 (although we are frequently here later than that) 5 days a week. We have seven EP physicians who do cases in our lab, and all cases are scheduled on a first come, first served basis. Our lab does an average of 13-15 cases per day, so there is no way we could get everything done otherwise. Most of our techs and nurses work the 0700-1530 shift, but we do have some who work 10-hour shifts (0700-1530) and only work 4 days a week. The flexible scheduling allows our staff to take classes, arrange child care, etc. We have a "call" team that stays until cases are done for the day; there are three teams, and each takes call for a week. If someone normally works 10-hour days, they work 8-hour days during their call week. Our staff members do not carry beepers once they leave the lab. The EP lab is not open weekends or holidays. I am not sure if this answers your question or not, but hope it was helpful. Sue Deck, BS, RN, RCES, EP Educational Coordinator, Lancaster General Hospital Our EP staff works 5 days a week. This allows for EP procedures to be done all week. No EP wants to work past 4 pm in the lab. name withheld by request Pocket Closure I am a registered nurse in a fairly new EP lab. The only procedures we currently do are EP studies and AICD/Bi-V AICDs. We have one electrophysiologist on staff. He requested that myself, an RN, and another staff member (an RCIS) learn how to close the pocket. He personally taught each of us how to suture the pocket closed. After approximately 10 months, hospital administration told us we were no longer allowed to perform this task, so we quit. Now, two months later, the RN is being formally reprimanded for working out of her "scope" of practice. Do rules about this vary from state to state, institution to institution, or is it just plain wrong for anyone besides the MD to close the pocket? anonymous (To reply to this question, please type Pocket Closure in your subject line.) Laws vary. We cannot suture. There is a credentialing to be able to do so, but this is not permitted for techs or RNs. Our 12 EP doctors and many cardiologists ALL suture their own pockets. D.L. Hart, RCIS, Valley Hospital, Las Vegas, NV It is out of the scope of practice for any of you to close the pocket of devices. If you are an extensively trained surgical RN to close wounds and are kept current, then closure of wounds is allowed. Having the EP doc show you is not training or education or demonstration of competency. The RN is being reprimanded because of her level of education and a license that can be threatened. I feel sorry for her. name withheld by request In response to your question regarding pocket closure by non-physician personnel, it is truly unfortunate that your RN is being reprimanded since he or she had physician support to perform device pocket closure, but hospitals may require certain procedures be listed in your particular scope of practice. As an RCIS, I often refer my physicians and administrators to the SICP scope of practice, which appears to have been written specifically for the practicing RCIS. It clearly states that the credential RCIS is the recognized cardiac cath lab credential of choice by the American College of Cardiology (ACC) and the Society of Cardiac Angiographers and Interventionalists (SCA&I). It does recommend that additional education and training be completed before assuming responsibilities for which you have not received previous formal training. If you look at that scope of practice, you will find those skills that the SICP believes are applicable for the practicing professional. I believe in the advanced practice of Allied Health Care Professionals in the cath lab, specifically those who have been certified as an RCIS and have the necessary experience to perform these advanced practices. As professionals who have this desire to provide advanced services to our patients move forward, we must do so carefully and make sure we have the approval of our department managers, physicians, and most importantly, hospital administration. Just as attorneys look for case laws to support their clients, we must have examples of programs that provide this service to their customers with excellent results. It is then and only then that we will be able to advance our practices and offer our customers (physicians, managers, and patients) an advanced level of service by qualified individuals that is acceptable to those who tend to question right and wrong. Good luck, and I wish you the very best in your endeavors. James H. Combs RCIS, RCES, EMTP Wearing Hats and Masks / Bringing Food and Drinks Inside the EP Lab Help! We ve been having major discussions about allowing food and drinks into the EP lab. Also, what is the protocol for wearing hats and masks during ablations? We would like to know what other facilities practices are. What do the policies and procedures read, and what is the actual compliance based on the policies and procedures? Janice Christian, RN, CCRN (To reply