Thrombolysis administration by nurses: An evolving UK evidence base?

Abstract

In the United Kingdom, an estimated 240,000 people suffer myocardial infarction yearly. Whilst primary angioplasty has emerged as the treatment of choice for many patients, thrombolytic agents are an effective class of medications which reduce myocardial damage, morbidity and mortality. They are most effective when given at the earliest opportunity, and United Kingdom government policy and professional standards aim to reduce these delays. This can be facilitated by nurse-led services. This systematic review of the literature charts the development of nurse thrombolysis in relation to UK government policy and assesses the research evidence since 2003. Six papers met the inclusion criteria, and the following themes emerged: Thrombolysis is safely administered by nurses, Nurse-led thrombolysis improves door-to-drug time, Nurse-led thrombolysis is seen as a positive change in practice, Issues in Emergency Department thrombolysis administration. Although the evidence retrieved does not rate highly in the accepted hierarchy of evidence, nurses can be accurate and safe in diagnosis and treatment of acute myocardial infarction; nurse-led thrombolysis reduces door-to-drug times; and these services are supported by other professionals. Local clinical leadership and local thrombolysis protocols have provided the greatest improvements. Managing acute myocardial infarction including primary angioplasty facilities and administering early thrombolysis are clearly core elements of emergency care that need to be provided on a full 24 h, 7 days a week basis by appropriate frontline clinical staff.