Emergency department triage nurses' self-reported adherence with American College of Cardiology/American Heart Association myocardial infarction guidelines.
OBJECTIVE
Mortality from acute coronary syndromes has decreased. This achievement is based on the rapid recognition of possible acute coronary syndrome, obtaining an electrocardiogram for diagnosis, and the prompt initiation of therapy, including aspirin, oxygen, thrombolytics, and cardiac catheterization. The importance of rapid diagnosis and therapy is emphasized by American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines. However, these goals are not always met, and their failure leads to increased mortality. The purpose of this study was to determine the frequency emergency department nurses report guideline-related activities when triaging patients for complaints suggestive of myocardial infarction.


METHODS
As part of a larger study examining nurses' cardiac triage decisions, 158 emergency department nurses who belonged to the Emergency Nurses Association responded to a mailed questionnaire, which asked how frequently certain nursing practice activities were performed that would facilitate the attainment of ACC/AHA myocardial infarction guidelines and goals. Responses were measured on a 5-point Likert-type scale from "none of the time" to "all of the time."


RESULTS
Not a single one of the 9 goals was met "all of the time" by all of the nurse participants. "All of the time" ranged from 52% for giving analgesics to 87% asking about chest pain. Only 81% of participants had a goal of obtaining electrocardiogram within 10 minutes of arrival, and only 27% of participants met all 9 goals "all of the time." The likelihood of nurses meeting goals was not associated with their age, experience, educational level, or certification status.


CONCLUSIONS
We recommend tailored educational interventions be developed to improve nurses awareness of the importance of complying with the ACC/AHA standard of care practice goals and the necessity of achieving these goals all of the time as a path to improving patient outcome.
School of Nursing, University of Michigan, 400 N Ingalls, Ann Arbor, MI 48109, USA. cmae@umich.edu
Cynthia
C
Arslanian-Engoren
Kim A
KA
Eagle
Bonnie
B
Hagerty
Sarah
S
Reits
D000328:Adult; D000368:Aged; D000572:American Heart Association; D016529:Emergency Nursing / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D057566:Self Report; D011795:Surveys and Questionnaires; D014218:Triage / Q000592:standards*; D014481:United States; D055815:Young Adult