Development of Care Model for Prevention of Contrast Induced Nephropathy in Elderly Patients with STEMI with Percutaneous Coronary Intervention by Team Participation in Sunpasitthiprasong Hospital Context, Thailand

Abstract

Elderly ST elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) are at high risk for CIN and mortality. This participatory action research (PAR) design study was to develop the care model for post-PCI CIN prevention in Elderly patients with STEMI with PIC by interprofessional team in Sunpasitthiprasong Hospital. There were four steps of PAR including situation analysis, model development, implementation, and evaluation. Key informants of the study were multidisciplinary care team and elderly STEMI patients in the Coronary Care unit. In-depth interviews, focus group and direct observation were employed for data collections. Data were analyzed by content analysis and frequency and percentage and Chi-square for qualitative and quantitative data, respectively.

Results: The result of the situation analysis showed that the most of key informant well-perceived the risk of post-PCI CIN, however there was no specific guideline for post-PCI CIN prevention implemented. Based on the medical record audit, only 6.6 % were pass its minimal requirement. In 2020, 13 out of 18 elderly patients developed CIN with hemodialysis (HD) were dead resulting in mortality rate 72.2%. Consequently, phase 2: the ASKME model was applied to develop the post-PCI CIN prevention. After the model validated by five experts with IOC =0.79., phase 3, it was implemented with three cycles model improvement by modifying the way to assess the CIN risk from papers and pencil to be a google form in the second cycle, and modifying               the contrast media protocol and monitoring protocol in the third cycle. Phase 4, evaluation phase, the 28 patients were cared for post-PCI CIN prevention and their medical records audited with increased passing rate (91.4%), especially the assessment for post-PCI CIN risk by using the post-PCI CIN scoring and monitoring. The outcome after the model implementation, in 2021, 10 post-PCI patients had CIN with HD, 6 were dead (60% mortality rate), however, in 2022, 3 out of 8 post-PCI CIN with HD cases were dead, thus mortality rate was decrease to 37.5%. The findings suggested that post-PCI CIN monitoring could help prevent post-PCI CIN and increase the quality of care and safety in elderly STEMI.