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101 All Patients Immediately Post Primary Percutaneous Coronary Intervention (PPCI) Are Cared for in An Acute Cardiac Care Environment. Is it About Time We Reviewed Our Practice?

Introduction Primary percutaneous coronary intervention (PPCI) targets early intervention, achieving better outcomes for patients suffering from ST elevation myocardial infarction (STEMI). European Society of Cardiology (ESC) guidelines (2012) advocate acute cardiac units as the environment of choice in which patients should be cared for by highly trained and skilled nurses who provide close monitoring and rapid response to acute changes. However the advancements in accessing early intervention by PPCI with fewer complications and improved outcomes, anecdotally some patients following uncomplicated PPCI are the most stable patients on the acute cardiac ward. We re-evaluated the nursing care pathway of the PPCI group of patients. Method A review of the literature on the nursing care post PPCI to establish an evidence base. A national benchmarking exercise on the context of the care setting, the timing of nursing interventions and length of stay on the acute cardiac units and within the hospital to identify whether unpublished care standards exist. Results The literature review identified few studies which established the standards of nursing care in this group (Oriolo and Tagney 2011, Viana-Tejedor et al 2009), much of the written nursing care is based upon traditional practices or consensus of medical opinion founded on the anticipation of complications post PPCI. For the bench marking exercise, 17/30 centres provided information by telephone. All patients post PPCI were admitted to an acute cardiac unit with ECG monitoring. There was large variation in the timing of nursing interventions; length of ECG monitoring (12 – 48 hrs), fluid balance monitoring (0 – 24 hrs) or mobilisation of the patients (6 – 24hrs). More than half kept their patients routinely on the acute cardiac unit for at least 24 h before stepping down to the ward. Two centres would step down at 12 h routinely, however five centres stated that step down was reviewed earlier dependant on patients need. Three centres discharge their patients home at 48 h with the largest number between 48–72 h, some considering “sleeps” rather than hours. One unit had no set criteria for movement, moving as part of acuity; however this was part of a larger unit so easier to manage patients. Some units varied the discharge home depending on area of STEMI or LV function or Doctor Preference. Conclusion There is little evidence to support the current timing of care of the patient post PPCI and the subsequent bench marking exercise demonstrated that set criteria was being applied to this patient group based on tradition or experience. There is little evidence that practices have changes with the advances in the outcomes post PPCI. With this variation nationally there is a need for further exploration in this area to provide a more concise, evidence based standards which would improve that patient pathway and make better use of the resources available.