Running head: USING A FLOW SHEET TO SOLVE PROBLEMS

Using a Flow Sheet to Solve Problems

Dana M. Turner, RN
Walden University
April 26, 2015

Using a Flow Sheet to Solve Problems

We all have tasks that we go through everyday whether it be in the workplace or in our
personal lives. Sometimes these tasks do not turn out to be as effective as we would like. In this
paper we will use a flow sheet to show us how a process can be improved and where the problem
started off first. The purpose of this paper is to look at the flow of a very busy cardiac
catherization lab and see where things may get off course with time. Finding out why these
things occur can lead us to answers on how to make them better.

Start
Are patients being
prepared for their
procedures in a
timely manner?

Yes

No

What can be done to

Are the physicians prepared to
speed
up the process?
take the patients to their
close
theirwas
This procedure
is indicative
thattothere
If an emergency arises the
Communication is key.
not an unscheduled emergency Regardless if the procedure iscommunication
with the patient
on
and the physician is available at time or that there has been about
the
delay
is
a must to keep
a
his predetermined time
tensions down
delay. Communication can solve

USING A FLOW SHEET TO SOLVE PROBLEMS

USING A FLOW SHEET TO SOLVE PROBLEMS

Getting Patients onto the Catherization Lab Table in a Timely Manner

There are several reasons why a patient is having a heart Catherization performed. Some
may be there as a diagnostic case without intervention, some may be there for diagnosing as well
as a possible percutaneous coronary intervention (stent). These are typically outpatient scheduled
services. The patient may have been seen Monday in the physicians office, and related to signs
and symptoms reported, the cardiologist may schedule for a cath to be done he next day. This
unit has a very fast paced set of steps that occur within every procedure. Sometimes related to a
delayed or longer than expected case, the person next on the list may have to have their
scheduled time delayed. If there is a STEMI (ST elevation myocardial infarction) then an active
heart attack takes precedence over stable patients who will physically be okay until after the
emergency is handled.

Are patients being prepped for their procedure in a timely manner? This step is handled
by Registered Nurses. Technology being used is an EKG machine and laboratory machines to
check blood work. Some patients come in with very complicated cases and comorbidities. Lab
work is immediately drawn to look for results that may interfere with the process. Potassium is
one of the first things we look at, knowing how this value can effect how efficiently and
regularly this organ works. We then look at kidney function related to the dye used. If their
creatinine is high, we hydrate them with normal saline to help their kidneys better adjust to the
dye they will be receiving and to help them flush it out post procedure. Knowing your critical
values for lab work as well as knowing about co-morbidities to ensure patent safety such as
Congestive Heart Failure (CHF). Giving too many fluids for an elevated creatinine may interfere
or exacerbate their CHF. There are checks and balances to our work. The cath lab Registered

USING A FLOW SHEET TO SOLVE PROBLEMS

Nurses check behind us looking for any errors that may have been made. Each patient needs a
history and physical signed by the MD within 30 days of procedure, an EKG within 7 days of
procedure. A signed consent by both the patient and a witness. If lab work is complete. These are
also things that have a third check prior to the time out. The physician looks for those same four
items.
Next in the yes or no pathway is pertaining to the original question of whether or not
patients are being prepped in a timely manner. If yes is chosen then there is no need to further
explain this portion. If the answer is no, we must move forward to make things progress faster.
This may be a breakdown in technology. Is the lab able to keep up with the demands we are
putting on them? Is the EKG machine working? Figuring out where the process is breaking down
is the key to moving forward.
If yes was chosen for the last scenario, we now must look at whether or not the
physicians are ready for the procedure to begin once the patient has been properly prepped for
their cath. There are several answer to this problem. If the answer is no, it could be related to an
unforeseen STEMI, a long case or simply stopping to have lunch so he can proceed safely with
the next case. There have been times where equipment could break and that puts that particular
cath lab down for a period of time, even a day. These patients will then have to wait until all of
the other case have been cleared up by other physicians before their turn to proceed is next. If no
was chosen to the proposed question, then we must understand why. Was it because an
unforeseen STEMI came in? Is it related to a longer case than usual or is it related to personal
issues that physicians may encounter. The more critical a patient is based upon factors found
through assessment, they may be bumped up on the schedule. For instance, active chest pain.

USING A FLOW SHEET TO SOLVE PROBLEMS

What can be done to speed up the process of getting the patients more quickly from the
door to the table? Triage style assessments need to be more intensely looked at. Getting patients
prepped quickly and effectively is the whole idea behind running a fast paced cath lab.
Communication is key. The patients need to be told a quickly as possible that a critical
situation has come up and that unfortunately their scheduled time, will have to be bumped. Tell
them you are sorry and genuinely mean it when you say it. People can be perceptive and can read
your non verbals to guide their opinions. Communication between the nurses and the cath lab is
also crucial, picking up the phone to say that labs arent back yet is one way to let them know
there is a delay on our side. Each person on this team is responsible for keeping everyone else
informed of all situations and keeping the patients informed is also just as important to ensure
customer satisfaction despite delays.

Summary
No matter what job or career you go to every morning, customer service is a must to keep
them coming back. Healthcare should be seen as patient centered care and customer service
should be of high quality and genuine. When processes are delayed, sometimes those on the
waiting side, dont understand. It is our job as healthcare professionals to relay messages and
keep them informed about whats going on. Their tensions are usually high knowing that they are
going to have a procedure and now that time is even further pushed out. Apologize and reassure
them that they will be seen as soon as possible. Customer satisfaction is what keeps patients
coming back instead of visiting the competing hospital likely not too far from your facility. The
flow of these step is crucial in keeping the process running smoothly. It also shows us where we

USING A FLOW SHEET TO SOLVE PROBLEMS

may be going wrong and how to rectify the issue. The flow chart really shows how important an
algorithm of the things we do daily can help guide us in ways we did not know we needed.