Deviation in the Standard of Cardiac Care When Caring for a Patient with a Pacemaker

Evaluate breaches in the standard of care when evaluating a Deviation in the Standard of Cardiac Care When Caring for a Patient with a Pacemaker

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the medical conditions did the patient present?
    AV block (not associated with MI)
    AV block associated with acute MI
    Chronic heart block
    Sinus node dysfunction
    Carotid sinus syndrome
    None elicited/documented
    Answer unknown
    Why is this important?
    The American College of Cardiology and the American Heart Association (ACC–AHA) joint task force has recently revised and updated the accepted indications for implantation of cardiac pacemakers.
    (1998) 16 EMDCNA 2 419

  • Were the risks of and benefits of pacemaker insertion explained to the patient? Why is this important?
    Answer this question
    
The rise in the number of pacemaker insertions is the result of technologic developments, as well as the low morbidity and almost zero mortality from the pacemaker implantation procedure.

    (2012) 65 ESCORS C 113-118 



  • Which of the following complications did the patient experience? Why is this important?
    Answer this question
    
Permanent pacemaker implantation is one of the most commonly performed surgical procedures involving the heart.

    (1998) 16 EMDCNA 2 419 



  • Was health education regarding pacemakers conducted prior to discharge? Why is this important?
    Answer this question
    
Health education must begin while the patient is in the healthcare facility. The patient needs to be educated about the sources of electromagnetic energy and the need to avoid those sources as they will interfere with the pacemakers functioning. The patient must understand that the pacemaker needs to be assessed frequently and on a regular basis. Signs and symptoms of pacemaker failure need to be reviewed and clearly understood by the patient prior to discharge.

    (2000) 18 ECARDC 1 219 



  • Did the patient receive information regarding pacemaker battery replacement? Why is this important?
    Answer this question
    
Pacemaker batteries usually last between 5 and 15 years, depending upon pacemaker dependency.

    (2010) 106 AMJLCA 6 810 



  • Was the patient educated regarding complications following insertion? Why is this important?
    Answer this question
    
Late complications are those that occur 30 days after pacemaker implantation.

    (1998) 16 EMDCNA 2 419 



  • Which of the following late complications did the patient experience? Why is this important?
    Answer this question
    
Late complications such as battery failure, lead wire fracture, infection, failure to sense and pace are most commonly detected on routine follow up.

    (1998) 16 EMDCNA 2 419 



  • Was the lead wire replacement required? Why is this important?
    Answer this question
    
The most common indications for lead removal are infection, venous occlusion, lead malfunction or mechanical lead failure.

    (2000) 18 ECARDC 1 193 



  • Was the patient advised to schedule and keep frequent follow-up evaluations? Why is this important?
    Answer this question
    
All patients with pacemakers must be maintained on a frequent and regular follow up schedule to ensure their safety.

    (2010) 90 ANTHSU 5 1411 



  • Was the complication identified promptly and attended to correctly? Why is this important?
    Answer this question
    
Patients with a pacemaker are seen regularly in the emergency department with a variety of pacemaker complications and malfunctions.

    (1999) 17 EJNEMM 4 697 



  • Which of the following diagnostic investigations were performed? Why is this important?
    Answer this question
    
Management of pacemaker malfunction involves a thorough history taking, a complete physical examination and a battery of diagnostic tests.

    (1999) 17 EJNEMM 3 479 



  • Which of the following were indications for lead replacement? Why is this important?
    Answer this question
    
The most common indications for lead removal are infection, venous occlusion, lead malfunction or mechanical lead failure

    (2000) 18 ECARDC 1 193-217 



  • Was an informed consent obtained for lead removal surgery? Why is this important?
    Answer this question
    
The clinician must explain to the patient the risks and benefits of lead removal surgery.

    (2010) 90 ANTHSU 5 1411 



  • Was the patient pre-medicated with prophylactic antibiotics? Why is this important?
    Answer this question
    
Lead removal is generally a complex procedure that requires a significant amount of advance preparation.

    (2000) 18 ECARDC 1 193 



  • Was the patient managed with a temporary pacing system? Why is this important?
    Answer this question
    
For patients who are pace-maker dependent and require continuous pacemaker support, a temporary transvenous pacing system or an external pacing system must be used during the procedure to ensure the safety of the patient.

    (2010) 90 ANTHSU 5 1411 



  • Did the patient experience any complications during the lead replacement procedure? Why is this important?
    Answer this question
    
Careful adherence to protocol is necessary to avoid even a minor complication during lead removal or extraction.

    (2000) 18 ECARDC 1 193 



  • Was the antibiotic treatment continued after lead replacement? Why is this important?
    Answer this question
    
All patients with infection as the indication for lead extraction need to have the administration of intravenous antibiotics continued until a complete culture and sensitivity of the leads has been completed.

    (2010) 90 ANTHSU 5 1411