PubMed · 3845021
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R Suhayda, M J Kim. 1985. Documentation: a vital link to nursing practice.. https://pubmed.ncbi.nlm.nih.gov/3845021/
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BACKGROUND: Rapid time to treatment with thrombolytic therapy is an important determinant of survival in acute myocardial infarction (AMI). HYPOTHESIS: We hypothesized that establishment of an AMI thrombolysis critical pathway in the Emergency Department could successfully reduce the "door-to-drug" time, the time between patient arrival and start of thrombolysis. METHODS AND RESULTS: Before establishment of the AMI critical pathway, median door-to-drug time was 73 min, which was reduced to 37 min after critical pathway implementation (p < 0.05). The percentage of patients treated within 30 min rose from 0% prior to establishment of the pathway to 43% (p = 0.03). Similarly, the percentage treated in within 45 min rose from 0 to 67% (p = 0.0005). Door-to-drug times were longer for women than for men (median 105 min for women vs. 70 min for men before pathway implementation). The pathway reduced door-to-drug time for both genders, but the median door-to-drug times were higher for women than for men (Mann-Whitney p = 0.013). The difference between men and women was 35 min before establishment of the pathway to 10 min by the end of the study period. CONCLUSIONS: Our critical pathway was successful in reducing door-to-drug times. We observed a "gender gap" in door-to-drug times, with longer mean times for women, which was reduced by the AMI critical pathway. Thus, our data provide support for the use of critical pathways to reduce door-to-drug times, as recommended by the National Heart Attack Alert Program.
This article reviews the evaluation of pain in critically ill patients of all ages. Sources of pain and its physiologic significance are discussed. Factors influencing pain, perception, and behavior are also addressed to broaden health care professionals' vision of the difficulties associated with accurate pain assessment. The evaluation process, including a discussion of several tools ranging from visual analog scales to bispectral analysis, as well as goals of therapy are discussed. Finally, a practical approach to the assessment process, which supports the need for established, regularly used evaluation and treatment protocols, is proposed.