level. The concept of Lean is aimed at increasing efficiency bydecreasing waste, improving quality and controlling costswithin a system. Value Stream Mapping (VSM) is one tool inthe Lean process, aimed at identifying the current state anddeveloping the desired future state through waste removal bybreaking down the barriers. A key Lean principle is that whena process is changed it is done by frontline workers where allvoices are equal.This interactive workshop will share the experience of utilizingVSM in a Cardiac Surgery program to improve quality andsafety from a patient care perspective. The workshop will beginwith the description of how the Lean process was introducedthrough On-Line learning modules, VSM and mock clinicalscenarios. The remainder of the time will provide the oppor-tunity for attendees to work through a VSM exercise.VSM can be applied in any clinical context where teammembers wish to review and improve a process to removewasted steps in a coordinated fashion. VSM could beinvaluable to healthcare professionals interested in quality andsafety by standardizing processes from a patient centered careperspective.

N003EARLY CARDIAC PRODROMAL SYMPTOMS: AN ELUSIVECLINICAL CHALLENGE

L Ready1, S O'Keefe-McCarthy2

1City of Kawartha Lakes Family Health Team, Lindsay, ON, 2University ofToronto, Toronto, ON

Nonspecific prodromal warning symptoms of an impendingcardiac event remain a challenge for health care profes-sionals to recognize, screen and treat. Lack of earlyprodromal symptom recognition from patients and clini-cians increase cardiac related morbidity and mortality.Typical prodromal symptoms may occur weeks to monthsbefore an actual cardiac-related event. Both men andwomen report chest and arm pain, dyspnea, fatigue, dizzi-ness, headache, sleep disturbance and anxiety as the mostprevalent symptoms. Clinicians need to focus attention onthe atypical, early pre-hospital warning signs of coronaryartery disease. To date, few assessment strategies andprodromal measuring tools are used in clinical practice to

CCCN Abstracts S393

Oral Abstracts of the 2013 Canadian Council ofCardiovascular Nurses Annual Scientific

Sessions

N001PERIPHERAL ARTERIAL DISEASE VERSUS PERIPHERALVENOUS DISEASE: ASSESSMENT, DIAGNOSIS AND TREATMENT

K Then, J Rankin, E Ali

University of Calgary/Alberta Health Services, Calgary, AB

Peripheral diseases both arterial and venous are widelyprevalent in patients with cardiovascular diseases. Peripheralarterial disease (PAD) is believed to affect approximately800,000 Canadians with between 12% and 29% beingassociated with the elderly. Peripheral venous disease, oftenreferred to as chronic venous insufficiency (CVI) includesvaricose veins, thrombophlebitis and effects of repeated deepvein thrombosis and coagulopathies. Varicose veins aloneaffect between 5% and 30% of the adult population withfemales being three times as likely as males to have varicoseveins. It is estimated that both peripheral and venousdiseases will be on the increase with our populationaging. The purpose of this presentation regarding CVI andPAD is to:

� Describe the different pathophysiologic mechanisms forCVI and PAD

� Understanding key risk factors� Outline key signs and symptoms� Describe clinical diagnosis and testing criteria� Discuss complications� Outline treatment and ongoing management strategies.

Nurses play a significant role in the ongoing assessment,documentation, treatment and evaluation of CVI and PAD.This presentation will focus on helping health care providersunderstand the differences between CVI and PAD and howtreatments are different for each. Knowing when to usecompression devices, elevate legs and what activities arerecommended for individuals with CVI and PAD areessential. Understanding of peripheral diseases will helpfocus nursing care and improve patient outcomes and satis-faction.

N002VALUE STREAM MAPPING TOWARD CARDIAC SURGERYPROCESS IMPROVEMENT: PUTTING LEAN INTO ACTION

C Laberge, C Roberts, K Kowal

Interior Health, Kelowna, BC

One challenge directly impacting health care delivery, front-line staff, and patients, is that key decisions are often made ata distance. This gap creates misunderstanding of the contextof work between administration and the inter-professionalteam leading toward quality and safety concerns at the patient

effectively assess and screen for prodromal symptoms. TheMcSweeney Acute and Prodromal Myocardial InfarctionSymptom Survey (MAPMISS) is an evidenced-based,psychometrically robust tool that screens for 33 potentialprodromal symptoms.The objectives of this interactive workshop are 1) to brieflyreview the status of current prodromal literature, 2) topresent and discuss two individual patient-related casestudies, and 3) to introduce the McSweeney Acute andProdromal Myocardial Infarction Symptom Survey (MAP-MISS) and discuss the potential implications for clinicalpractice.