P020: INSTITUTION OF AN ELECTRONIC PRESCRIPTION FOR CIED'S IN OUR INSTITUTION'S ELECTRONIC MEDICAL RECORD, TO FACILITATE THE PREOPERATIVE ASSESSMENT OF THIS GROUP OF PATIENTS.
Keya A Locke, MD, Idania Mejias-Rodriguez, MD, Peggy James; University of Florida-Jacksonville
Introduction: The purpose of our project is to create an electronic tool in EPIC for the assessment of the patients with CIED’s, that would serve as a “CIED prescription” with the Cardiology recommendations, clear and pertinent interrogation results, manufacturer, and performance with magnet placement. In this way all the patients that come to the OR and have a CIED do not need to be delayed for the device to be interrogated in the pre-operative area. We are going to create a link in EPIC where the “CIED Prescription” can be reviewed including the recommendations of the Cardiology team, date of the last interrogation, etc.
Background: After the first permanent pacemaker implantation in 1958 the initial developments in pacemaker technology were aimed towards more efficient pacemaker performance (1). The standard mode of pacing in these early years was a single chamber ventricular stimulation and this became established as effective lifesaving therapy (2). Over the past years, however, there has been a wealth of different features incorporated into the pacemaker design; including programmability, telemetry, and different modes of pacing (3,4,5,6). The ASA and ACHA have recommendations on how to proceed with the patient that presents for an operation and has a Cardiac Implantable Electronic Device (CIED).
Procedures: After IRB approval we distributed a 5 question survey which was distributed to all anesthesia providers in our department. This survey was aimed at discovering current satisfaction with assessment and ease of data availability for patients with CIED’s. We worked with the electronic medical record department to create a prescription template within EPIC and then collaborated with Cardiology to have that link filled out whenever patients present for routine CIED care/interrogation. 30 days after implementation we will then conduct a “post electronic prescription” survey to determine if this has in fact improved provider comfort with intra-op management of patients with CIED’s, satisfaction with access to easily accessible, pertinent and concise CIED information, and mitigated delays in starting the case.
Results: Preliminary results indicate that our institution stands to improve delays in start times as well as provider satisfaction and comfort with management of AICD’s. By improving the presentation of pertinent CIED information and magnet responsiveness, we hope to improve in these areas.
Summary: Our project consists of creating an electronic link in EPIC that incorporates all the information and recommendations from Cardiology department, in accordance with current ACHA regarding the Cardiac Pacemaker or ICD, via an electronic prescription. In our setting most of the patients do not have a wallet card with all the specifications of the device and possible recommendations for anesthesia if possible events happen. For that reason we have collaborated with Cardiology Department and Informatics Service in an attempt to create a conclusive electronic prescription in EPIC that Anesthesia personnel can review. Preliminary results indicate that our institution stands to improve delays in start times as well as provider in the presentation of pertinent CIED information and magnet responsiveness.