Development of Acute Myocardial Infarction Patient Care Management in Surin Hospital

Abstract

Background: Acute myocardial infarction (AMI) is critical condition in medicine area. At present, mortality rate of this disease tends to be increased. Prompt screening and intervention will confine the infarction zone and decrease mortality rate of the patient.
Objective: To study mortality rate, clinical outcome of patient care, nurse and customer satisfaction of the new developed AMI patient care management protocol.
Study Design: Action research
Method of study: Research data was collected from 30 hospitalized patients diagnosed with AMI and 184 nurses who provided nursing care to these patients. Research tools were quality of care assessment form, nurse knowledge assessment form and satisfaction assessment form for nurse and customer in which were tested and modified for content validity by expert opinion. Phase I of this study was situation and involved factors analysis. In Phase II, patient care management was developed and applied to practice in Phase III of the study in Deming cycle (plan, apply to practice, monitoring and development, evaluation). The study period was started from October 1st 2005 to December 31st 2010.
Study Result: After the developed management protocol was applied to practice, 1) เท quality of care outcome; mortality rate from AMI decreased from 22.72 in 2006 to 11.20 and 9.42 in year 2009 and 2010 respectively. Fast tract registration rate was 100% and rate of thrombolytic therapy within 30 minutes increased from none in 2006 to 10.00 and 8.11 in year 2009 and 2010 respectively. Average Door to Needle time decreased from 228.76 minutes in 2007 to 88.64 and 94.25 minutes in year 2008 and 2009 respectively. 2) Score of nursing knowledge was significantly increased (p<.0013). Customers and nurses satisfaction increased at significant level p<.001.
Conclusion: The developed AMI patient management protocol resulted in participation of multi-disciplinary team to provide patient care and response patient’s need in all aspects. These consequently improved the clinical outcome, decreased mortality rate and average Door to Needle Time.