7 Implementation and audit
7.1 When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if a patient has acute myocardial infarction and the doctor responsible for their care thinks that thrombolytic drugs are the right treatment, they should be available for use, in line with NICE's recommendations.
7.2 NHS organisations that currently offer or plan to offer treatment for patients with AMI, including ambulance paramedic services, general practitioners and all clinicians involved in the care of these patients, should review policies and practices regarding drugs for early thrombolysis in the treatment of patients with AMI to take account of the guidance set out in Section 1.
7.3 Clinical teams involved in the care of patients with AMI should review and revise, if appropriate, any local guidelines or care pathways on early thrombolysis in the treatment of patients with AMI to incorporate the guidance in Section 1.
7.4 The CHD Collaborative of the NHS Modernisation Agency is developing approaches to increase the timeliness of care topeople with AMI.
7.5 The Myocardial Infarction National Audit Project (MINAP) collects data that enable clinicians to examine the managementof patients with AMI within their hospitals in comparison tothe standards in the NSF for CHD. This national audit includes collection of the following data that are relevant to this guidance:
thrombolytic drug used
reasons for non-administration of thrombolytic treatment
reasons for delay in the administration of thrombolytic treatment
location for the administration of treatment
who made the initial decision for treatment.
For more information on MINAP, see:
Birkhead JS, Norris R, Quinn T, Pearson M on behalf of the NSFCHD Steering Group (1999) Acute Myocardial Infarction Core Data Set for Monitoring Standards of Care. London: Royal College of Physicians.
The current core dataset appears on the website; the newly revised dataset appears on the NHS Information Centre website.
7.6 The JRCALC and the Ambulance Service Association (ASA) are carrying out a national clinical audit to assess the quality of care by ambulance services for people with AMI. The audit relates to the standards set for ambulance services in the NSF for CHD, including pre-hospital thrombolysis. This national audit includes collection of the following data that are relevant to this guidance:
thrombolytic drug used
who made the decision to administer thrombolysis
location of the administration of treatment
reasons for non-administration of thrombolytic treatment.
7.7 Local clinical audits on the care of patients with AMI also could include criteria for the management of AMI based on the national standards, including standards in the NSF. However, given existing national audit programmes no further audit suggestions are made.