Teaching Local Providers Advancements in Care

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When Jackson County Regional Health Center in eastern Iowa learned an area resident was coming home after a specialized procedure at University of Iowa Hospitals and Clinics to implant a ventricular assist device (VAD), the Maquoketa hospital turned to experts with UI Health Care for direction on continuing care.

VAD is a mechanical blood pump that takes over the function of a heart ventricle. It’s typically used to treat patients with advanced heart failure who are critically ill and waiting for a heart transplant, but it can also effectively prolong life and improve the quality of life for patients ineligible for transplant. The Ventricular Assist Device Program at UI Hospitals and Clinics is the only one in Iowa that offers this type of therapy. VAD patients have resided in 30 counties across Iowa and Illinois.

“We’re a small community hospital. We deal with (VAD) on a very infrequent basis, and we want to provide our patients with the best care,” said Cheryl Curl, RN, chief nursing officer at Jackson County Regional Health Center. “It’s imperative that we receive training because we have the ambulance service and home care therapy these patients might use.”

The UI Heart and Vascular Center sent VAD coordinator Jennifer Franzwa, RN, to Maquoketa to train 21 providers who could be involved in a VAD patient’s care. This includes Jackson County Regional’s emergency, home health services, physical therapy, and cardiac rehabilitation departments, as well as the hospital ambulance service and a primary care clinic’s physicians and nurses.

The local providers learn general information necessary for treating a patient with a VAD, including medications and imaging tests to avoid—such as MRI—and what to expect in an emergency. Patients and their support people have been taught to change their VAD batteries, which are carried in holsters worn over each shoulder and attached to a controller, or computer, on the belt; change their controller; and troubleshoot alarms. In an emergency, however, these tasks might fall to providers.

Because UI Hospitals and Clinics implants 15 to 20 VADs each year, Franzwa and colleague Julie Shepherd, RN, regularly travel throughout Iowa and western Illinois to train providers.

“It is a true testament that they want their patients to have good care not only in Iowa City but when they go home to their communities,” said Mary Brandt, RN, cardiac rehabilitation coordinator at Pocahontas Community Hospital in northwest Iowa, where Shepherd trained 28 providers. “I know Julie had to drive much of the day to do it for us.”

The VAD coordinators take along HeartMate II, the most recent FDA-approved VAD, for hands-on training, plus a slide presentation, DVD, and reference cards with phone numbers where UI VAD staff can be reached around the clock. The device’s manufacturer, Thoratec, offers additional online education.

“Local medical staff tend to feel more comfortable working with these devices after attending training,” Shepherd said. “We encourage our patients to stop by the ambulance service, local fire department, and the local emergency room to introduce themselves and to show staff their (VAD) equipment.”