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Management and Ordering of Cardiac Implantable Electronic Devices – Adult – Ambulatory [143]

Management and Ordering of Cardiac Implantable Electronic Devices – Adult – Ambulatory [143] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 143

Delegation Protocol Title:
Management and Ordering of Cardiac Implantable Electronic Devices – Adult – Ambulatory

Delegation Protocol Applies To:
UW Health Cardiovascular Medicine patients with cardiac implantable electronic devices (CIEDs),
including pacemakers, implantable cardioverter-defibrillators (ICDs) and implantable loop recorders.

Target patient population:
All adult patients with CIEDs including pacemakers, ICDs and loop recorders.

Delegation Protocol Champion:
Miguel Leal, MD – Department of Medicine – Cardiovascular Medicine Division

Delegation Protocol Reviewer:
Shannon Schauff, RN – UW Cardiology

Responsible Department:
UW Health Heart & Vascular Care Clinic

Purpose Statement:
To delegate authority from the patient’s Electrophysiology Provider to Registered Nurses (RNs) in the
Cardiac Electrophysiology (EP) / Device Clinic to order routine diagnostic testing or enable specific device
algorithms, such as rate-adaptive pacing or rate response, during routine monitoring and management
of patients with CIEDs.

Who May Carry Out This Delegation Protocol: RNs in the Cardiac Electrophysiology (EP) / Device Clinic
who are specially trained in interrogation and programming of Cardiovascular Implantable Electronic
Devices (CIEDs), and who have also been trained in the use of this delegation protocol.

Training on device programs will include scheduled training sessions and weekly meetings, including
dedicated didactic training.

Guidelines for Implementation:
1. This delegation protocol is initiated when the patient has a CIED.
2. Prior to placing any orders, the RN will review the patient’s medical record and any provider
documentation to determine if any of the indicated tests has been previously ordered in order to
avoid duplicate orders.
3. The RN will order device checks at intervals indicated for the specific type of device or if/when there
are any questions regarding adequate device function.
4. The RN will place orders for specific diagnostic tests in addition to the device check for patients
meeting the following criteria:
4.1. For patients with a CIED who are right ventricular (RV) paced > 40% of the time, the RN will
order a Transthoracic Echocardiogram or TTE (to be performed approximately every 2 years)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

4.2. For patients with CIEDs that have Cardiac Resynchronization Therapy (CRT), the RN will order a
12-lead electrocardiogram at each clinic visit in order to ensure adequate device function
(electrocardiographic evidence of true biventricular or left ventricular capture)
4.3. For CIED patients who are atrial paced > 30% of the time (or ventricular paced > 30 % for single-
chamber ventricular devices), the nurse will order enabling of rate-adaptive pacing (rate
response).
Order Mode: Cosign Required – Protocol/Policy

References:
1. Goldschmidt H. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med.
2013;369(6):578-9. http://www.nejm.org/doi/full/10.1056/NEJMoa1210356#t=article
2. Chaturvedi V. Current research on the relevance of electrocardiography in cardiac resynchronization
therapy. Indian Pacing Electrophysiol J. 2015;15(2):145-7.
http://www.sciencedirect.com/science/article/pii/S0972629215000170
3. Kousoulis AA, Kympouropoulos SP, Pouli DK, Economopoulos KP, Vardavas CI. From the Classroom
to Facebook: A Fresh Approach for Youth Tobacco Prevention. Am J Health Promot. 2016;30(5):390-
http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2015-HRS-EHRA-APHRS-
SOLAECE-Expert-Consensus-Statement-on-Optimal-Implantable-Cardioverter-Defibrillator-
Programming-and-Testing
4. Roberts PR. Follow up and optimisation of cardiac pacing. Heart. 2005;91(9):1229-34.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769065/

Collateral Documents/Tools:
1. UW Health Departmental Policy Number: HVC: Implantable Cardioverter Defibrillator ICD Clinic
Check, Routine
2. UW Health Departmental Policy Number: HVC: Pacemaker Clinic, Routine Visits

Approved By:
UW Health Ambulatory Protocol Committee: May 2016
UW Health Clinical Knowledge Management Council: July 2016
UWHC Medical Board: August 2016
UW Health Chief Medical Officer: August 2016

Effective Date: August 2016

Scheduled for Review: August 2019


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org