Intraosseous access and the emergency nurse

Abstracts episodes of bypass and off-stretcher times; improve clinical handover and relationships between wards and ED; and increase documentation compliance Significance: The PAH ED sees 46,000 patients/year (09/10) with 36% admitted to hospital. With 41% of patients waiting >8 h to be admitted this is a risk to patient safety and decreases patient satisfaction Strategy and implementation: Using lean-thinking the current state was mapped, patients ready for admission were tracked, staff were surveyed and documentation audited. After analysing the results the strategy was to have clinical unit nursing staff manage the admission of the patient instead of ED staff. Implementation included a marketing campaign to all staff. This included A3 posters, general media communication, screen savers, tours to ED, presenting at all staff forums leading up to the implementation. Development of 24-h communication links for management of patients to be admitted. This included generic email address, designated hotline phone number. Implementation of a green (READi) line on the floor to act as a visual cue to direct staff to the collection point in ED. Development and implementation of checklists, workplace guidelines outlining roles and responsibilities of each member of the team. Finally the development of daily and weekly feedback loops and an evaluation processes Evaluation: The average time for a patient to leave ED once identified as ready to leave significantly improved by an average 32 min (p = 0.000). Documentation demonstrated improvement in most components including clinical documentation and patient property with significance from p = 0.000—0.003. There is a daily saving on average of 10 h additional emergency nursing time related to not being out of department on ward transfers. Implications for practice: READi has shown that streamlining systems to improve the journey of patients from ED to the clinical unit has significantly improved patient care and reduced risk of harm. It has fostered a whole of hospital approach to management of ED capacity and throughput of patients. It has significantly improved the nursing time spent in ED directly related to not being on ward transfers. doi:10.1016/j.aenj.2011.09.024 Intraosseous access and the emergency nurse Kane Guthrie Sir Charles Gairdner Hospital, 2/115 Lockhart Street, Como, WA, 6152, Australia Keywords: Intraosseous; Difficult access; Intraosseous route; Christchurch earthquake disaster E-mail address: [email protected]. The use and role of intraosseous access in the adult patient has dramatically changed over the past decade. Originally used in the child with difficult vascular access, is now readily supported by literature highlighting its effective use in the adult patient. The humble manual needle device as a means of access has come a long way when compared to current intraosseous devices consisting of power driven bone injection guns that can insert an intraosseous catheter in under 10 s with first pass success rates between

S9 92 and 97%. Recently published case reports have demonstrated successful administration of fibrinolysis in a STEMI patient, massive transfusion of blood products in the resuscitation of massive obstetric haemorrhage, and successful administration of computed tomography contrast in a multi trauma patient all via the intraosseous catheter route. The intraosseous catheter has changed the way we look at vascular access in the difficult vascular access patient in both emergent and non-emergent situations, and should be a core component in every emergency nurses’ armamentarium. The presentation will cover: • Review of the literature surrounding intraosseous use in the adult patients. • Notable published case reports demonstrating the effectiveness of intraosseous access. • The indications for intraosseous use in adult patients. • The role of the emergency nurse in insertion and management of the intraosseous device. doi:10.1016/j.aenj.2011.09.025 Christchurch earthquake disaster. The lived experience AUSMAT deployment February 2011 Rob McDonald E-mail address: [email protected]. 12:51 h New Zealand time, a 6.3 magnitude Earthquake struck the second largest city in New Zealand. Christchurch suffered large scale destruction, injury and loss of life. A state of civil Emergency was declared and the New Zealand Government made a request to Emergency Management Australia for medical assistance. Emergency Management Queensland in conjunction with Queensland Health were tasked to provide an AUSMAT team to respond to the health needs of the affected people of Christchurch. A 24 person team comprising of Medical, Nursing and Administration specialists were deployed and landed in Christchurch within 36 h. This team aligned themselves with a 6 person Queensland Ambulance Service, Special Operations Response Team (SORT) and established a ‘Field Hospital’ in the eastern suburbs of Christchurch — a low socioeconomic area with vast cultural diversity that was significantly impacted by the earthquake with no running water, sewage, power and limited access to medical assistance. This presentation will focus on the lived experience of the staff responding to a disaster for the first time. It will reflect on the Emergency Nurses ability to adapt and respond to new situations. It will also detail challenges faced, what was achieved and consider the emotions felt and individual preparedness when being deployed to a disaster for the first time. Another member of the AUSMAT nursing team will explore the dynamics of the mission, the lessons learnt, and propose a way forward for future AUSMAT teams in disaster zones. doi:10.1016/j.aenj.2011.09.026