Effects of nursing practice guideline implementation to reduce time delays in patients with STEMI treated with streptokinase at Fang Hospital, Chiang Mai

Abstract

     This study employs an interrupted time series quasi-experimental design, which involves alternating the administration and withdrawal of an intervention with equal duration for both groups under study. The objective is to compare the effects of a nursing practice guideline to reduce the time to administer thrombolytic therapy in patients with STEMI.

      The scope of the research is at the emergency department of Fang Hospital in Chiang Mai province. The sample is divided into two groups: Group 1 consists of 19 professional nurses and emergency medical technicians responsible for STEMI patient care, and Group 2 includes patients diagnosed with STEMI, aged 45 and above, who received SK thrombolytic therapy at the emergency department of Fang Hospital. The samples are divided into control and experimental groups using purposive sampling. Data were collected before the implementation of the practice guideline over 12 months (April 1, 2022 – March 31, 2023) and after the implementation over another 12 months (April 1, 2023 – March 31, 2024). Data analysis was conducted using descriptive statistics for frequency distribution, percentage, mean, and standard deviation. Inferential statistics were used to test the differences between sample groups using Chi-square, paired samples t-test, and independent samples t-test.

      The results showed that the mean knowledge scores on STEMI patient care among professional nurses and emergency medical technicians were not significantly different before and after the intervention (t = -1.26, p-value = 0.225). However, the time from patient arrival at the hospital to receiving thrombolytic therapy (door to SK) was significantly lower in the experimental group compared to the control group (t = -3.96, p-value < 0.001). Additionally, the experimental group had a significantly higher survival rate than the control group at the 0.05 level (p-value = 0.042). These research findings can be applied to STEMI patients who are eligible for thrombolytic therapy.