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Clinical Nurse Specialist Influence on Safe Management of Hospitalized Pulmonary Hypertension Patients requiring Prostacyclin therapy

Tania Von Visger

E. Chipps

Namita Sood


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

T. Von Visger, APRN, MS, CCNS, PCCN; E. Chipps, PhD, RN; N. Sood, MD, FCCP
The Ohio State University Medical Center: Department of Critical Care Nursing, College of Medicine: Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Columbus, OH

PURPOSE: The aim of this study was to evaluate the effectiveness of Clinical Nurse Specialist (CNS) influence in the safe management of hospitalized PH patients using intravenous and subcutaneous Prostacyclin Therapy.

BACKGROUND AND RESEARCH SIGNIFICANCE: Pulmonary Arterial Hypertension (PAH) is a rare and serious clinical condition affecting approximately 1-2 cases per million individuals annually (1). Life-long continuous infusion of Prostacyclin (Epoprostenol or Treprostinil) is demonstrated to be an effective treatment for patients in moderate to advanced disease stages (2, 3, 4). The goal of this project was to evaluate the clinical impact of a new evidence based educational nursing competency program to reduce errors in the nursing management of hospitalized PAH patients requiring Prostacyclin infusion therapy.

METHOD: To ensure safe patient outcomes in this complex patient population, the AACN organizational framework for CNS competency was the backdrop for this implementation (5). At the unit level and in collaboration with the nurse manager and the pulmonary hypertension physician team, 100% of the RN staff completed extensive educational training on the intricacy of the infusion management in critical care settings. For additional staff support, the CNS provided individualized consultation and 24/7 phone consultation to all clinicians. Patients who are new to this infusion therapy received detailed education and training from a PAH specialty pharmacist, pharmaceutical nurse educator, and staff RN.

In accordance to the system thinking focus (6), education was provided to other hospital areas that may interact and manage these patients. Based on our successful unit level implementation of the education program, the Pulmonary Hypertension In-Patient Clinical Practice Guideline was approved in early 2011. The key CNS roles of clinical expert, consultant, educator, researcher, and leader are utilized to effectively optimize patient outcomes (5).

FINDINGS: Comparative data between the years of 2005 and 2009 shows process and safety outcome improvements. The percentage of events related to Prostacyclin administration and clinical care management therapy decreased from 8% to 1.5%. There was almost a 50% reduction in the average event severity level from 1.8 to 1.0, respectively. Of most significance, the percentage of event reports with severity level >3 decreased from 33% to 0%. The design and revision of Epoprostenol and Treprostinil computer based learning modules is an effective mode of learning for medical, nursing, and pharmacy staff who manage PAH patients.

IMPLICATIONS: Our data demonstrate that these initiatives have positively benefited patient care and improved patient safety overall. The work of the interdisciplinary team as led by the CNS, and the common goal that all members share to provide the best patient care have led to these successful outcomes (7).


  1. Gaine, S. P; Rubin Lj. Primary Pulmonary Hypertension. The Lancet. 1998; 352: 719-25.
  2. Gomberg-Maitland, M; Preston, L.R. Prostacyclin Therapy for Pulmonary Arterial hypertension: New Directions. Seminars in Respiratory and Critical Care Medicine 2005; 26 (4): 395-401.
  3. Badesch, D. B; Vallerie, V. M.; Delcroix, M.; Vizza, C. D., Olschewski, H., Sitbon, O.; Barst, R.J. Prostanoid Therapy for Pulmonary Arterial Hypertension. J. of the American College of Cardiology, 2004; 43 (12 Suppl): 56S-61S.
  4. Benvenuto , D. B. Prostacycline (Flolan): Intravenous Nursing Responsibilities in the Care of the Patient with Primary Pulmonary Hypertension. Journal of Intravenous Nursing. 1999; 22(5): 267.
  5. Clinical Nurse Specialist Core Competency. Executive Summary 2006-2008. The National CNS Task Force. Accessed August 5, 2010.
  6. Harden, S.R.; Kaplow, R. (2005). Synergy for clinical Excellence: The AACN Synergy Model for Patient Care. Jones and Barlett Publishers. Canada.
  7. Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999; 27(9): 1991-1998.