<p> STEMI ALERT Nurse Checklist Apply Patient Sticker Here</p><p>Date: RN Name: ED Provider: Patient Name: (if no sticker) Hospital: Add your Hospital name here STEMI reperfusion “Time to treatment goals” Door to ECG complete and read by provider: <10 minutes Door in door out of your facility: < 30 minutes Fibrinolytic Therapy < 30 minutes First medical contact (FMC) to device < 120 minutes Check boxes: 12 lead ECG done and to ED provider within 10 minutes. REMEMBER: TIME IS MUSCLE! Activate STEMI ALERT Note time of ECG and patient arrival time (door – define this) and report to STEMI scribe Note time of onset of symptoms and report to STEMI Scribe (refrain from using “yesterday, last night, etc”) IV 20 gauge obtained, (right arm if possible) – saline lock, obtain 2nd IV access if possible If thrombolytic therapy is being considered, have lytics at bedside, ready to mix Follow physician’s order or facility’s protocol for medications, oxygen, pain control, and labs Place patient in hospital gown, all clothing (including under garments) removed and placed in bag, valuables given to family if present or to family or placed in bag, label with patient’s identification clearly labeled. Keep patient NPO (except for medications) Verify transport paperwork is done (EMTALA forms) prior to EMS Arrival. Note EMS arrival time and departure time on Data Sheets A & B Make sure the following goes to PCI receiving hospital with the patient:  EMTALA form  Data Sheet B (yellow)  ECG (verify initials of ED provider and time read are documented) historical, current and EMS  Patient’s belonging bag with patient’s identification clearly labeled. The following can be faxed (don’t delay transfer): (add fax number of PCI cath lab)  Demographic sheet, pertinent lab, ED visit physician and nursing notes, medications given, CXR After STEMI alert is Resource Numbers: Please provide feedback/comments here, over, place completed ED Shift Mgr ______for example, what went well, what went STEMI data collected by: wrong in order to improve the next Data Sheet A, Nurse, ______STEMI ALERT. (use back if needed) Physician, and Scribe Contact number: ______RT lace in mail checklists back in STEMI Physician responsible for alert packet review of STEMI patients: ______Receiving facility contact/fax: Send Data Sheet B to ______receiving facility EMS contact: ______</p><p> www.heart.org/HEARTORG/Affiliate/Kansas-Mission-Lifeline_UCM_454367_SubHomePage.jsp www.projectupstart.com </p><p>NOT PART OF THE MEDICAL RECORD 08.07.13</p>