Development of Patient Care for ST Elevated Myocardial Infarction in Acute Ischemic Heart Disease by Nursing Case Management Model in Lamphun Hospital

Abstract

This study was quasi experimental research. The objective was to study the quality care outcomes in acute ischemic heart disease patients with ST elevated myocardial infarction (STEMI), Lamphun Hospital. Using Nursing Case Management Model. The sample consisted 60 patients with STEMI respectively. 30 Samples were before using Nursing Case Management Model. And the other 30 samples were afterusing Nursing Case Management Model . The data
was collected from April 1, 2014 to March 31 , 2015. There were 2 nurse case managers care from admission until discharge and also do coordinating and collaborating among multidisci- plinary patient care team. Nursing Case Management Model process consisted symptomatic screening, referral screening, health assessment, coordinating, surveillance and final health as-sessment after discharge. Both nurse care managers had managed since the patients were at
the emergency room, during admission at ICU or at medical ward until they were discharged.Research instruments comprised, 1) Handbook and guidelines for patients with STEMI including Clinical Practice Guideline, Standing order, Cardiac Rehabilitation Program, Discharge Plan of Coronary Artery Disease, Patients training in their home cares for Acute Coronary syndrome and Catheter intervention VDO. 2) Data Collection Tools including acute coronary disease patient
chart and Thrombolysis In Myocardial Infarction(TIMI score) card for STEMI screening. The result of 7 indicators quality care outcomes were analyzed and compare between the samples before and after using Nursing Case Management Model. The data was analyzed by using descriptive statistics including frequency, percentage, average and the characteristics was verified by Mann - Whitney U test The results revealed that quality care outcomes of the samples after using Nursing Case Management Model were improved. Time of door to needle until receiving streptokinase in 30 minutes was improved from 33.33% to 69.24 %. Average length of stay reduced from 7.10 days to 4.33 days. Receivingthe specific treatment by percutaneous coronary intervention(PCI) or Coronary Artery Bypass Graft(CABG) were increased from 20.00 % to 70.00 % that showed statistically significant. The results of this study indicated improved quality care outcomes by using Nursing Case Management Model for patients with STEMI