| Objective1.To understand the characteristics of elderly patients with acute chest pain,and development status and deficiencies of clinical pathways.Design and develop the nursing version of the clinical pathway for elderly patients with acute chest pain;2.The constructed clinical nursing pathway was put into clinical application,study the application effect of clinical nursing path for elderly patients with acute chest pain.MethodsThis research is divided into two parts:1.By searching to domestic and foreign literature and combining with the analysis of clinical cases,the draft of the clinical nursing pathway for elderly acute chest pain patients in emergency department was developed.Determine the inclusion criteria and list of experts,two rounds of Delphi expert method were used to increase or decrease and revise indicators,to construct the clinical nursing path table of elderlyacute chest pain patients in emergency department.2.The constructed clinical nursing path table was put into clinical application for elderly acute chest pain patients.305 elderly patients with acute chest pain visited the emergency department of the first affiliated Hospital of Chongqing Medical University from July 2018 to November2019,and received emergency nursing treatment,including typical and atypical chest pain patients.The pre-implementation stage of emergency nursing pathway was from July 2018 to March 2019,160 patients were the control group.From April to November 2019,the clinical nursing path was implemented,145 patients were the observation group.By comparing the accurate rate of triage,the time of emergency treatment before and after implementation,etc,the clinical application effect of the table was verified.Results1.A clinical nursing path table was constructed for elderly patients with acute chest pain in the emergency department.It included 5first-level indicators: triage,auxiliary examination and preliminary treatment,interpretation of check results and assist screening of myocardial infarction,preliminary shunt,and assist in the differential diagnosis.There were 25 second-level indicators,including pre-hospital treatment,consultation content,priority placement in the emergency room,preparation for transport,etc.There were 54 three-level indicators,including whether the first ECG was checked and drugs were used,and MEWS score,pain score.The recovery rates of the two rounds of questionnaires were 100.00% and 95.24%,and the rate of expert suggestion were 61.90% and 45.00%.The expert authority coefficient was 0.865,the judgment coefficient was 0.982,the familiarity coefficient was 0.748,and the coordination coefficient was 0.23 and 0.30.2.Through the clinical use of the emergency nursing pathway table,the accuracy of triage increased from 89.38% to 96.55%(P<0.05).The average treatment time of elderly chest pain patients was reduced from51.99 min to 39.86min(P<0.05).After treatment,the pain score decreased from5.23 to 2.16(P<0.05).There was no statistically significant difference in medical cost during the emergency department(p>0.05).Conclusion1.The two rounds of Delphi consultation experts have high authority,high positivity and good coordination degree,indicating that the nursing path table of elderly patients with acute chest pain in emergency department has more consistent expert opinions,which is more scientific and reliable.2.Through the application of clinical nursing path for the elderly acute chest pain patients in emergency department,the correct triage rate was improved,the emergency treatment time of the patients was shortened,and the pain was relieved.It can be seen that there hasachieved certain results in the early correct treatment of the elderly patients with chest pain in the emergency department.The clinical nursing table is worthy of clinical reference and promotion. |
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