Academic journal article ABNF Journal

Are Triage Nurse Knowledgeable about Acute Coronary Syndromes Recognition?

Academic journal article ABNF Journal

Are Triage Nurse Knowledgeable about Acute Coronary Syndromes Recognition?

Article excerpt

Introduction

ardiovascular disease has been the leading cause of death since 1921 and is the cause of death for approximately one out of every four people in the United States (Centers for Disease Control and Prevention [CDC], 2015). Heart disease is caused by a partial narrowing or fully occluded coronary vessel which prevents oxygen-rich blood from reaching the affected heart muscle. The reduced or occluded blood flow to the coronary muscle served by the affected artery or arteries cause the heart muscle to become ischemic and sends pain signals to the brain. These pain signals usually prompt patients to seek treatment at an ED. If the blockage is not removed and the coronary blood vessel patency restored, resulting in reperfusion, the affected heart muscle can become injured in as little as 20-30 minutes. This is the reason that national efforts are being made to reduce the time to reperfusion for patients.

Despite community awareness and prevention efforts, chest pain remains the second most common complaint upon presentation to the ED, equating to over six million visits annually (Hollander & Chase, 2016). Of the one million patients who are diagnosed annually with an acute myocardial infarction (AMI) or heart attack, 350,000 patients die during the acute phase and their mortality and morbidity are directly linked to the amount of time from the onset of symptoms to the time when the coronary artery is opened through either percutaneous coronary intervention (PCI) or through a clot-busting medication known as a thrombolytic (Hollander & Chase, 2016). Healthy People 2020 recognized this connection in one of their objectives, calling for early identification and treatment of heart attacks. Healthy People 2020 also call for an increase in the proportion of heart attack patients who are eligible for and obtain PCI within 90 minutes of hospital arrival (Healthy People 2020, 2016). Currently, only 88.6% of eligible patients receive reperfusion within this timeframe (Healthy People 2020,2016).

Emergency departments are charged with applying evidence-based practice to rapidly identify those patients who have Acute Coronary Syndrome (ACS) and those whose chest pain is related to non-cardiac causes. The triage nurse is commonly the first medical point of contact within the Emergency Department (ED) and, therefore, it is crucial that triage nurses can identify these emergent patients quickly. In the U.S., standardization of triage guidelines is nonexistent; yet, triage nurses in the emergency department are the first health professionals ACS patients meet on arrival. These ED professionals have the responsibility to use advanced clinical decision knowledge to sort patients into their perceived level of urgency based on their severity of illness and to initiate lifesaving treatment. If triage nurses have the knowledge to recognize ACS patients and take immediate action, they are able to directly affect early intervention and care; yet multiple studies show triage level inaccuracies and the inability of the triage nurse to identify patients with emergency symptoms (Hitchcock, Gillespie, Crilly, & Chaboyer, 2013). The challenge for ED triage nurses is that, in addition to other competing priorities, ACS patients have very broad, complex clinical presentations, making quick recognition of ACS a major problem for ED nurses even though ACS is one of the most time-critical conditions in the ED. In fact, a 2014 study used multivariate logistic analysis to determine that only 16% of acute myocardial infarction (AMI) patients are accurately triaged in the ED (Sittichanbuncha et al., 2015). Another recent study showed low triage accuracy rates of 54% for patients with symptoms suggestive of ACS and determined that neither ED nursing experience nor general experience is a predictor of ACS triage accuracy rates in the ED (Sanders & DeVon, 2016). In the case of AMI patients, the consequences of the nurses' inaccurate ACS recognition at triage can be muscle damage or potentially even death. …

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