Myocardial Infarction Minimizing Hospital Readmission
Phase 1: EBP for Effective Patient Care Transition

Donald, an acute myocardial infarction (MI) patient, has undergone angioplasty, a procedure in which a catheter is inserted into clogged arteries in a patient’s heart to widen them and improve blood flow. To supplement the angioplasty, Donald has had cardiac stents placed to prop the affected arteries open and reduce their risk of narrowing again. Studies have shown that several complications could result from angioplasty procedures and the insertion of stents as in Donald’s case. The most common complications include bleeding or vascular complications (6 percent of patients), acute renal failure (5 percent of patients), and stroke (0.3 percent of patients) (Dunlay et al., 2012). A study analyzing readmission rates among MI patients in Minnesota found that bleeding was the most common complication after angioplasty, affecting 6 percent of patients (Dunlay et al., 2012). The most common form of bleeding was bleeding at the catheter access site, which was shown to affect 62.7 percent of patients. 37.4 percent of patients report complications associated with groin hematoma, gastrointestinal bleeding and bleeding from other sites (Dunlay et al., 2012). At times, the bleeding is just a bruise, but other times, the bleeding may be serious enough to require surgical procedures or a transfusion.

To minimize the risk of side effects related to cardiac catheterization, the nurse plans to educate the patient on the potential side effects of the same and what they could do to minimize the risk. This includes availing information sheets explaining the symptoms of retroperitoneal bleeding and hematoma formation at the groin site as well as methods of preventing the same (dunlay et al., 2012). The nurse will also distribute simplified information sheets teaching the patient how to self-hydrate as a way to minimize the risk of renal failure resulting from cardiac catheterization (Lambert et al., 2017). Since the patient’s extended family is nearby, it would be plausible to include them in the awareness-raising as a way of ensuring that they can adequately distinguish between what is normal and abnormal. It is also prudent that the nurse connects the patient with their primary care provider to facilitate constant monitoring of side effects upon discharge (Lambert et al., 2017). Studies have shown that patient education has significant benefits in reducing the risk of renal complications after angioplasty by 20 percent (Lambert et al., 2017).

Phase 2: EBP for Prevention of Hospital Readmission

Besides the disease-related complications, several non-disease specific factors also influence the risk of readmission. A prominent factor in Donald’s case is that he has not visited his primary care physician for the last 7 months. Given that Donald has been under the observation of a hospitalist during his five days at the hospital, there is a need to involve his primary care physician to ensure sufficient follow-up and post-procedure assessment. According to the Center for Medicare and Medicaid, racial and ethnic minorities are less likely to follow up with a primary care physician or an appropriate specialist after discharge for chronic illness treatment (CMS, n.d.). In this case, the nurse plans to educate the patient, in the simplest terms possible, on the importance of making early follow-ups with their primary care provider (CMS, n.d.). However, the nurse may also need to engage the patient and his family to identify why he has not visited his primary care provider for the past 7 months. This would help the nurse identify whether the problem results from transportation issues, cultural issues, or language barriers. Upon obtaining this information, the nurse will work together with the patient’s PCP to...…of MI by 45, 55, and 35 percent respectively (Borghi & Ambrosioni, 1996).

Prevention strategies at the secondary level focus on halting the progression of asymptomatic disease following an early diagnosis. A crucial intervention strategy at this level is to link the patient with a primary care provider. It is unlikely that patients at this level have a PCP given that they are still asymptomatic. Linking them with a PCP would ensure that risk factors and the progression of disease are constantly monitored (Karunathilake & Ganedoda, 2018). Further, linkage with the PCP would provide avenues for medicinal interventions such as beta blockers and antiplatelet therapy (chiefly aspirin), which help to slow down the progression of the disease. The nurse at the secondary level needs to, if necessary, link patients with programs where they can access statin therapy, a medical program used to manage blood lipids and cholesterol (Karunathilake & Ganedoda, 2018). Lifestyle interventions will also be continued at this stage to supplement the medicinal interventions (Karunathilake & Ganedoda, 2018). Studies estimate that medicinal intervention using beta blockers and antiplatelet drugs reduce the risk of death from MI by 22 percent and 54 percent respectively (Borghi & Ambrosioni, 1996).

Tertiary prevention focuses on increasing the life expectancy of MI patients and helping them manage pain (Karunathilake & Ganedoda, 2018). Prevention strategies at this level include insertion of pacemakers, stents, coronary angioplasty, bypass surgery, and defibrillators (Karunathilake & Ganedoda, 2018). These strategies are to be supplemented with the medicinal interventions (chiefly beta blockers, calcium channel blockers, and Aspirin) and lifestyle interventions identified at the primary and secondary levels (Karunathilake & Ganedoda, 2018). Studies have shown that the long-term administration of beta blockers and antiplatelet drugs reduces the risk of recurrent myocardial infarction by 27 percent and 54 percent respectively (Borghi & Ambrosioni, 1996).…