1. Dimick, Melissa MS, RN, CCRN

Article Content


The purpose of this quality improvement project was to use evidence-based strategies to standardize treatment for patients who develop atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery.



Atrial fibrillation (AF) is the most common complication following CABG surgery and can be associated with complications that increase hospital length of stay (LOS), along with increased healthcare costs. This improvement project focused on pharmacologic as well as nonpharmacologic therapies to treat new-onset AF and restore sinus rhythm within 24 hours of recognition.



A retrospective review was conducted on postoperative CABG patients who developed AF in 2007. The data revealed gaps in practice, including failure to recognize and report AF to the physician, along with inconsistent treatment by the practitioner. Consequently, patients had increased complications and longer hospitalizations. After implementation of an AF protocol/order set, a chart review is planned to monitor the new process.



Data from the retrospective review was presented to the appropriate stakeholders. A multidisciplinary committee was created that reviewed evidence-based treatment strategies for post-CABG AF. They developed a protocol and order set focused on accurate identification of AF, immediate pharmacologic treatment with amiodarone, early electrical cardioversion, and appropriate use of anticoagulation. Nurses were educated on the use of the protocol/orders, along with the results of the chart review, significance of AF, and projected outcomes. Cardiologists and surgeons were also provided education during their monthly section meetings.



The goal is to use a standardized treatment approach for AF using amiodarone coupled with early cardioversion. This plan is predicted to restore sinus rhythm within 24 hours and decrease hospital length of stay by 1 day.



After implementation of a post-CABG AF protocol/order set, the patient will experience safe and timely passage through the healthcare facility. The CNS student not only focused on patient-centered outcomes but also advanced the practice of nursing by empowering the nurse to solve problems at the point of care. The organization benefits from decreased healthcare costs.


Implications for Practice:

A best-practice approach to post-CABG AF management provides predictable patient-centered outcomes. It also decreases complication risk for the patient and reduces hospital length of stay.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.