ProvenCare relies on evidence-based standards — what’s been shown in medicine to work best for patients — to guide surgery and post surgical care. Here are the 40 steps involved in ProvenCare for coronary artery bypass graft surgery:
- ACC/AHA indication
- Screening for and consultation re: IMI (inferior myocardial infarction)/RV (right ventricular) involvement
- Treatment options and patient preference
- Need for warfarin - Ant.MI (myocardial infarction) or WMA (wall motion abnormality)
- Current user of clopidogrel or warfarin?
- Screening for stroke risk
- Carotid doppler (if the test is indicated)
- Vascular surgery consultation (if indicated)
- Ejection fraction
- Screening for need to use intra-aortic balloon pump (IABP)
- Screening using epiaortic echo (as indicated)
- Patient withheld clopidogrel/warfarin for 5 days pre-op
- Patient received correct dosing of beta-blocker (pre-op)
- Correct use of intra-aortic balloon pump (pre-op -->post-op)
- Pre-op Abx (within 60 minutes of incision; Vancomycin within 120 minutes)
- Blood cardioplegia (on-pump patients)
- Epiaortic echo of the ascending aorta and the peer consult
- Intra-operative hyperglycemia screening
- Correct insulin management (as indicated; per protocol)
- Use of LIMA (left internal mammary artery) for LAD (left anterior descending) grafting
Post-Operative patient documentation
- Anteroapical MI within prior 7 days: post-op echo
- Monitoring for atrial fib for >48 hours
- Anticoagulation therapy (as indicated)
- Abx (antibiotics) administered (post-op for 24-48 hours)
- Aspirin (six hours post-op or 24 hours post-op)
- Beta-blocker (within 24 hours post-op)
- Statin administered (post-op)
- Surgical debridement and revascularization of any sternal wound infection
- Plastic surgery consult regarding ongoing management of sternal wound
- Tobacco screening and counseling
- Referral to cardiac rehab
- Discharge medications (e.g., beta-blocker)
- Discharge medication: aspirin
- Discharge medication: statin
- Patient correctly taking beta-blocker?
- Patient correctly taking aspirin?
- Patient correctly taking statin?
- Patient correctly administering anticoagulant?
- Did patient resume smoking?
- Patient enrolled in cardiac rehab?