The Development Process of Acute Myocardial Infarction (AMI) Patient Care in Surin Hospital

Abstract

Introduction: AMI is the condition of heart muscle disintegration resulting from lacking enough blood circulation because of Coronary Vessel Obstruction. Patients always come to hospital with chest pain symptom. AMI is the highest percentage of death patients in the first 24 hours. Most of the death problems found are hospital transfer problems, slow screening, insufficient Streptokinase (SK) medicine, including, no standard care procedures and low rate of ICU admission because of unavailable beds.
Objectives: 1. To develop patient care guideline
2. Interdisciplinary team will help to lake care patients
Operating Procedures: PCT Medicine Department meets and consults to find the AMI Patient Care guideline resolution starting from Emergency Room (ER) having express way for AMI patients l) screening by evaluating 2 of 3 criteria of chest pain, Trop-T, EKG 12 lead diagnosis and examination within 10 minutes. After that doctors have to increase skills to report General Medicine to make therapy decision 2) provide Oxygen and First Aid Treatment 3) If need SK drug, request and use it at ICU 4) Transfer patient within 30 minutes ICU Medical Department 1) Prepare equipment 2) Contact doctor to take care while having medicine 3) Doctor explains side effect of the medicine and make a note for therapy permission 4) Prepare patient to receive SK drug 5) Following symptoms while giving medicine 6) Record the symptoms 7) Take care following CPG and CNPG under relatives cooperation 8) Discharge plan Medical Department l) Take care patients in recuperate period 2) Educate and set up discharge plan by Interdisciplinary Team
Operating Periods: First Phase in Year 2004- 2005, Second Phase in January 2006 - August 2006, Third Phase under developing process.
Operating Results: Indicators prove that Patients under Fast Track system 51 people receiving Streptokinase 11 people. Troponin T examination results positive 41 people. The first phase died 42 people. The second phase death reduced to be 7 people (7 months) continuous improvement l) Make CNPG Patient Care, AMI at the first admission until discharge out of the hospital 2) Make an acute pain evaluation form in order to allow caretaker to evaluate the pain correctly and can help patient effectively 3) Patients have been taken care by interdisciplinary team which each of team member works under career standard
Criticism: ICU of Medical department should always have a reserved bed for the AMI patient. Each discipline should work under career standard to reduce death ratio; including, General Medicine should have standard procedures of patient care in the same manner. Nurses should have knowledge and patient care plan covering since admission process, following the patient therapy until patents arriving home in order to increase AMI patient care efficiency and continue improvement.
Key words: Acute ST elevation Myocardial Infarction (ASTEMI), Care