Could a nurse initiated fast track system reduce the door-to-needle-time for thrombolysis to twenty minutes or less?

Abstract

In context of this study, the focus was to examine the appropriateness of the diagnosis and the use of the correct drug therapy. Close scrutiny of the nurse and her decision making process focused on her/his competency to correctly diagnose an AMI on the electrocardiogram (ECG) and ultimately choose the appropriate thrombolytic drug. The study looked all patients with chest pain who had a primary diagnosis of AMI presenting with 'classic' electrocardiographic evidence, representative of acute myocardial infarction. It was deemed appropriate to use twenty patients as the sample because the patients all had suffered an acute myocardial infarction. Having undertaken a critical review of the theoretical framework and an in-depth literature review, it gave the researcher an insight into the problem of slow door-toneedle-tirnes. The research study was experimental type in its design and fell within the boundaries of the quantitative approach. The particular research design, with the use of questionnaires enabled data to be collected from facts and opinions. The main method of data collection was questionnaires as the appropriately trained nurse assessed the patient with AMI, made a diagnosis and administered the appropriate drug. Decker and Blecke (1994) suggested that adopting a particular methodology is essential. It could be argued that in order to generate scientific knowledge, it must emerge from the application of logical principles and reasoning. The design chosen was therefore appropriate to the problem, as it systematically tested the hypothesis nurses could help reduce the door-to-needle-times for thrombolysis to 20 minutes or less.The overall findings were that nurses did reduce the door to needle times to below 20 minutes, an average of 18.2 minutes and a median time of 18 minutes. In all 20 cases, 100%, the correct diagnosis was made and the appropriate thrombolytic drug administered. Seventy five percent received the thrombolysis in less than twenty minutes and 95% within 30 minutes. Overall the conclusion was that this system did work and the nursing staff made a huge difference in reducing the door-to-needletime. Ultimately, it will have a huge impact on nursing practice and will require extra resources if this system or similar is to remain successful.

Date of Award	5 Feb 2003
Original language	English
Awarding Institution	University of Bedfordshire