Purpose: To outline training and competency standards for non-physician staff who supervise cardiac stress tests at UK HealthCare.

Transcription

1 University of Kentucky / UK HealthCare Policy and Procedure Policy # A Title/Description: Cardiac Stress Test Supervision by Non-Physician Staff Purpose: To outline training and competency standards for non-physician staff who supervise cardiac stress tests at UK HealthCare. Policy See Appendix A. Procedure Staff Requirements Documentation Persons and Sites Affected Policies Replaced Effective Review/Revision s Appendix 1: Stress test supervision by non-physician training and competency requirements Supervision of Exercise Stress Testing Supervision of Pharmacologic Stress Agents Policy Non-physician staff at UK HealthCare (e.g., appropriately trained nurses, physician s assistants, nurse practitioners, exercise physiologists) may supervise stress tests under a physician s direction. The facility or Medical Director shall document appropriate training and competence according to the Intersocietal Accreditation Commission s Standards and Guidelines for Adult Echocardiography Accreditation, which references the American College of Cardiology and American Heart Association s Clinical Competence Statement on Stress Testing. See Appendix A. Procedure 1. A physician s order is required to perform a cardiac stress test. (a) Appropriate indications are required to perform this test (See American College of Cardiology and American Heart Association s guidelines regarding appropriate use criteria). (b) In general, the physician shall be present to observe and personally supervise the patient continuously when the test is performed on a patient with a recent (within 7 to 10 days) history of documented acute coronary syndrome, severe left ventricular dysfunction, severe valvular stenosis (eg, aortic stenosis), or complex arrhythmia. 2. A signed Form AM-0009 Authorizations for Special Procedures: Cardiac Stress Testing is required before performing this test. Policy # A Cardiac Stress Test Supervision by Non-Physician Staff 1

2 (a) An assessment of the patient, the patient s medical history and patient s current complaint shall be performed by the individual monitoring the stress test. After this assessment, an explanation of the risks and benefits of the test shall be provided and all questions will be satisfactorily answered by the monitoring RN, PA, and NP. A written consent shall be signed by the patient, patient s surrogate or Responsible Party(See A Responsible Party; Surrogate guidelines) before performing the test. Staff Requirements 1. Only qualified and competent personnel who meet requirements a-e below shall perform and/or monitor stress tests in the Gill Heart Institute Adult Echo Lab and UK HealthCare Good Samaritan Adult Echo Lab, according to the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and Adult Echo Lab policies and procedures for stress testing, : (a) Have an active and current professional license. (b) Have a current Advanced Cardiac Life Support (ACLS) certification. (c) Have passed the EKG annual competency. (d) Have observed or supervised 50 stress tests (exercise or pharmacological) under the supervision of a Cardiology Attending and 25 stress tests per year to maintain competency. (e) Have proven competency, according to the ICAEL Standards and Guidelines, referencing American College of Cardiology and American Heart Association s Clinical Competence Statement on Stress Testing, as determined by the Adult Echo Lab Medical Director. 2. Documentation of these competencies shall be placed in the individuals personnel file. 3. Maintaining competency: (a) Competency is ongoing through physician observation. (b) Quality Assurance is maintained through physician exam review. Documentation 1. Written consent shall be obtained before testing and placed in patients chart 2. The stress test is stored in a computer based system. Policy # A Cardiac Stress Test Supervision by Non-Physician Staff 2

3 Persons and Sites Affected Enterprise Chandler Good Samaritan Kentucky Children s Ambulatory Department Policies Replaced Chandler HP Good Samaritan Kentucky Children s CH Ambulatory KC Other Effective : 05/20/2013 Review/Revision s: Approval by and date: Name Annette Smith, Review Team Leader Name Bernard Boulanger, Chief Medical Officer Name Jonathan Curtright, Chief Operating Officer, Ambulatory Services Name Anna L. Smith, Chief Administrative Officer Name Michael Karpf, Executive Vice President for Health Affairs Policy # A Cardiac Stress Test Supervision by Non-Physician Staff 3

4 Appendix 1: Stress test supervision by non-physician training and competency requirements If a non-physician (e.g., properly trained nurse, physician assistant, nurse practitioner, exercise physiologist) practicing under the physician s license is supervising the stress test, the facility or Medical Director shall document appropriate training and competence as outlined in the American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. Supervision of Exercise Stress Testing 1. Knowledge of appropriate indications for exercise testing; 2. Knowledge of alternative physiological cardiovascular tests; 3. Knowledge of appropriate contraindications, risks and risk assessment of testing (not limited to Bayes theorem and sensitivity/specificity, including concepts of absolute and relative risk); 4. Knowledge to promptly recognize and treat complications of exercise testing; 5. Competence in cardiopulmonary resuscitation and successful completion of an AHAsponsored course in advanced cardiovascular life support and renewal on a regular basis; 6. Knowledge of various exercise protocols and indications for each; 7. Knowledge of basic cardiovascular and exercise physiology, including hemodynamic response to exercise; 8. Knowledge of cardiac arrhythmias and the ability to recognize and treat serious arrhythmias; 9. Knowledge of cardiovascular drugs and how they can affect exercise performance, hemodynamics and the ECG; 10. Knowledge of the effects of age and disease on hemodynamic and ECG responses to exercise; 11. Knowledge of principles and details of exercise testing, including proper lead placement and skin preparation; and 12. Knowledge of end points of exercise testing and indications to terminate exercise testing. Supervision of Pharmacologic Stress Agents 1. Knowledge of appropriate indications; 2. Knowledge of appropriate contraindications; 3. Knowledge of advantages and disadvantages of different exercise and pharmacological stress for echocardiography; 4. Knowledge of complications and ability to recognize and appropriately treat complications, including use of adenosine/dobutamine antagonists such as theophylline and aminophylline; Policy # A Cardiac Stress Test Supervision by Non-Physician Staff 4

5 5. Competence in cardiopulmonary resuscitation and successful completion of an AHAsponsored course in advanced cardiovascular life support and renewal on a regular basis; 6. Knowledge of various vasodilator, adrenergic stress protocols; 7. Knowledge of the pharmacokinetics of vasodilator and adrenergic drugs; 8. Knowledge of basic cardiovascular physiology, including heart rate and blood pressure response to vasodilators and adrenergic-stimulating agents; 9. Knowledge of electrocardiography and changes that may occur in response to vasodilators or adrenergic-stimulating agents; 10. Knowledge of cardiac arrhythmias and their treatment, including high-grade ventricular arrhythmia and heart block; and 11. Knowledge of cardiovascular drugs (and other agents, e.g., caffeine) and their effects on vasodilator and adrenergic drugs. Policy # A Cardiac Stress Test Supervision by Non-Physician Staff 5