Improving documentation of advice given to patients with a diagnosis of Acute Coronary Syndrome (ACS)

Quality Improvement Poster Download

Background & Problems

All patients with a diagnosis of ACS are entered into MINAP (Myocardial Ischemia National Audit Project). There is a lack of documentation on advice given to patients, in particular on smoking and diet. Therefore, it wasn’t possible to complete all fields in the database.

As cardiology audit nurse, part of my role is to record data for a National audit - MINAP (Myocardial Ischaemia National Audit Project). This covers all patients admitted with a diagnosis of ACS (NSTEMI / STEMI). I am unable to complete some of the fields due to lack of documentation (notably fields for ‘smoking’ and ‘diet’).

From information taken from the ‘National Audit of Cardiac Rehab Report 2015’:

• In England –Total no. of patients starting cardiac rehab is only 47% –Specifically for MI, the uptake has increased by 5% –Though this is encouraging, the overall uptake remains too low
• The main reason stated for patients not taking part in the Cardiac Rehab programme is ‘lack of interest’ – 39% of 23,662 patients recorded.

Aim

• That all patients diagnosed with ACS (NSTEMI and STEMI) on cardiology wards at Gloucester receive the correct literature and advice, particularly on smoking and diet.
• To adhere to NICE guidelines
• To improve the quality data input into MINAP by 10% by April 2016
• Highlight the importance of Phase 1 of the cardiac rehab process.

Method

PDSA cycles:
1. Team to allocate jobs - look into NICE guidelines for cardiac rehab prevention for further MI Staff questionnaire, raise awareness of QI , teaching board
2. Design a sticker. Communicate to cardiology ward teaching sessions to update staff from cardiac rehab community nurse. Check IP care plans to check stickers and labels in use. In 2 weeks low use of sticker. Staff questionnaire – positive to change
3. Involve ward clerks to collect data using proforma. Make sticker larger and clearer. Change place where sticker use to communication sheet.
4. Extend project to cardiac ward CGH April 2016 communicate to staff by email, communication book. Use improved sticker, place on CR red booklet with MINAP label capture data weekly.

Results

Sticker use at Gloucester, cardiology (February - April 2016):

• Sticker used - 2
• Not referred to CR -3
• No documentation - 2
• Elsewhere - 10

Sticker use at cardiac ward, Cheltenham General Hospital (April 2016)

• Sticker used - 7
• Documented elsewhere - 3

Implications

As an ongoing project I have extended it to Cardiac ward at CGH from April 2016. I will continue to monitor the results from the NICOR database. The Trust will approve the sticker and be available for the cardiology wards.