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Creating the Team

Ann Ziehmer

Jennifer Priziola

Andrea Alwes


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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Ann Ziehmer, MSN, APRN-BC; Jennifer Priziola, PharmD, BCPS; Andrea Alwes, PharmD
Beaumont Hospital, Troy, MI

The process of developing a comprehensive Pulmonary Hypertension Center within a community hospital requires a multidisciplinary approach. Pulmonary Arterial Hypertension (PAH) is considered an orphan disease, and there are only a few centers-primarily academic-that provide the complex diagnostic and treatment modalities required for PAH. There has been an effort to educate and increase awareness of this disease, at a community level, allowing for earlier diagnosis and initiation of treatment. Often these university-affiliated PAH centers are located hundreds of miles from the patient. The goal, therefore, is to bring the best evidence-based medicine to patients within familiar surroundings, whereby their family and key contacts are nearby and able to offer support through this devastating diagnosis and complicated treatment. We identified a physician champion for the PAH center, as he had the experience-but more importantly, the passion-for treating PAH patients. It was determined, due to the complexity of the diagnostic regime and subsequent treatment modalities, that an advanced practice nurse would be best prepared for the coordinator role. An experienced NP joined the center and further developed the interdisciplinary team, created center-specific tools, provided staff education, and became the patient's link to care. We identified that we needed to promote awareness of not only the center, but also of the disease. Educational forums were held for the RN staff, emergency center, cath lab, house staff, and peri-operative staff, especially as it related to anesthetic issues. Patient safety was key. Our pharmacist took a lead role in organizing standard orders and protocols. "Just-in-time" in-services continue for those who need reinforcement of process at the time patients are admitted. The team determined that the pharmacy would be our gatekeeper, and when a PAH drug was noted on the medication reconciliation form, the appropriate staff would be notified to ensure continuation and safe delivery. Other team members include the cath lab staff and key cardiologists who provide consistency with right heart catheterizations. We developed a vasodilator testing protocol and provided training to ensure accurate data collection. Our physician champion worked with the non-invasive staff and cardiologists to develop a pulmonary hypertension protocol for echo. After 8 months, we surveyed the staff to assess awareness and confidence levels in regards to PAH patients and determine future educational offerings. The ability to provide treatment for PAH within the community hospital environment is invaluable. Patients and families are able to be treated in a center that provides evidence-based care and is close to home, saving them long drives and allowing for families to be integral in treatment. We have invited our patients to participate in the PH network, and have encouraged them to initiate a support group. Individualized information packets are given to patients along with phone support. We have also developed a collegial relationship with a university-affiliated program and identified common research interests. Our ongoing goals include expanding our services, interfacing with integrative medicine to provide comprehensive symptom management, and increasing links for psychosocial and spiritual support.