Standard 56: Cardiology, Outpatient and Cardiac Procedures

Sample. Review the risk assessments and decisions for every cardiac investigation and procedure in the last 3 months.

1. Every referred patient has a documented risk assessment before the investigation or procedure.

Method. Check each sampled investigation for an assessment dated before the date of the test.

Evidence to show. Cardiac risk assessment before investigation or procedure (CAR-SOP-001); cardiac risk assessment record (CAR-FRM-001).

Pass when. Every sampled investigation has an assessment dated before it.

2. The assessment is signed by the cardiologist and records the decision.

Method. Check each sampled assessment for the signature and the decision.

Evidence to show. Cardiac risk assessment record (CAR-FRM-001).

Pass when. Every sampled assessment is signed and records the decision.

3. High-risk patients are reviewed by a senior cardiologist.

Method. Check each high-risk sample for the senior review before the procedure.

Evidence to show. Cardiac risk assessment before investigation or procedure (CAR-SOP-001).

Pass when. Every high-risk sample has a senior review recorded before the procedure.

Immediate fail (any one means the criterion is not met)

• A patient with unstable chest pain goes to angiography without a risk assessment, and has an arrhythmia during the procedure.

Sample. Review the procedure log and the pre-procedure checks for every cardiac procedure in the last 6 months.

1. Each procedure follows the written protocol for access, sedation, contrast and radiation.

Method. Check each sampled procedure against the protocol steps for contrast and radiation.

Evidence to show. Cardiac procedure safety standard (CAR-SOP-002); contrast media safety protocol (CTR-SOP-001, existing, reused); radiation justification and dose optimisation (RAD-POL-001, existing, reused).

Pass when. Every sampled procedure follows the protocol for contrast and radiation.

2. A cardiac emergency team and equipment are ready for each procedure.

Method. Check the pre-procedure check for each sampled procedure.

Evidence to show. Cardiac procedure log (CAR-REG-001); cardiac and medical emergency plan (FW-PLN-001, existing, reused).

Pass when. Every sampled procedure has the team and equipment recorded as ready.

3. Each procedure and adverse event is logged.

Method. Check the log against the procedure list for the sample period.

Evidence to show. Adverse reaction record (PRO-FRM-006, existing, reused).

Pass when. Every procedure and adverse event is in the log.

Immediate fail (any one means the criterion is not met)

• A complication during an angiogram occurs with no emergency team in the room, and the event is not logged.

Sample. Review the daily checks of the defibrillator and emergency equipment for a sample of days in the last 3 months, and the rehearsal records.

1. The defibrillator, pads and emergency equipment are checked every day.

Method. Compare each sampled day with the daily check record.

Evidence to show. Daily defibrillator and emergency equipment check (CAR-FRM-002); resuscitation equipment checks (HOS-SOP-015, existing, reused).

Pass when. Every sampled day has a recorded check.

2. Pads and drugs are in date.

Method. Check the expiry dates recorded on each sampled day.

Evidence to show. Daily defibrillator and emergency equipment check (CAR-FRM-002).

Pass when. Every expiry date is in the future on each check.

3. Staff rehearse the emergency response at the set interval.

Method. Check the rehearsal register for each staff member on the sampled days.

Evidence to show. Defibrillator check and rehearsal register (FW-REG-003, existing, reused).

Pass when. Every staff member on the sampled days has a rehearsal within the interval.

Immediate fail (any one means the criterion is not met)

• The defibrillator pads expired three months earlier, and the daily check was never done during a cardiac arrest.

Sample. Review the anticoagulant and antiplatelet records of every patient on therapy in the last 12 months.

1. Antithrombotic therapy is recorded, with bleeding risk assessed.

Method. Check each sampled patient for the therapy record and the bleeding risk assessment.

Evidence to show. Anticoagulant monitoring and reversal (ANT-POL-001, existing, reused); anticoagulant use and reversal register (ANT-REG-001, existing, reused).

Pass when. Every sampled patient has the therapy and bleeding risk recorded.

2. A written reversal plan exists for each patient on therapy.

Method. Check each sampled patient for the written reversal plan.

Evidence to show. Anticoagulant use and reversal register (ANT-REG-001, existing, reused).

Pass when. Every sampled patient has a written reversal plan.

3. Doses are checked at the set interval.

Method. Check the dose checks against the interval for each sampled patient.

Evidence to show. Anticoagulant monitoring and reversal (ANT-POL-001, existing, reused).

Pass when. Every dose check is within its interval.

Immediate fail (any one means the criterion is not met)

• A patient on anticoagulation has a major bleed after a procedure, and no reversal plan is recorded.

Sample. Review discharge records and follow-up appointments for every cardiac procedure in the last 6 months.

1. Each patient leaves with a written follow-up and risk reduction plan.

Method. Check each sampled discharge for the written plan.

Evidence to show. Cardiac follow-up and risk reduction plan (CAR-SOP-003); cardiac follow-up and risk reduction plan record (CAR-FRM-003).

Pass when. Every sampled discharge has a written plan recorded.

2. The follow-up appointment is booked and confirmed before discharge.

Method. Check each sampled discharge for the booked and confirmed appointment.

Evidence to show. Follow-up booking before discharge (AFT-FRM-001, existing, reused).

Pass when. Every sampled discharge has a booked and confirmed appointment.

3. Devices and antithrombotic therapy are reviewed at the set interval.

Method. Check the review dates against the interval for each sampled patient.

Evidence to show. Cardiac follow-up and risk reduction plan record (CAR-FRM-003).

Pass when. Every review is within its interval.

Immediate fail (any one means the criterion is not met)

• A patient with a pacemaker is discharged with no device follow-up booked, and the device fails unnoticed for a year.