• Logo
  • SBMUJournals

Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

Mostafa Mehrara, Nader Tavakoli, Marzieh Fathi, Babak Mahshidfar, Mohammad Amin Zare, Azita Asadi, Saeedeh Hosseinzadeh, Mehdi Safdarian
396

Views

PDF

Abstract

Introduction: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC).

Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards.

Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78) were audited (55.4% male). 61 (60.3%) patients had chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%), O2 therapy (32.8%), nitroglycerin administration (60.7%), and aspirin administration (52.5%) in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%), O2 therapy (75%), cardiac monitoring (25%), pupils examination (25%), bedside glucometery (50%), and assessing for naloxone administration (55%) in prehospital care of patients with LOC were fair to poor.

Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting.

Keywords

Emergency medical services; protocol adherence; chest pain; unconsciousness; medical audit

References

Mathew T, Menown I, McCarty D, Gracey H, Hill L, Adgey A. Impact of pre-hospital care in patients with acute myocardial infarction compared with those first managed in-hospital. European heart journal. 2003;24(2):161-71.

Cantor WJ, Hoogeveen P, Robert A, Elliott K, Goldman LE, Sanderson E, et al. Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training. American heart journal. 2012;164(2):201-6.

Quinn T, Johnsen S, Gale CP, Snooks H, McLean S, Woollard M, et al. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014:heartjnl-2013-304599.

Lugtenberg M, Burgers J, Westert G. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Quality and Safety in Health Care. 2009;18(5):385-92.

Kirves H, Skrifvars MB, Vähäkuopus M, Ekström K, Martikainen M, Castren M. Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients. European Journal of Emergency Medicine. 2007;14(2):75-81.

Wik L, Kramer-Johansen J, Myklebust H, Sørebø H, Svensson L, Fellows B, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. Jama. 2005;293(3):299-304.

Scliopou J, Mader TJ, Durkin L, Stevens M. Paramedic compliance with ACLS epinephrine guidelines in out-of-hospital cardiac arrest. Prehospital Emergency Care. 2006;10(3):394-6.

Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC medical informatics and decision making. 2008;8(1):1.

Muayqil T, Rowe BH, Ahmed SN. Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room. Epileptic disorders. 2007;9(1):43-50.

Hale K, Gavin C, O’Driscoll B. Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emergency Medicine Journal. 2008;25(11):773-6.

Franschman G, Peerdeman S, Greuters S, Vieveen J, Brinkman A, Christiaans H, et al. Prehospital endotracheal intubation in patients with severe traumatic brain injury: guidelines versus reality. Resuscitation. 2009;80(10):1147-51.

Lee P, Luo J, Shieh W, Nien C, Yang P, Kuo S-H, et al. Hospital-based management of acute asthmatic exacerbation: an assessment of physicians' behavior in Taiwan. Journal of Asthma. 2001;38(7):575-83.

Mahshidfar B, Sheramin PH. Fast and practical prehospital approaches to patients in emergency situations. 1st ed. Tabriz, Iran: GhaziJahaani, Golban Nashr; 2010 [Persian Book].

Johansson J, Hammerby R, Oldgren J, Rubertsson S, Gedeborg R. Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines. Acta anaesthesiologica scandinavica. 2004;48(7):909-13.

Charpentier S, Sagnes-Raffy C, Cournot M, Cambou J-P, Ducassé J-L, Lauque D, et al. Determinants and prognostic impact of compliance with guidelines in reperfusion therapy for ST-segment elevation myocardial infarction: results from the ESTIM Midi-Pyrenees Area. Archives of cardiovascular diseases. 2009;102(5):387-96.

Sandouk A, Ducassé J-L, Grolleau S, Azéma O, Elbaz M, Farah B, et al. Compliance with guidelines in patients with ST-segment elevation myocardial infarction after implementation of specific guidelines for emergency care: Results of RESCA+ 31 registry. Archives of cardiovascular diseases. 2012;105(5):262-70.

Goldstein P, Wiel E. Management of prehospital thrombolytic therapy in ST-segment elevation acute coronary syndrome (< 12 hours). Minerva anestesiologica. 2005;71(6):297-302.

Pham JC, Kelen GD, Pronovost PJ. National study on the quality of emergency department care in the treatment of acute myocardial infarction and pneumonia. Academic Emergency Medicine. 2007;14(10):856-63.

Draper HM, Eppert JA. Association of pharmacist presence on compliance with advanced cardiac life support guidelines during in-hospital cardiac arrest. Annals of Pharmacotherapy. 2008;42(4):469-74.




DOI: https://doi.org/10.22037/emergency.v5i1.12418

Refbacks

  • There are currently no refbacks.