FDP2 TASK 1 NURSING LEADERSHIP AND MANAGEMENT FIELD EXPERIENCE — C823 PERFORMANCE ASSESSMENT

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C. Summary of Proposal:

1. Problem Identification:
   The identified problem is the extended Door to Balloon (D2B) time for patients experiencing ST-Elevation Myocardial Infarction (STEMI), which significantly impacts patient outcomes.
2. Justification for Practice Change:
   The prolonged D2B time is critical as it directly affects patient mortality and morbidity rates. Reducing D2B time is a widely recognized quality improvement measure to enhance STEMI patient outcomes.
3. Causes of the Problem:
   Causes of prolonged D2B time may include delays in patient presentation, inefficiencies in emergency department triage, delays in obtaining electrocardiograms (ECGs), and procedural delays in catheterization laboratory activation.
4. Stakeholders Identification:
   a. Hospital Administration:
   Interest: Ensuring quality patient care and meeting accreditation standards.
   Power: Ability to allocate resources and implement policy changes.
   Influence: High influence due to their decision-making authority. b. Emergency Department Staff:
   Interest: Streamlining patient flow and optimizing patient outcomes.
   Power: Direct involvement in patient triage and initial management.
   Influence: Moderate influence as key frontline healthcare providers. c. Cardiology Department:
   Interest: Optimizing cardiac care and reducing D2B time.
   Power: Expertise in cardiac care protocols and procedures.
   Influence: High influence due to their specialized knowledge. d. EMS Personnel:
   Interest: Timely recognition and transport of STEMI patients.
   Power: Ability to initiate pre-hospital interventions and alert hospital staff.
   Influence: Moderate influence as initial responders in the STEMI care pathway.

D. Purpose of the Project:
The purpose of the project is to decrease D2B time for STEMI patients, ultimately improving patient outcomes and adhering to best practice guidelines.

E. Proposed Solution:
Implementing a multidisciplinary protocol involving pre-hospital notification, streamlined emergency department processes, and catheterization laboratory activation protocols to expedite the management of STEMI patients.

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F. Evidence Summary:

1. Dauerman, H. L. (2015). Achieving the Door-to-Balloon Time: How Do We Get There? Journal of the American College of Cardiology, 66(13), 1551–1553.
2. McNamara, R. L., Wang, Y., Herrin, J., Curtis, J. P., Bradley, E. H., Magid, D. J., … & Peterson, E. D. (2006). Effect of Door-to-Balloon Time on Mortality in Patients with ST-Segment Elevation Myocardial Infarction. Journal of the American College of Cardiology, 47(11), 2180–2186.
3. Rathore, S. S., Curtis, J. P., Chen, J., Wang, Y., Nallamothu, B. K., Epstein, A. J., … & Krumholz, H. M. (2009). Association of Door-to-Balloon Time and Mortality in Patients Admitted to Hospital with ST Elevation Myocardial Infarction: National Cohort Study. British Medical Journal, 338, b1807.
4. Terkelsen, C. J., Sørensen, J. T., Maeng, M., Jensen, L. O., Tilsted, H. H., Trautner, S., … & Lassen, J. F. (2010). System Delay and Mortality Among Patients with STEMI Treated with Primary Percutaneous Coronary Intervention. Journal of the American Medical Association, 304(7), 763–771.
5. Nallamothu, B. K., Normand, S. L., Wang, Y., Hofer, T. P., Brush, J. E., Messenger, J. C., … & Krumholz, H. M. (2011). Relation between Door-to-Balloon Times and Mortality after Primary Percutaneous Coronary Intervention over Time: A Retrospective Study. The Lancet, 385(9973), 1114–1122.

G. Proposed Implementation Plan:

1. Plan of Action: Develop and implement standardized protocols for pre-hospital notification, triage, and catheterization laboratory activation.
2. Timeline: Phase 1: Protocol development and staff education (4 weeks). Phase 2: Pilot implementation and data collection (12 weeks). Phase 3: Full-scale implementation (ongoing).
3. Needed Resources and Personnel: Dedicated project team, training materials, technology resources for data collection and analysis.
4. Proposed Change Theory: Utilize Kotter’s 8-Step Change Model to facilitate organizational change and ensure sustained improvements.
5. Barriers to Implementation: Potential barriers include resistance to change among staff, resource constraints, and logistical challenges in protocol implementation. Strategies to address these barriers will be outlined in the project plan.

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