Myocardial Ischaemia National Audit Project - University College ...

of six individual criteria - all interventions that should, whenadded to PHT, optimize the chances of restoring coronaryblood flow in someone with STEMI. Together they constitute acare bundle, namely:Aspirin administrationGlyceryl Trinitrate (GTN) administrationPain assessmentMorphine administrationAnalgesia (Morphine and/or Entonox) administrationOxygen saturation measurementExisting national guidelines for ambulance personnelmanagement of heart attack exclude some patients fromconsideration for PHT, e.g. age limit. Such clinical practiceguidelines are being reviewed and we will continue to referto them in our efforts to provide the best of care for thepopulation we serve.8. Our serviceLuke Coleman - Service Improvement Analyst, GreaterManchester and Cheshire Cardiac and Stroke NetworkNorth Regional Thrombolysis NewsletterA “call to needle” time is calculated for every patient whohas received PHT. Acquired 12 lead ECG rhythm stripsare reviewed and collated on to a database prior to beingforwarded to the audit department. Acute Coronary Syndromeforms and Patient Clinical Records relating to these patientsare scrutinised for exceptions to the 60-minute target. Whenthe target is not met, a review takes place in an attempt toimprove the service.Meetings are held each month at each of the hospitals,allowing detailed discussions of all relevant cases, focussingon areas for improvement – lessons to learn. Individualparamedics are offered feedback and any necessary support.I work closely with each of the hospital leads to ensure accurateMINAP data entry, particularly insofar as it reflects the earlieststage of heart attack care. We also support each other throughtraining. It is important that all paramedics are confident in 12lead ECG interpretations. Paramedics attend a programme ofECG refresher training, organised and delivered by CardiologyNurse Practitioners from Betsi Cadwalader University HealthBoard. Each month a North Regional Pre-Hospital ThrombolysisNewsletter is circulated to operational staff.Within the Ambulance Trust the pre hospital management ofSTEMI, including PHT, are included as a part of overall clinicalperformance indicators (CPI). This is a useful tool in theclinical effectiveness toolbox that can be used in the drive toimprove the quality of patient care. The STEMI CPI is made upSamantha Chapman - Primary PCI Coordinator, CentralManchester University Hospitals NHS Foundation TrustAdelaide Berrie - Primary PCI Coordinator, UniversityHospital of South Manchester NHS Foundation TrustRoger Gamon - Programme Manager, Greater Manchesterand Cheshire Cardiac and Stroke NetworkDr Farzin Fath-Ordoubadi - Consultant InterventionalCardiologist, Central Manchester University Hospitals NHSFoundation TrustIn Greater Manchester and Cheshire, we have two Heart AttackCentres (HACs) that perform primary PCI – Manchester RoyalInfirmary and Wythenshawe Hospital. They treat about 1200heart attacks a year, accepting patients directly from NorthWest Ambulance Service (NWAS) and from twelve Accidentand Emergency (A&E) departments across the local DistrictGeneral Hospitals. We serve a population of nearly 3 millionpeople (equivalent to the population of Wales!)We have the benefit of two primary PCI co-ordinators, onebased at each HAC. Although busy members of the cardiologyteam, they also act as a point of contact for any problemsthat may occur. They collect data for MINAP and the CardiacNetwork; monitor performance; as well as run educationalroad-shows with local A&E staff.All primary PCI services are keenly watching their call-toballoontimes and monitoring for bottlenecks in their servicewhich may lead to delays in patients receiving the best care.MINAP Eleventh Public Report 201289