to this question, please type Inside the EP Lab in your subject line.) Check your Policies and Procedures and Joint Commission rules. No food or drink inside the EP lab; covered drinks are allowed in the separate control room, but still, no food. During EP studies or ablations, hats and masks are worn by scrubbing staff. If the EP study is to be followed by a device, then all in the room have hats and are masked for both procedures. D.L. Hart, RCIS, Valley Hospital, Las Vegas, NV Antibiotics Our electrophysiologist wants to know what is the standard practice for antibiotics post PM and ICD implants. He currently gives a second dose of IV antibiotics, and no oral antibiotic is given at home. Is it common to send patients home on oral antibiotics? Janice Christian, RN, CCRN (To reply to this question, please type Antibiotics in your subject line.) Currently the practice in our EP lab is to give two doses of IV antibiotics, making sure that the first dose has infused completely a half hour prior to incision, and the second IV dose is given 8 hours following that, unless of course vancomycin is used. Our physicians also irrigate the pocket with a 50,000 units/liter solution of Bacitracin throughout the procedure, with one physician doing a dwell time of 5 minutes before the pocket is closed. Oral home antibiotics are given routinely. K.T. Manfull, RN, Affinity Medical Center It is standard practice for antibiotics 24 hours post implant. Patients are not sent home on oral antibiotics routinely. name withheld by request EP Training I have taken a job in the cath lab. I am an RT, wishing to obtain EP training. Could you please tell me where I could go to get effective training without being away from my children for months? Thanks! Cyndi, Ft. Smith, Arkansas (To reply to this question, please type EP Training in your subject line.) There are a number of online resources that can increase your knowledge of EP, including NACCME, which EP Lab Digest links to (www.naccme.com), and the Heart Rhythm Society (www.hrsonline.org). But the most comprehensive is EPreward, who has outlined and organized links to the online education programs from a large variety of sources (www.epreward.com). Go to the EP Links section of their website. Mona, RN Other Questions for Discussion: DFT Testing in Patients with Low Ejection Fractions (EF) Less than 10-15% Shaking the bushes to see if anyone has any anecdotal data regarding defibrillation threshold testing during implant in patients with a low EF% of 10 or less: initial shock, second shock, third shock, rescue-limiting inductions and testing to one course or multiple courses. Single initial shock with number of joules 10 less than defib max. Dana St. John, RN (To reply to this question, please type DFT Testing in your subject line.) EP Exams Has anyone used the online tutorial from HRS and taken the Cardiac Pacing and Defibrillation Exam in the same year? What are your thoughts about the tutorial with regard to passing the exam? How do you feel about the new RCES certification from SICP that was unveiled this year? Has anyone taken this exam? Did the SICP exam appear more difficult than the HRS EP exam, and which exam do you feel is perceived as the more state of the art and respected more by peers and employers? Dana St. John, RN (To reply to this question, please type EP Exams in your subject line.) Atrial Fibrillation Ablation We are newly starting to do atrial fibrillation ablations, and I was wondering if anyone could give me examples of their institution s policy on AF ablations? anonymous (To reply to this question, please type AF Ablations in your subject line.) Service for the EP-3i Stimulator At our hospital (E. Wolfson Medical Center), there is an EP-3i Stimulator that needs technical service (we need to buy a key pad). Is there a distributor in Israel? S. Hanan (To reply to this question, please type EP-3i Stimulator in your subject line.) CT Scanner Integration I am currently working with a Toshiba 64-slice CT scanner, and would like more knowledge on the integration with CartoSync. Where can I find more information about CartoSync? Michael J. Moore BSRT, CT (To reply to this question, please type CartoSync in your subject line.) Roles in EP Lab I have two questions. We are having trouble in our lab hopefully you can help me out. We have three labs, and will be getting our fourth. One of our three labs is an EP lab. We have 3 RTs, 1 RN and an EP coordinator, who is also an RN. How do you handle call time, and what is the role of the coordinator? anonymous (To reply to this question, please type Roles in EP Lab in your subject line.) Loop Implant/Explant I was just wondering what some protocols are for loop procedures, particularly explants. I have recently been told that loop explants should take place in a positive pressure room. Any comments on this matter would be appreciated. Edward Muxlow (To reply to this question, please type Loop Implant/Explant in your subject line.)