การพัฒนาแบบประเมินคัดกรองผู้ป่วยเจ็บ-แน่นหน้าอกหรือใต้ลิ้นปี่ หน่วยงานอุบัติเหตุและฉุกเฉินโรงพยาบาลระนอง The Development of the Screening and Assessment Form for Patients with Chest or Epigastric Pain in Emergency Department at Ranong Hospital

Abstract

The common signs of an acute coronary syndrome is chest pain. The pain may radiate to the neck, back and arms. However, some patients came to the hospital with chest pain that cannot be determined by any cause may cause delayed diagnosis and lead to death of the patient. The purpose of this action research aims to develop a screening and assessment form that determines the symptoms of chest or epigastric pain caused by acute coronary syndrome at the Emergency department of Ranong Hospital by using three steps of action research and they are as follow: 1) plan, 2) action, and 3) evaluation. The sample consisted of 17 registered nurses and 71 patients who were admitted to the Emergency department with chest or epigastric pain. The research instrument is composed of the chest or epigastric pain screening and assessment forms and the satisfaction of registered nurses in using the chest or epigastric pain screening and assessment form questionnaires. The data were analyzed using percentage, mean, standard deviation, and pair-sampled t-test.

                The results revealed that the screening and assessment form that was developed composed of 1) initial assessment including screening and severity of chest pain, history, characteristic of chest pain using PQRSTT, chief complaint, co-symptom and definitive risk stratification 2) basic nursing care for chest pain 3) physician reporting and care 4) coordinating and 5) transferring and patients' continuity of care during transfer which is practical and practicable. These helped the nurses to evaluate the patient with chest pain at the time of arrival, the percentage of patients who received an EKG within 10 minutes after arriving at the hospital and reported to the doctor within 5 minutes are increasing as well as reduced the door to needle times ( =24.80). The satisfaction with the chest or epigastric pain screening and assessment forms among nurses was high. In conclusion, the effectiveness of screening and assessment tool for patient with chest or epigastric pain can help rapidly diagnosis and reducing harm in patients.