Effectiveness of Practice Guideline Implementation for ST-Elevation Myocardial Infarction Patients Receiving Thrombolysis at Emergency Department of DokKhamTai Hospital
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Abstract
This research and development aimed to develop and evaluate the effectiveness of the practice guideline for ST-elevation myocardial infarction patients receiving thrombolytic drugs at emergency department, DokKhamTai hospital during April, 2015 to September, 2018. The samples were: 37 ST-elevation myocardial infarction patients; and the care team comprising of 6 doctors and 13 nurses. Research instruments included: patient’ data recording forms; and assessment forms of the effectiveness and opinions toward the guidelines. The research comprised of 3 phases: (1) system and guideline development phase, included screening, STEMI fast-tract, specialist consultation, treatment & care, and referral guidelines; (2) guideline implementation phase, employed 1) action & observation by coaching and participation, 2) reflection by after action review (AAR), 3) re-planning and 4) summing up the practice guideline; and (3) evaluation the effectiveness of the practice guideline phase. Data were collected continuously during the fiscal year of 2015 to 2018. Descriptive statistics were used for data analysis. Results of the effectiveness of guideline implementation showed that patients received EKG screening within 10 minutes by 20.00, 36.36, 72.72 and 100.00%, respectively. Patients received thrombolytic drug within 30 minutes by 20.00, 50.00, 54.54 and 70.00%, respectively. They had no death case during treatment and refer. The care team followed the practice guideline increasingly by 20.00, 54.54, 81.81 and 100.00% respectively. The developed practice guidelines helped patients get access to the services in time, and resulted in reducing the patient’ death rate.
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References
2. Hengrassami K. Situation of ST elevation myocardial infarction in Thailand in standard and referral system of acute myocardial infarction 2554. Bagnkok Thailand: Sukumvit Printing; 2011. (In Thai)
3. Srimahachota S, Boonyaratavej S, Kanjanavanit R, Sritara P, Krittayaphong R, Kunjara-Na-Ayudhya R, et al. Thai Registry in Acute Coronary Syndrome (TRACS)-an extension of Thai Acute Coronary Syndrome Registry (TACS) group: lower in-hospital but still high mortality at one-year. Journal of the Medical Association of Thailand 2012;95(4):508. (In Thai)
4. Arayapong J, Jongpipathwanich P, Sumamarn T, Singhathud T, Penkitti P, T-piasuan T. Service plan of Heart disease Bureau of Health Administration, Ministry of Public Health Bangkok: Agricultural cooperative printing demonstrations of Thai Ltd. 2003. (In Thai)
5. Sanguanwong S, Srimahachota S, Tungsubutra W, Srichaiveth B, Kiatchoosakun S. Predictors of in-hospital mortality in Thai STEMI patients: Results from TACSR. Journal of the Medical Association of Thailand 2007;90:91-7. (In Thai)
6. Tungsubutra W, Tresukosol D, Buddhari W, Boonsom W, Sanguanwang S, Srichaiveth B. Acute coronary syndrome in young adults: the Thai ACS Registry. Journal of the Medical Association of Thailand 2007;90:81-90. (In Thai)
7. Every NR, Frederick PD, Robinson M, Sugarman J, Bowlby L, Barron HV. A comparison of the national registry of myocardial infarction 2 with the cooperative cardiovascular project. Journal of the American College of Cardiology 1999;33(7):1886-94.
8. Antman EM. ST-elevation myocardial infarction: pathology, pathophysiology, and clinical features. Heart disease;2008:1207-32.
9. Fuster V. The AHA guidelines and scientific statements handbook [Internet]. USA: Dallas, TX; 2009. [cited 2014 June 15 ]. Aviable from: https://th.2lib.org/book/694530/2fbdf3
10. Trialists FT. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. The Lancet 1994;343(8893):311-22. (In Thai)
11. O’gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, De Lemos JA, et al. 2013. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127(4):529-55.
12. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. The Lancet 1996;348(9030):771-5.
13. Taha R, Oraby M, Nasr G, El-Hawary A, Prevalence and causes of failure of receiving thrombolytic therapy in patients with acute ST-segment elevation myocardial infarction. The Egyption Heart Journal 2013; 65 : 51-55.
14. The Health Ministry. Service Plan for Cardiac Network: Guidelines. Bagnkok Thailand: Agriculture cooperative association of Thailand printing house; 2013. (In Thai)
15. Kemmis S, McTaggart R, Nixon R. The action research planner: Doing critical participatory action research [Internet]. Springer Science & Business Media; 2013. [cited 2014 June 15 ]. Aviable from: https://scholar.google.co.th/
16. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies[Internet]. World Health Organization;2010. [cited 2014 June 15] . Available from: WHO_MBHSS_2010_full_web.
17. Somjit K, Pawinee P, Orathai P, Tabsuri P. The Development of Nursing Practice Guideline for Patient with Acute ST Elevated Myocardial Infarction, Mukdahan Hospital. Medical journal of Srisaket Surin Buriram Hospitals 2557;29(3):149-58. (In Thai)
18. Suwanit P. Development of a Case Management System for Patients with ST-elevated Myocardial Infarction in Khon Kaen Hospital. Journal of Nurse’ Association of Thailand, North-Eastern Division 2554;29(1):22-30. (In Thai)
19. Juntaraporn S, Arunsri R, Piyatiida B. Development of Caring System for ST Segment Elevation Myocardial Infarction (STEMI) Patients undergoing Thrombolytic agents in Cardiac Network Suratthani Province. Region 11 Medical Journal 2017;31(3):495-506. (In Thai)
20. Chantima P, Kavinnat B. Effects of Clinical Pratice Guildelines for ST Elevate Myocardial Infarction Patients in Emergency Department, Nakhonnayok Hospital. The Journal of Faculty of Nursing Burapha University 2015;23(3):97-111. (In Thai)
21. Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. New England Journal of Medicine 2005;352(12):1179-89.
22. Surasak S. Cost-effectiveness of Thrombolysis Service for Patient with ST Segment Elevation Myocardial Infarction in Community Hospital. 2015. (In Thai)