Anne Nakano

Patient perception and assessment of admission to acute cardiac care unit

Background: To provide equal care and treatment of cardiac patients it is common practice to base the work on clinical guidelines. These guidelines mainly cover the provider perspective rather than the patient perspective. Patient satisfaction, however, is an important parameter within quality development of professional services in hospitals. Patient satisfaction is, i.e. connected with the amount of information provided to the patient and how much patients are involved in their care and treatment. This is also assumed to apply within cardiac practice. However, in relation to acute admission there is no clear picture of the patients real preferences; likewise there is no documentation whether these preferences correspond with the nurses assumptions. Aim: The aim of this study was primarily to investigate what preoccupied patients admitted to cardiac care units with acute coronary syndrome in connection with the first hours of their admission, and secondly to discuss these perceptions in relation to the nurses perception from a previous pilot study. Method: A qualitative descriptive analysis of 30 semi-structured interviews was carried out to investigate the patient perception and assessment of care and treatment by acute admission. Results: The patients included 22 men and 8 women with an average age of 59 (SD = 11.5) years. In all, 5 themes: efficiency, professionalism, pain management, compassionate nursing and information were considered essential and all together they expressed what preoccupied the patients. Conclusion: It is possible to show what the patients think is important, also during acute admission. In general, the patients felt they were in good hands. Most important was the care providers competencies and that they “knew their job”. The patients experience of pain management might suggest insufficient care and treatment within this field.

30-days mortality in patients with perforated peptic ulcer: A national audit

Background In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator “30-days mortality” showed major discrepancy between the observed mortality of 28% and the chosen standard (10%). Rationale An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery. Methods Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred. Results The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3–4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient. Discussion As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality.

1314: Developing a Survey Questionnaire as a Tool in Regarding Patients Perceptions and Priorities in Acute Admittance to a Heart Care Unit:

in providing thrombolysis. In the Netherlands, for example, ambulance nurses provide pre-hospital thrombolysis. Furthermore, a substantial potential exists in reducing the high prevalence of modifiable cardiovascular risk factors in ST-elevation ACS patients, through programmes aiming at lifestyle improvement. In addition, medications to prevent further cardiovascular events are less often prescribed than expected according to guidelines. Although the number of nursing initiatives is growing regarding lifestyle interventions, screening under use of medical therapy, and stimulating adherence to prescribed medication, a more active role of nurses in ACS care is needed to further close the gap between science and practice.