Myocardial Ischaemia National Audit Project - University College ...

6. Using MINAP data to reduce Call to Needletime in North WalesLucy Trent – Independent Nurse Practitioner, CardiologyWrexham Maelor HospitalWrexham Maelor Hospital is one of three general hospitalsthat form part of Betsi Cadwaladr University Health Board- the largest health trust in Wales. Our area is one of thefew places in the UK where medication (thrombolysis) is thecommonest treatment for acute heart attack (rather thanimmediate coronary stenting) and we continue to strive toincrease the delivery of thrombolysis in the community, beforearrival at hospital - pre-hospital thrombolysis (PHT) - whichis around 19% of the total. Because of the rural geography ofNorth Wales, there are significant challenges in meeting theCall-to-Needle (CTN) time standard of 60 minutes, unlessthe patient receives PHT. Monitoring the level of PHT throughMINAP and close working with the Welsh Ambulance Serviceis crucial for us to provide a high quality service for patients.Other issues influencing achievement of the CTN timeare the level of Paramedic confidence in interpretationof the ECG and the fairly restrictive Joint Royal CollegesAmbulance Liaison Committee protocol for pre-hospitalthrombolysis administration.Various methods have been adopted in an attempt to increasethe confidence of Paramedics in North Wales to give PHT. Forexample, a rolling programme of ECG teaching incorporatingBasic, Advanced and Arrhythmia days have been provided on amonthly basis for the past 4 years. These days are delivered byCardiology Nurse Practitioners at all three sites across NorthWales and are aimed at Primary and Secondary care staff andat Ambulance Service personnel. Additionally, ThrombolysisUpdate days, targeted at Paramedics, incorporate discussionabout real cases, advanced ECG recognition and how to accesssupport, advice and feedback about cases they have dealt with.Monthly Thrombolysis Review meetings take place and involvea Consultant Cardiologist, and staff from the cardiologyward, the emergency department (ED) and the WelshAmbulance Service, the ED/Cardiology Ward Matron and aCardiology Nurse Practitioner. MINAP data and particularcases are reviewed and critiqued in order to identify areas forimprovement. Examples of good practice are also highlightedand fed back to the relevant staff.Later this year an exciting development will be thetransmission of ECGs via email as pdf files from theambulance directly to the ED or Coronary Care Unit atthe receiving hospital. This has been a difficult project todevelop in no small part due to transmission problemswithin the beautiful but mountainous landscape of NorthWales. Following technological advances the quality of thetransmitted ECG is now good enough for clinicians in theED to give advice to the Paramedic on scene. This shouldenhance the decision making skills of the Paramedic whileensuring that the clinical decision of whether or not to deliverthrombolysis rests firmly with the Ambulance staff on theground. A telemetered ECG will also enhance the ‘pre-alert’sent to the receiving unit, even on those occasions when theParamedic cannot deliver PHT. This can save valuable minutesin providing definitive treatment.We hope that these initiatives will continue to improve the carefor heart attack patients in North Wales.7. Using MINAP to reduce Call to Needle times inNorth WalesPhilip M. Jones - Clinical Support Officer,North Region, Welsh Ambulance Service TrustTime is critical in the management of people with myocardialinfarction. Minutes lost at any stage may adversely affectoutcomes. Early diagnosis is pivotal and early treatment maybe life-saving. If, as in North Wales, primary PCI is not readilyavailable, thrombolysis should be given to patients with STEMIas soon as possible and within 60 minutes of their call forhelp, by the first appropriately trained person available. In ourlargely rural community, for many patients this can only beachieved by the delivery of pre-hospital thrombolysis (PHT)– intravenous thrombolytic treatment given before or duringtransport to hospital by paramedic ambulance personnel.During the past year 86 patients have received PHT.One of my responsibilities within the Welsh Ambulance ServiceTrust is to review all cases of PHT. This requires close liaisonwith colleagues in our receiving hospitals, with our team ofparamedics and our audit department.88 MINAP How the NHS cares for patients with heart attack