The Development of Care Guidelines for Patients with ST-Elevation Myocardial Infarction (STEMI) at Pathumrat Hospital

Abstract

Pupose: To study the problem, develop guidelines and evaluate the use of guidelines for the care of patients with ST-Elevation Myocardial Infarction (STEMI) at Pathumrat Hospital.

Study design: Research and development (R&D).

Materials and methods: The target group consisted of 7 nurses and medical personnel for 10 focus group discussions, 30 patients and relatives, and 30 patients for trial use of the guidelines.Including semi-structured interviews, needs questionnaires, suitability assessment forms, and satisfaction assessment forms. Qualitative data were analyzed using content analysis and quantitative data using descriptive statistics, One Sample t-test.

Main finding: The main problems in caring for STEMI patients were found to be incomplete assessment, delayed diagnosis and treatment due to lack of specialized personnel, and limitations in referrals. The highest priority (PNI) was the readiness of doctors and nurses to support patients 24 hours a day (PNI = 0.530). The developed guidelines consisted of 6 steps. 1) Screening of symptoms using the chest pain assessment form for acute myocardial infarction patients at Pathumrat Hospital. Increase screening in DM, HT, old MI patients who present with dizziness, dyspepsia. Perform EKG in every case and create a notification system in the HOSxP program. 2) Perform EKG and report results to the doctor within 10 minutes. 3) Consult cardio med at the main hospital, announce FT, give SK medication using the express channel for waiting to reduce the time for giving medication, workshop for officers on giving SK medication, record medication giving, specify the time of medication giving, the time the medication expired in order to receive medication in time effectively. 4). Coordinate the transfer to the main hospital, Roi Et Hospital, send information in the line to forward STEMI FT, deliver the patient by 2 nurses. 5) Follow up on treatment results, follow up on home visits for every case. And 6) Chronic disease clinic nurses and hospital staff provide health education to patients about AMI and the EMS system, so that patients and their relatives know about emergency symptoms that require hospital visits. The evaluation found that 27 people (90%) entered the Fast Track process, 15 people (50%) received EMS services, the average door-to-needle time was 27 minutes for 25 people (83.33%), the Onset to Needle Time (OTN) was 85 minutes for 21 people (70%), and the mortality rate was 0%.

Conclusion and Recommendations: This research demonstrates that the aforementioned approach reduces mortality rates and enhances the quality of care. It is therefore recommended to implement continuous staff training and development programs, establish a real-time ECG system, and promote the adoption and adaptation of this approach by other community hospitals.