Development of Caring System for ST Segment Elevation Myocardial Infarction (STEMI) Patients undergoing Thrombolytic agents in Cardiac Network Suratthani Province

Abstract

              This research and development study was conducted to develop a caring system for ST Segment Elevation Myocardial Infarction (STEMI) Patients undergoing Thrombolytic agents in Cardiac Network Suratthani Province and evaluate the outcomes after the network development. Research participant comprised of 100 Registered Nurse who were in charge of STEMI patients in community hospitals and tertiary hospital. And the samples were 142 STEMI patients undergoing Thrombolytic agents in Cardiac Network Suratthani Province from January, 2015 to August, 2017. Data were collected from ACS registry and participatory questionnaire. Descriptive statistics were used to analyse quantitative data. Caring system development for ST Segment Elevation Myocardial Infarction patients undergoing thrombolytic agents in cardiac network Suratthani province among 20 hospitals enabled the STEMI care network to meet the goal of service plan of which 100% of community hospitals were able to administrate thrombolytic therapy. Registered nurses were designated as a case manager also coordinated care for STEMI patients among all levels of health facilities. This system was designated area for each hospital to available for establishing timely coronary reperfusion: fibrinolytic therapy. The responsible area of each hospital was defined and the caring system among the hospitals was organized to allow in-time accessibility of coronary reperfusion and fibrinolytic therapy for patients. A clinical nursing practice guideline for patient care and referral was developed and implemented to ensure equivalent quality of care throughout the network. Moreover, Streptokinase was made available to share among network hospitals to prevent expire before use. For improved competencies in STEMI care, workshop was organized for nurses which comprised of knowledge and skill in basic EKG interpretation, nursing management in Acute Coronary Syndrome, administration of thrombolytic therapy and referral system and caring including the follow up assessment of caring outcome of each hospital. These programs enabled better outcome of care, decrease of mortality rate and complication, improvement of patients’ accessibility to thrombolytic therapy, reduction of first medical contact to needle time, as well as reduction time between onset to needle time which resulted in improvement of continuing care after discharge. The result of this study suggested that the caring system among hospitals for STEMI Patients should be further promoted and implemented for sustainable services and effectiveness. In addition, registered nurses who working with STEMI patients should enhance their competencies especially updated knowledge and skill in treatment and nursing care. Eventually, continuous assessment and improvement of caring system is vital for continuing care. The outcome of caring system should be published and presented in national and international health care academic symposium or seminar.