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Orders for Cardiac Electrophysiology Lab Procedures – Adult/Pediatric ‐ Ambulatory [85]

Orders for Cardiac Electrophysiology Lab Procedures – Adult/Pediatric ‐ Ambulatory [85] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 85

Delegation Protocol Title:
Orders for Cardiac Electrophysiology Lab Procedures - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
University Hospital Electrophysiology Laboratory

Target Patient Population:
Adult and adolescent patients scheduled for cardiac electrophysiology procedures such as
cardioversions, implantation or explantation of devices, and electrophysiology studies.

Delegation Protocol Champion:
Michael Field, MD - Department of Medicine – Division of Cardiology

Delegation Protocol Reviewers:
Christine Griffin, RN, BSN – Invasive Cardiology
Magda Valdes, RN, BSN – Electrophysiology Laboratory
Jill Triphan, RN, BSN – Cardiology – East Clinic
Karna Boquet, NP – Invasive Cardiology

Responsible Department:
Department of Medicine – Division of Cardiology

Purpose Statement:
To delegate authority from the provider performing the cardiac electrophysiology procedure to
Registered Nurses (RNs) who are trained as Cardiology Coordinators to enter preprocedure
orders for the planned procedure.

Who May Carry Out This Delegation Protocol:
Registered Nurse Cardiology Coordinators trained in the use of this protocol.

Guidelines for Implementation:
1. This delegation protocol is initiated when a patient is scheduled for a procedure in the
Cardiac Electrophysiology Laboratory.
2. RN enters orders using one of the following order sets:
a. Cardiac Cath/EP – Cardioversion Delegation Protocol – Adult – Preprocedure [5178]
b. Cardiac Cath/EP – Implantable Devices Delegation Protocol – Adult – Preprocedure
[5180]
c. Cardiac Cath/EP – Study/Ablation Delegation Protocol – Adult – Preprocedure
[5181]
3. If the patient has allergies to any of the medication in the order set the RN will consult
with the provider before placing orders.

Order Mode: Cosign Required, Protocol/Policy

References: NA

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

Collateral Documents/Tools:
Cardiac Cath/EP – Cardioversion Delegation Protocol – RN – Adult – Preprocedure [5178]
Cardiac Cath/EP – Implantable Devices Delegation Protocol – RN – Adult – Preprocedure [5180]
Cardiac Cath/EP – Study/Ablation Delegation Protocol - RN – Adult – Preprocedure [5181]

Approved By:
UW Health Ambulatory Protocol Committee: July 2013, *April 2015; *August 2017
UW Health Lab Practices Committee: September 2013, *April 2015; *August 2017
UWHC Pharmacy & Therapeutics Committee: August 2013, *April 2015; *August 2017
UWHC Medical Board: September 2013, *April 2015; *August 2017
UW Health Chief Medical Officer: *May 2015; *August 2017

Effective Date: August 2017

Scheduled for Review: August 2020
*Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org