Professional Practice, Quality Improvement, and Care Coordination
Professional practice
Practice must reflect current ACC/AHA and specialty guidelines and the nurse's scope of practice. The RN performs assessment, teaching, and evaluation and may not delegate these to unlicensed assistive personnel; tasks such as vital signs or ambulation may be delegated with clear instructions. Informed consent is obtained by the provider; the nurse verifies understanding, witnesses the signature, and clarifies - never obtains consent or pressures the patient. Advance directives and DNR orders must be verified and honored.
Quality improvement
QI is not research: it improves local processes using PDSA cycles, root cause analysis after a sentinel event, failure mode and effects analysis, and care bundles. Key cardiac metrics include door-to-balloon ≤90 minutes, door-to-needle ≤30 minutes, aspirin and statin prescribed at discharge, beta-blocker at discharge for eligible patients, smoking-cessation counseling, and 30-day readmission rates. Public reporting and pay-for-performance make accurate documentation part of care quality.
Care coordination
Transitions are high-risk. Perform medication reconciliation at admission, transfer, and discharge; arrange follow-up within about 7 days; give clear written instructions; refer to home health or telehealth; and screen for social determinants of health. Multidisciplinary rounds include pharmacy, case management, nutrition, physical and occupational therapy, and social work.
Safety culture
Just culture encourages reporting errors and near misses without punishment for system failures, while holding individuals accountable for reckless behavior.
Traps
- Confusing QI with human-subjects research and IRB requirements.
- Assuming the nurse obtains informed consent.
- Delegating patient education or assessment to unlicensed personnel.
- Failing to recognize a near miss as reportable.
Rule of thumb
Every cardiac patient leaves with a follow-up appointment, a reconciled medication list, and documented teach-back.