Myocardial Ischaemia National Audit Project - University College ...

10. Effective data collection for nSTEMIFiona Robinson – Cardiac Nurse PractitionerMid Essex Hospital Services NHS TrustWhen we started collecting data for MINAP we needed afool-proof method of identifying patients. It quickly becameapparent that if we were to rely on colleagues informingus of patients admitted with acute coronary syndrome, wewere unlikely to capture all the patients requiring entry intoMINAP. Therefore patients admitted to hospital with obviousor dynamic changes on their ECGs would have been identified,but those with more subtle changes may have been missed.We approached our colleagues in our Biochemistry laboratoryand, by liaising directly with them, we arranged that we wouldget a daily print out of all the patients who had had a Troponinblood analysis performed.We have adapted the MINAP data collection form, dividing itinto two parts. The data for Part 1 (Figure 25) is collected bythe Acute Cardiology Nurses who see the patients shortly afteradmission to the hospital. The patients’ demographic datais obtained from the Patient Administration System, alongwith dates of admission, names of admitting consultants,and General Practice details. Patients are then located withinthe hospital and visited on an individual basis and reviewed.Audit data is collected from the patient’s notes. It also givesus an opportunity to review the patient’s history, symptoms,risk factors and ECG and ensure an appropriate managementplan is in place for the patient. This therefore combines theprocess of data collection with enhanced clinical care. Themajority of the patients we follow up are situated on our AcuteAdmission Wards and therefore have been reviewed by theCardiology team who perform a daily ward round. Howeverthere are a few who have been admitted to outlying wardsand are picked up as a result of the elevated blood Troponinlevel. A typical example of such a case would be an elderlypatient, possibly admitted with a fracture to an Orthopaedicward, who may have had a Troponin estimation on admissionblood testing to investigate the cause of his/her fall. We wouldthen ask the Orthopaedic team to consider getting a formalCardiology review and to consider transfer of the patient to amore appropriate area. By identifying these patients they canFigure 25. Part 1 collected by Acute Cardiology NursesPart 1Part 1 BFH BFH PreviousmedicalhistoryPrevious medical history ng/ml ng/ml Data set V9.1 Data set V9.1 ECTC ECTC *Cath lab access delayed14. Delay in activating cath lab teamPre-PCI complication16. Equipment failure *Complete section below if 3.10 =5.Cardiac Arrest NB: All fields marked with # should be completed to achieve 100% on Data Completeness.92 MINAP How the NHS cares for patients with heart attack