Nursing care of transradial angiography and intervention in a tertiary hospital in Shanghai: a best practice implementation project.

BACKGROUND: Coronary heart disease is common in the general population and is estimated to cause as many deaths worldwide as cancer. Percutaneous coronary angiography and intervention is the most common method in the diagnosis and treatment of coronary heart disease. To achieve best practice in the nursing care of transradial angiography and intervention, there is an urgent need for clinical knowledge.

OBJECTIVES: This aim of this project was to improve clinical nursing care for transradial angiography and intervention in Zhongshan Hospital, Shanghai.

METHODS: Seven criteria identified from evidence by the Joanna Briggs Institute were audited in the coronary care unit of Zhongshan Hospital, Shanghai. Twenty-three nurses and 80 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over six months.

RESULTS: This best practice implementation project improved the rates of written discharge instructions and radial artery patency assessment at the first post-procedure from 0% to 100%. Implementation rates for pre-procedural checklist as well as the radial artery patency assessment before discharge were 100% at baseline. Pre-procedural checklists including adequate criteria reached 78%, up from 0%. The implementation rate for regular monitoring of vital signs recorded for the first two hours post-procedure reached 22% from 0%. The implementation rate for details of discharge instructions, including procedure review, limitation of physical activity, general physical status, comorbidities, medication reconciliation and follow-up appointment improved from 36.6% to 100%. Barriers to implementation were identified as: (1) the structured pre-procedural checklist not being ready, (2) nurses lacking knowledge regarding discharge education for transradial angiography and intervention, (3) heavy clinical workload and lack of time, and (4) nurses lacking awareness and enthusiasm for implementing discharge education.

CONCLUSION: This project achieved significant improvements in establishing evidence-based practice in nursing care of transradial angiography and intervention for patients. Strategies for sustaining best practice should continue to be developed in the future.