Refelection_on_Communication

Incident A female patient was presenting with central chest pain that radiated into her arm and neck. Even though the 12 lead ECG showed normal sinus rhythm a Myocardial Infarction (MI) could not be ruled out as the cause. However, her list of allergies indicated she had an intolerance of aspirin due to a gastric complaint. I explained to her that, given the nature of her symptoms, 300mg of aspirin could be beneficial even though we recognise that this may cause her some gastric discomfort. Due to this gastric complaint she was at first reluctant to take the aspirin. However, after some further explanation of the potential benefit she was happy to be administered the drug. Feelings This was my first experience of explaining to a patient the rationale as to why we were administering a certain drug. I was pleased that my communication drew both the required consent and alleviated her fears and concerns. Evaluation By explaining the rationale and potential benefits of the aspirin to the patient I was able to administer a drug that could well have prevented further deterioration of her condition. I had also gained the required consent needed prior to drug administration. Analysis Fisher, Brown and Cook (2006) indicate that, “Aspirin should be administered to any patient with chest pain unless the diagnosis is very clearly non – cardiac”. Further to this the guidelines state that “a single dose of 300mg aspirin outweigh the potential risks to patients with gastric ulcers”. As we were unable to clarify that this woman’s condition was ‘non- cardiac” a clinical decision was taken to administer a drug that cautioned. CKS guidelines (2009) state that, “Aspirin (300 mg daily) should be started immediately, unless it is contraindicated or not tolerated, and continued at this dose until reviewed in secondary care” Aspirin has an anti-platelet action that reduces clot formation. Clots reduce the flow of blood. “A complete obstruction to blood flow in a coronary artery may result in a Myocardial Infarction” (Tortora & Grabowski. 2003, p-691) Great Western Ambulance Service (GWAS) clinical instruction AS0097 (2010) indicates aspirin when chest pain in suspected as being of cardiac nature. Its use in suspected ST Elevation Myocardial Infarction is also audited; the GWAS reperfusion team publishes a Clinical Performance Indicator (CPI) as part of the audit. Reaction This experience was extremely useful - teaching me both clinical and interpersonal skills. It showed the importance of explaining all procedures to patients in order to gain both consent and trust. My knowledge of the use of aspirin was also improved as a result of the further reading I undertook. Finally, I have learnt that there may be situations when cautioned drugs are still administered where the potential benefits outweigh the risks. When dealing with suspect MIs in the future I can encompass this knowledge into my practice. It is likely that my clinical performance will also be monitored against the CPI.