Development Of The Preoperative Nursing Practice Guideline For Emergency Percutaneous Coronary Intervention

As one of the most common emergency and severe disease in the clinic,the incidence and mortality of acute coronary syndrome are on the rise,and it has already became one of the leading causes of death and disability in China.The percutaneous coronary intervention(PCI)in emergency is the preferred treatment for acute coronary syndrome(ACS)with indications.The nurse participates in the management of the emergency PCI patient with the whole course and plays an important role in it.However,at present nurses in our country have different nursing behaviors in the management of emergency PCI patients.There is a lack of evidence-based standard for preoperative nursing for emergency PCI patients.The nursing practice guideline is a directive opinion developed systematically for medical workers to make appropriate treatment under specific clinical scenarios.There are few recommendations related to nursing in the existing domestic and foreign emergency PCI medical guidelines,and there are few descriptions of nursing measures and outcome indicators,so it is difficult for nurses to apply them.Therefore,it should be combined with the current state of clinical practice of preoperative nursing in our country to find out the best evidence for emergency PCI nursing,and to construct a suitable local nursing practice guideline for preoperative nursing of emergency PCI,so as to standardize the preoperative emergency PCI nursing behavior.Purposes:To construct "Preoperative Nursing Practice Guideline for Emergency Percutaneous Coronary Intervention"and to form recommendations for preoperative emergency PCI nursing clinical problems.Methods:Constructing the guide based on the evaluation,formulation and GRADE system rated by evidence recommendations.Specifically include:1.Set up a guideline group;2.By searching domestic and foreign emergency PCI-related medical guidelines and the related primary research of emergency PCI preoperative nursing,and interviewing with key informants,a list of emergency PCI preoperative nursing clinical problems and outcome indicators was drafted;3.Three rounds of Delphi method were used to determine the important clinical problems and outcome indicators of preoperative nursing for emergency PCI;4.For the important clinical problems produced by theDelphi method,through the search,synthesis and evaluation of relevant medical guides,systematic review or the original research evidences,the corresponding recommendations were initially formed;5.The consensus group reached a consensus on the strength of recommendations and recommended content;6.Conduct external peer review of guideline clinical problems and recommendations;7.Recommendations for preoperative nursing for emergency PCI was formed.Results:1.The guideline group consisted of a steering committee,a consensus expert group,a secretary group,an evidence evaluation group,and an external audit team,including medical experts,nursing experts,and methodologists in the field of emergency PCI,all together 45 of them;2.According to the domestic and foreign emergency PCI-related medical guidelines and preoperative nursing for emergency PCI-related primary studies and key informant interview results,the steering committee drafted nine clinical problems of preoperative nursing for emergency PCI and 20 outcome indicators.3.The guideline consensus expert group completed consensus on important clinical problems for preoperative nursing of emergency PCI and and outcome indicators through three rounds of Delphi method.Six clinical important nursing problems were finalized,including assessment and identification,oxygen inhalation,condition monitoring,safe transport,skin preparation,and iodine allergy testing;Determined 9 key outcome indicators and 7 important outcome indicators.4.Evidence for assessment and identification,oxygen inhalation,and disease monitoring were derived from the evidence synthesis of the sources of 4 high and middle-quality emergency PCI-related medical guidelines at home and abroad.Evidence for safe transport,skin preparation,and iodine allergy tests were derived from relevant original studies and evidence comprehension and evidence body evaluation were conducted,six recommendations was initialized;5.Experts reached a consensus on the strength of recommendations and recommended content,and the six recommendations were all strongly recommended,while five recommendations and a practical guidance was added;6.A total of 10 external peers participated in the review of the guideline clinical problems and recommendations.The mean score of necessity and importance of 6 clinical problems of preoperative nursing for emergency PCI were all rated ? 3;The mean score of clinical applicability of the recommendations were all>4;The original recommendation had no modification part,and supplements were made on the practical guidance part.6.The six recommendations for clinical problems of preoperative nursing for emergency PCI and the practical guidance for five of them were formed.Conclusions:Based on the "Preoperative Nursing Practice Guideline for Emergency Percutaneous Coronary Intervention"constructed under the principle of evidence-baseing,which was in line with the status quo of preopernative nursing for emergency PCI clinical practice in our country and the judges of professionals in the field,a total of 6 recommendations and 5 practice guidance for the recommendations were formed.To guide preoperative nursing for emergency PCI practice.