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Developing a Pulmonary Hypertension Program in a Community Hospital

Peggy Kirkwood


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

P Kirkwood, RN, MSN, ACNPC, AACC
Mission Hospital, Mission Viejo, CA

BACKGROUND AND SIGNIFICANCE: Prior to this program, patients with PH who lived in this area had to travel 60-75 miles to a tertiary care setting for inpatient/outpatient care and management. Because more patients are surviving PH, they are requiring more intense and specialized care. As a result patients are seeking care in community hospital settings as well as their primary PH center. Community hospitals in which the staff are not aware of the intricacies of PH care are being asked to care for these patients with potentially devastating results if proper procedures are not followed and education is not provided.

METHODS: A local pulmonologist specializing in PH who had a growing population of patients approached the hospital administration and the Advanced Practice Nurse (APN) to start a program in this community hospital. Collaboration between many players helped to develop this unique program. A multidisciplinary team was formed to develop policies, procedures, order sets, competencies and educational tools. The team consisted of:

  • Advanced Practice Nurses
  • Managers of several departments
  • Staff nurses from several departments
  • Physician
  • Educator
  • Pharmacists
  • Case Manager
  • Respiratory Therapist
  • Representative of Specialty Pharmacy


  • Epoprostenol and Treprostinil order sets
  • Six Minute Walk Test Procedure, Care of the Patient on Prostacyclins Clinical Guidelines, Inhaled Nitric Oxide Protocol
  • Reminder guidelines for: Remodulin Patients on CADD-MS3, Flolan Patient on CADD Legacy Pump, Flolan Patient on Smart Pump
  • Performance Criteria Checklist for Care of the Patient on Prostanoids
  • Self Learning Module for Pulmonary Hypertension Patients

Education was provided for staff of many different departments, including Cardiac Intensive Care Unit, Cardiac Telemetry Unit, Emergency Department, Surgery, Rapid Response Team, Nursing Supervisors, physicians, and staff at our satellite campus. CICU and Cardiac Telemetry staff complete an annual competency on PH. A community support group for patients and families was started which meets every other month and generally has about 20 attendees.

OUTCOME:This community hospital developed an innovative multidisciplinary program to effectively care for PH patients in the area. Challenges and barriers were identified and addressed, education and competencies were developed, policies and procedure were written, networking with academic and tertiary PH programs was accomplished, a community support group was established, and the collaboration with the specialty pharmacy was strengthened. Barriers addressed were:

  • Education for newly diagnosed patients needed and created
  • Patients coming to hospital for other surgeries or emergencies are admitted to designated cardiac unit regardless of reason for admission
  • Outpatient surgeries are performed in the main OR with cardiac anesthesiologist
  • Patients with PAH IV or SQ medications at satellite hospital are transferred to main campus

IMPLICATIONS FOR PRACTICE: Mission Hospital now provides a comprehensive program to manage the needs of PH patients in the community. Work will continue in order to monitor its success and enhance the program to provide cutting edge therapies for these high risk patients.