Shave up to 15 minutes off treatment of chest pain

Would you like to cut door-to-treatment times for patients with acute coronary syndrome and acute myocardial infarction by up to 15 minutes? Put together a "Chest Pain Tackle Box," recommends Marilyn Swinford, RN, director of emergency and outpatient services at Saint Joseph Hospital in Lexington, KY.

These patients require rapid intravenous (IV) line access and medications at the onset of their treatment and diagnosis pathway, she says. To speed the process, "one-stop access" to supplies is needed, she says. "The automated medication dispensing system in our ED contains essential supplies as does our supply system, but each would require separate selection and removal," says Swinford. "This takes considerable time and removes staff from the bedside to the med room."

To address this, a portable tackle box containing all necessary supplies for chest pain patients was put together. The box contains IV supplies including prep kits, IV catheters and start kit, primary IV tubing, syringes, and nitroglycerin set. Medications include reteplase, heparin for bolus and infusion, nitroglycerin infusion, D5W normal saline, aspirin, atropine, atenolol, and metoprolol. A numbered breakaway plastic lock ensures that the box has all its required contents, as long as the lock is not broken.

When a patient is admitted or transferred to the cardiac catheterization lab, ED nurses return the box to the pharmacy, exchanging it for a replacement kit so the ED is never left without a box. "Pharmacy then replenishes the medications and central distribution replenishes the IV supplies, and the patient is only charged for those items used," says Swinford.

A sticker is affixed to the box listing the expiration date of medications, the name of the pharmacist and technician who filled the box, the date checked, and the lock number.

"The staff retrieves this box upon arrival of an acute coronary patient and proceeds to remove IV and medication supplies as indicated," says Swinford. "The nurse remains at the bedside communicating with the patient while initiating care with first-line therapy."

[Editor’s note: For more information, contact Marilyn Swinford, RN, Director, Emergency and Outpatient Services, Saint Joseph Hospital, Lexington, KY 40504. Telephone: (859) 313-1672. E-mail:]