420 JOURNAL OF EMERGENCY NURSING 29:5 October 2003

CLINICAL ABSTRACTS

13. Development and Implementation of a Myocardial In-farction Alert Process. Christina Lewis, RN, BSN, MPH, Mark S.Gutekunst RN, CEN, Diana Haines, RN, MSN, CEN, Kathy Herron-Butillo, RN, BS, Lehigh Valley Hospital-Muhlenberg, 2545Schoenersville Rd, Bethlehem, PA 18017 (E-mail: Christina.Lewis@ LVH.com)Clinical topic: The intent of this project was to develop and im-plement a myocardial infarction (MI) alert process that evolvedfrom primary thrombolytic therapy to percutaneous coronary in-tervention. The goal of the MI alert process is to assure rapidtriage of patients and to mobilize key staff for immediate inter-vention. The standard of care for the MI patient is primary coro-nary intervention when cardiac resources are available. This in-tervention provides rapid and lasting reperfusion to themyocardium.

Implementation: A multidisciplinary committee comprisingED staff, physicians, and the cardiac catheterization team devel-oped the new approach. The committee developed a notificationprocess and determined an implementation timeline. Goal timeswere benchmarked at the national level. The target time was door-to-balloon inflation of less than 90 minutes. A process and algo-rithm were developed to guide team members.A phone log was created to simplify the process and aid with eval-uation. The log is used by staff to facilitate notification of the car-diac team. Phone logs are reviewed for performance improve-ment. An MI alert box was assembled to include the necessarymedications and equipment. MI alert packets were preparedincluding standard physician orders, the MI alert protocol, andalgorithm.The practice council served as the education team. The practicecouncil comprises ED staff from each job classification. Theypresented the education program to each shift and served asresources. Evaluations from mock MI alerts help fine tune theprocess.

Outcomes: Each MI case treated according to the MI alert pro-tocol was evaluated by the practice council and the physician per-formance improvement (PI) director. Since implementation, theaverage door-to-balloon inflation times have consistently beenbelow the national standard. The phone log served as a tracking tool and assisted with problemidentification. MI alert times are posted to assure employees areaware of their success. The practice council excelled in process development, education,implementation, and evaluation of the process. Due to the multi-disciplinary committee, staff teamwork, and clear communica-tion lines, the MI alert process resulted in superb care for the MIpatient and team pride.

Recommendations: The practice council will continue to eval-uate each case and revise the process. Future plans are to recognizethe individuals and team members for expedient door to EKGtimes and door-to-balloon inflation times. This process could beutilized in other institutions with in-house cardiac resources aswell as for rapid stabilization from facilities without an interven-tional cardiac catheterization lab.