Julie Shardlow Matron Cardiology Services
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Transcript of Julie Shardlow Matron Cardiology Services
Nurse Initiated Thrombolysis
♦ Why ♦ What ♦ How♦ Results♦ One year later♦ Lessons learned
Why
♦ 1997 - 25% of eligible patients received thrombolyisis within 60 minutes of arrival at hospital
♦ 1998 – 50% of eligible patients received thrombolyis within 60 minutes of arrival at hospital
♦ 2000 – No patients received thrombolysis within 30 minutes of arrival at hospital
Why
♦ Improve care
♦ Improve patient outcome
♦ Meet NSF targets
How
♦ No money
♦ No extra resources
♦ Lots of enthusiasm and support
Who
♦ E grades and above in CCU
♦ F Grades and above in A/E dept
Who
♦ Chief Nurse♦ Ward staff♦ Senior nurses♦ Cardiologists – Lead Clinician♦ Pharmacist♦ Nurse manager♦ Practice development♦ Professional development♦ Trust advisory group (Advancing Practice Group)
Patient Group Direction
“ specific written instruction for the supply or administration of named medicines in an identified clinical situation. It is drawn up locally by doctors, pharmacists and the appropriate professionals and approved by the employer. It applies to groups of patients or other service users who may not be individually identified before presentation..”
(Crown report 1988)
Principles of PGD
♦ PGD to be used where it provides an advantage to patient care without compromising safety
♦ All disciplines affected by the PGD to be involved in the development
♦ Regular formal review dates
♦ Changes to PGD to be submitted through formal process
When
♦ First course February 2001
♦ Courses scheduled throughout each year
according to demand
Results:
♦ 24hour cover by nurses on CCU.♦ Senior nurses in A/E and CCU trained♦ All patients thrombolysed by nurses safely
and effectively.♦ Improvement in door needle times
Results% Thrombolysed in 30 minutes or less 2001-2002
0
20
40
60
80
100
120
Jan Feb Mar AprMay
June July AugSept Oct Nov
Dec
Perce
ntag
e
% in 30 mins or less in year2001% in 30 mins in year 2002
ResultsMedian Door To needle Times 2001 and 2002
0
10
20
30
40
50
60
70
Jan
Feb
March Apr
MayJu
neJu
lyAug
Sept
Oct NovDec
Tim
e in
min
utes
Median Time in Year 2001
Median Time in Year 2002
ResultsThrombolysis 2002
0
20
40
60
80
100
120
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Per
cent
age
% in 20 mins
% in 30 mins
Direct admission to + NITs CCU
Problems……….
♦ Bed availability on CCU♦ Majority of patients were thrombolysed in
A/E♦ Senior staff trained to thrombolyse in A/E
were often busy with other things♦ Thrombolysis in A/E much slower
One Year Later
♦ Secured extra funding from PCTs ( Two E grades)
♦ Thrombolysis link sister in A/E
♦ Nurses in CCU bleeped to attend Chest pains in A/E to support thrombolysis
(July 03)
Results2003 Door to Needle Times
0
10
20
30
40
50
60
70
80
90
100
Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar
% Thrombolysed<30 mins
% Thrombolysed< 20 mins
Results
Call to Needle Times 2003
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1 2 3 4 5 6 7 8 9 10 11 12
%<60 mins
Lessons learned
♦ Solve one problem find another one ♦ Continuous monitoring and review ♦ Everyone's problem♦ Team approach is essential ♦ Communication and Education is on going♦ Relationships matter
Lessons learned
♦ Continuous feedback is essential ♦ Accurate documentation/audit systems♦ Requires multidisciplinary approach♦ Eliminate interdepartmental barriers♦ Develops Staff (confidence and
communication and team work) ♦ Solutions don’t always depend on extra
funding
Lessons Learned
♦ NITs course evaluated very well
♦ Survey of A/E staff show NITs perceived to be extremely beneficial
♦ To extend it to E grade staff in A/E
Lessons Learned
New ways of working
