Effects of Nursing Supervision System Development for Patients with ST-Segment Elevation Myocardial Infarction (STEMI) to Increase the Quality of Primary Percutaneous Coronary Intervention Received at Phrapokklao Hospital

Abstract

BACKGROUND: The Heart Center at Phrapokklao Hospital had a higher mortality rate among STEMI patients than the target. Thus, the development of nursing supervision to increase the capacity of personnel in network hospitals so that patients could be transferred efficiently for primary percutaneous coronary intervention (PPCI) during the golden period was necessary.

OBJECTIVES: This study aimed to develop a nursing supervision model for STEMI patients to increase referral quality for standardized PPCI procedures and to evaluate the effect of the model.

METHODS: The study used a research and development design with a target population consisting of 19 network coordinator nurses from 16 hospitals in the heart center network, Phrapokklao Hospitals and 40 patients diagnosed with STEMI sent for PPCI from October to December 2022. The research process consisted of a situational analysis of the STEMI patient care problems at the heart center, development of the temporary nursing supervision model, and supervision to encourage network coordinator nurses to comply with standards using the developed guidelines. The model was tried and tested, with follow up on the supervision and evaluation of performance. The model was then updated and monitored for results. The Satisfaction Assessment Form for the Supervision Model, and the Standard Compliance Assessment Form showed reliability of 0.95 and 0.87, respectively. Information was recorded for STEMI patients and the first medical contact to device time. Data were analyzed using descriptive statistics, Independent t-test, Chi-square test, and content analysis.

RESULTS: The developed nursing supervision model was based on formative supervision principles and normative supervision standards using the principles of restorative clinical supervision and participation. A handbook of STEMI patient care for PPCI submission consistency, flow chart manuals, and real-time forwarding records were provided. Zoom technology and line groups were set up to communicate information, solve problems, and supervise the practice of referral coordinator nurses in network hospitals. The results showed suitable standard compliance among nurse coordinators from the network hospitals (94.7%), the good satisfaction with the supervision method (M=3.7±0.3). The target population consisted of 40 STEMI patients; the majority were males (82.5%). After the model development, the referral time for STEMI patients from network hospitals for PPCI was significantly lower than before the model development (M=95.6±29.6 vs M=135.4±62.4, p<0.001), and the number of patients referred for PPCI within 120 minutes was significantly higher than before development (82.5% vs 50.4%, p<0.001).

CONCLUSIONS: The developed model could be used as a guideline to increase referral efficiency from network hospitals, thus enabling STEMI patients to receive more standardized PPCI and reduce patient mortality.