Tools and Materials

Once you have your team, your partnerships and your infrastructure, the next step is to develop the tools you need to run the clinic efficiently.

ED Pathway and Ordersets:

As our intervention starts in the ED, we created institution-specific order sets for the emergency management of acute atrial fibrillation.  This facilitated a standardized approach to both rate/rhythm control as well as stroke prevention management.  In addition, we incorporated our referral process right into the order sets.  Take a look….


Patient Education Handouts

As an important component of care for these patients is having an understanding of their illness and how to self-manage, patient education modules were created for use both in the ED as well as in clinic.  In our approach, patients are given the entire education package when in ED and are asked to review it and bring it with them to their AFQCP visit.  During the visit, the clinical team is able to get a sense of the patient’s knowledge and is able to tailor any additional education to them, using the materials as a reference and reinforcing the key teaching points.  Here they are…


Referral forms

Our approach to facilitating easy referral from the ED to the AFQCP was to provide appointment dates and times to enable the patients to actually leave with an appointment versus the “usual” faxing of a referral form and then the patient waiting to hear back from a clinic.  We tried to minimize the amount of information needed and after several revisions, here is a sample of the referral form we are now using, with good results….


Initial Assessment Form

One of our goals was to embed current AFIB guidelines into the care our patients receive.  As such, we created an initial assessment form that incorporates the guideline recommendations for initial assessment and set up the form for ease of gathering all of the relevant information without unnecessary details.  In addition, it was also created with the intention to standardize the initial assessment from patient to patient, and as our AFQCP currently lives in an academic teaching institution, it also facilitates teaching of the important components of an AFIB assessment.  This form underwent several iterations  and here is the current version….


Medication Reconciliation Form

As medications are the mainstay of care for AFIB, it was important to ensure accurate, detailed information regarding a patient’s medication history was gathered and made available to all clinicians.  Our Med Rec Form was modeled after a successful outpatient form in use at University Health Network’s ambulatory Dialysis clinic, modified for our purposes.  It requires the collection of a best possible medication history and provides structure to address and evaluate each medication at each visit.  The process of Med Rec is completed by both the pharmacist in the clinic as well as the Nurse Practitioner.  You can find the latest verison of our Med Rec Form here….


Care Plan

Based on feedback from family doctors, we designed our care plan to be a one-page, structured form that incorporated the plan for the key components of care – namely rate/rhythm/QOL and stroke prevention in a standardized way.  We also embedded a section to clearly indicate which care plan next steps the AFQCP was taking responsibility for, and which we were asking the patient’s family doctor to take responsibility for, and created a writable .PDF for efficient creation of the written plan to be communicated to the family doctor within 48 hours of their visit.  Here is the form…


Patient Care Plan

In addition to the Physician care plan, we also identified the need for the patient to have a written summary of care and instructions to take away with them after their visit.  We use this form when we are communicating the plan to the patient and ensure that they have a summarized plan with next steps and any treatment changes. We hand write the summary and make a copy for the patient’s chart. We also include instructions on what to do if they experience another AFIB episode…


AFIB in One Page

This is a handy one-page summary of AFIB management created for the primary care provider.  It is divided into two sections:  one for Stroke Prevention and one for Symptom Management and Quality of Life.  It was created by a team with clinical perspectives from Electrophysiology, Cardiology, Internal Medicine, Pharmacy, Nursing and Family Practice.  In our clinic, we fax this along with the Care Plan to the family doctor for their reference.


Catheter Ablation

This is a handy one-page summary to help primary care practitioners determine when to refer their patients for consideration of Catheter Ablation treatment.