Improving Recognition and Treatment of Acute Myocardial Infarctions with Thrombolytic Therapy in a Rural Emergency Department

Monday, July 11, 2011: 2:25 PM

Scott Carter Thigpen, DNP, RN, CCRN, CEN
Division of Nursing, South Georgia College, Douglas, GA

Learning Objective 1: Examine current evidence based practice guidelines for recognition and treatment of acute myocardial infarctions with thrombolytic therapy in rural emergency departments.

Learning Objective 2: Recognize the ability to improve acute myocardial infarction patient outcomes with thrombolytic therapy through the implementation of national cardiovascular guidelines.

The goal of this study was to improve the recognition and treatment of acute myocardial infarction (AMI) within the recommended thirty minutes from arrival to a rural emergency department. The first part was designed to identify the perspectives of health care providers regarding improving this process. Focus groups were held to identify methods to improve patient outcomes. The second part of this study was to evaluate the impact of an educational session developed for a group of emergency department nurses. This was evaluated by utilizing a pretest and posttest to evaluate evidence based knowledge related to recognition of acute myocardial infarctions and treatment issues. The participants were asked to complete a pretest questionnaire which will be followed by a 20 minute in-service presentation on evidence based thrombolytic therapy for acute myocardial infarctions. The subjects were then post tested following the in-service session. Data was collected using an 18 item questionnaire. Eight items focused on demographic data of the group and the remaining 10 items consist of questions related to evidence based thrombolytic therapy for AMI. Two focus groups were held. A convenience sample of 52 subjects participated in the pretest and post test section and 10 subjects participated in the focus groups. To evaluate the effectiveness of the educational session, the pretest and post test total scores and scores on individual items were analyzed using Chi square. The focus group transcripts were analyzed for common themes and factors regarding delay in timely treatment. The research project identified barriers to prompt identification and recognition of acute myocardial infarctions. Nurses demonstrated an increased knowledge of evidence based practice guidelines for thrombolytic administration. This in turn will improve compliance with the Joint Commission core measure for treating acute myocardial infarctions with thrombolytic therapy within 30 minutes of arrival to a rural emergency department.