Letters to the Editor

European Professional Shares DES Experience Greetings from Switzerland. We now use (pretty much exclusively) coated stents in our lab. We started with the Cypher, and all of our patients have been included in a registry with telephone follow-ups at one, six, and twelve months. We hope to justify the higher cost of the stents by showing that the patients tend not to come back or a repeat procedure due to in-stent restenosis. So far the results are great, but not perfect. We have had at least one acute instent thrombosis which resulted in the patient's death. We have recently begun a study randomizing patients to either Cypher or Taxus stents, with the same follow-ups as the Cypher registry, and extending to 2, 3, 4, and 5 years. As for the price of the stents, Switzerland is relatively well off, but that just means that they charge us more. It is an expensive country, too, and that means that everything is more expensive, and that includes a re-coro. We are hoping that the savings we make on the one-procedure scenario will offset the cost of the stents. It is looking good so far. We have come so far that we rarely place an uncoated stent. In fact, Medtronic was here this week with a study comparing their new coated stent with their uncoated, and we probably can’t participate because our IRB wants to know how we can ethically implant an uncoated stent nowdays. It is an exciting phase for invasive cardiology, but the economic climate is not really one where risks can be taken without trepidation. I think that it is one of those cases where you just have to jump in and see how it goes. Sandy Watson, RN, BN Cath Lab Digest Editorial Board Member Editor, Invasive Cardiology: A Manual For Cath Lab Personnel Swiss Cardiovascular Center Bern University Hospital Bern, Switzerland Work together as a team I usually do not write a letter to the editor, but after reading Barry Brown’s letter in the April Cath Lab Digest, I felt compelled to write a letter of rebuttal. I am a registered cardiovascular technologist, and have been employed in a cardiac cath lab for the past eight years. I monitor, scrub, circulate, and yes I administer emergency medications. That is part of my job, that is what I am trained in, that is whatI have extensive knowledge of, and that is what I am professionally trained to do. It's time to let go of the old ways of trying to scare patients because of personal concerns about job security and to work together as a team of highly trained professionals who are able to treat patients during emergencies while making those patients our number one priority. The previous letter stated that between 44,000-98,000 patients were injured because of medication errors. My question is, who gave these medications? Maybe the solution to eliminating medication errors is in training and education; it obviously is not related to credentials. We follow several medication rules here: 1. Correct patient 2. Correct order 3. Correct medication 4. Correct dose 5. Correct route 6. Correct time 7. Expiration date 8. Allergy status 9. Knowledge of medication’s effects and side effects 10. Double check on medication with another member of the team. The sign on our cath lab door states, We are all highly trained professionals, who are here for your well-being, and perhaps, to help save your life. Donna Gagne, RCIS ACLS certified/BLS instructor Cath lab is unique entity I must respectfully disagree with the views expressed by Mr. Brown in the April 2003 issue of Cath Lab Digest. Unlicensed does not equal incompetent. Let me set up a scenario: during a cath procedure, there is one nurse circulating, one technologist scrubbing, and one technologist monitoring. Only the nurse can give meds and defibrillate (this is a standard in many cath labs across the country). The lab is busy as usual, with no extra help available. The patient codes. Only the nurse can defibrillate, push bolus IV emergency meds, and mix and hang emergency IV drips. Anyone who had been in a code situation knows this is not feasible. Now, the patient's life is in the balance, and only one person in that room is qualified to help. This is poor patient care, period. Any staff member who is ACLS-certified is qualified to assist in any capacity during a code, including pushing meds. The cath lab is a unique entity that bears no resemblance to any other department in the hospital. It is at once a patient care area, a patient monitoring area, a diagnostic testing area, a radiation area, and a therapeutic intervention area. Events happening during the procedure center around direct orders from the attending physician. Non-nursing personnel are covered in this situation by the medical practice acts in their respective states. It is essential to have all staff members involved in every aspect of a procedure to ensure the best patient care standards possible. Any cath lab with a documented orientation program and regular competency checks can have full cross-training of all staff. JCAHO has approved these fully cross-trained labs for years. The SICP has a great standards of care document on its website pertaining to the cardiac cath lab; their website is www.sicp.com. Cardiovascular technology is a relatively young profession in comparison to nursing and other allied health professions. Many informed minds predict licensing of all invasive professionals is inevitable. Until that time, let’s work together to give patients the best cath lab environment we can offer a multidisciplinary team that is highly trained, skilled, and specialized to handle the needs of today's cardiac patients. Sincerely, Janette LaFroscia, RCIS, RCS Greensboro, NC Key is training & environment I appreciate and respect Mr. Brown's perspective as well as his research. I believe that he has the best interest of our patients in mind. What concerns me is that his letter makes a blanket statement that seems to target all unlicensed professionals, from every training program, with any length of experience. I believe that Mr. Brown’s last sentence, The right person doing the right job at the right time is the direction needed to ensure the highest standards of care, invalidates his entire thesis. The right person may be a CVT who is well-trained and tested competent to administer medications. The right job at the right time may be a CVT with 20 years of experience and who is an ACLS instructor administering medications in an emergency situation. Yes, we must work within our scopes of practice. Yes, we must work within the guidelines of our state regulatory agencies. I don’t think it is appropriate to portray the 7,000 deaths that occur each year as a result of medication errors as being caused by unlicensed personnel. Anyone who has spent a few years in a cath lab has seen medication errors caused by both licensed and unlicensed personnel. The key to ensuring patient safety is ensuring that all personnel, including RNs, are well-trained to do their job as well as developing a nurturing environment to grow professionally. Michael Cogliano, BS, RCIS Supervisor, Cardiac Cath Lab Gettysburg Hospital Heart Center Gettysburg, PA

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