Paper
Wednesday, July 21, 2004
9:30 AM - 10:00 AM
Wednesday, July 21, 2004
2:30 PM - 3:00 PM
This presentation is part of :
PostersSuccessful Strategies in AMI Care
Margaret A. Morley, RN, MSN, CNS/ANP-C, Hoag Hospital, Newport Beach, CA, USA
CHALLENGE: The dilemma we encountered was restoring coronary blood flow via primary percutaneous coronary intervention (PCI) in a timely manner. Our second objective was to improve the AMI patients’ in-hospital care. Despite evidence that secondary prevention medical therapies reduce mortality in AMI patients, these therapies continue to be underutilized (Am J Cardiol 2001; 87:819-822). When compared with like hospitals, we were gravely below average in the use and documentation of secondary prevention methods. This challenge was extensive, and required educating all nurses and physicians, including internists in regards to the current recommendations of the American Heart Association (AHA). GOALS: ° Door to thrombolytic 30 minutes or less. ° Door to balloon inflation 90 minutes or less. ° Compliance with AHA Get with the Guidelines treatment for secondary prevention, which includes the following: ASA, Beta Blocker, ACE Inhibitors and Statin therapy within 24 hours and on discharge. Counseling regarding diet, exercise and smoking cessation. SOLUTION: The development of the Code 10 Team emphasized the urgency of AMI intervention. Flowcharting the process with proposed changes made expectations clear. Staff and Physician delays were tracked and addressed. Bi-weekly meetings identified process variables and developed action plans to prevent reoccurrence. Pre-written Orders, Discharge Prescriptions and Discharge Progress Notes were created to facilitate physician conformity. OUTCOMES: Results included enhanced relationship between Cath Lab and ECU. Increased physician compliance with GWTG. Better door to EKG, Drug and Balloon Inflation. Heightened nursing staff awareness regarding evidence-based practice and secondary prevention. Our organization is now superior to “like hospitals” in all aspects of AMI care as reflected in NRMI and VHA benchmark data. Accomplishments stimulated the development of derivative improvement groups such as smoking cessation and GWTG.
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Sigma Theta Tau International
July 21, 2004