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What else is your patient taking?
6th International Conference for Emergency Nurses What else is your patient taking? Gail Ross-Adjie
1,∗
, Kerry Deakin
2
1 Nursing Clinical Practice, Policy and Research, St John of God Hospital, Murdoch, WA, Australia 2 Emergency Department, St John of God Hospital, Murdoch, WA, Australia
Despite the widespread use of complementary and alternative medicines (CAM) and the well documented interactions between some CAM and prescribed medications there is no Australian research which examines the rate of disclosure of CAM to health professionals in the emergency department (ED). This study aims to identify what proportion of patients who present to our ED use at least one non-medically prescribed CAM and their frequency of usage; and to explore the knowledge of ED nursing staff towards patient use of complementary and alternative medicines. The study is being conducted in two parts. Part 1 is a cross-sectional descriptive study of 371 ED patients at a private Perth ED using a validated self-administered questionnaire. Patients are also requested to provide information about their current CAM usage and attitude towards CAM, their prescription medication usage and CAM disclosure to their medical practitioner. Part 2 invites the permanent ED nursing staff who work at our facility to complete the Nursing Staff Questionnaire which is largely based on the patient questionnaire. It aims to collect information about nurses’ knowledge in relation to CAM. Preliminary results suggest that many patients do currently take CAM which have the potential to interact with their prescription medication. Alarmingly many of these patients do not disclose their CAM usage to either their prescribing doctor or pharmacist. Not only do triage nurses need to be aware of this potential for interaction but both nursing and medical staff require education about the well-documented interactions between CAM and commonly prescription drugs. doi:10.1016/j.aenj.2007.09.062 Identifying and improving staff knowledge of pelvic binder placement Nicholas Santeloudi Emergency Department, The Alfred Hospital, Melbourne, VIC, Australia Major pelvic fractures are associated with a high risk of haemorrhage. However, bleeding can potentially be controlled by appropriate application of a non-invasive pelvic binder. Importantly, the binder must be properly placed to be effective and this requires knowledge of the process. In a retrospective review of trauma series pelvic Xrays from patients with non-invasive pelvic binders in situ, a significant number of incorrectly placed pelvic binders were identified. This meant these patients had not received adequate pelvic binding. The binders had been applied prehospital, in rural hospitals and in a primary trauma centre. A two-phase pilot study was commenced to identify and improve staff knowledge of pelvic binder placement in a
211 major trauma centre. Phase one of the pilot study involved retrospective review of trauma series pelvic X-rays and the delivery of education sessions on pelvic pathophysiology, assessment and non-invasive pelvic binding to the same group of staff. Initial outcomes of the study demonstrated a lack of knowledge by nurses and medical staff of binder placement, pelvic fracture pathology and management. The next phase will involve collection of retrospective trauma series pelvic X-rays to evaluate improvements in binder placement post education. It is hoped this study might be used to generate education on pelvic binder placement cross the state, at all levels of trauma management. Keywords: Pelvic binder; Trauma centre; Trauma series Xrays; Non-invasive doi:10.1016/j.aenj.2007.09.063 The Oxford Chair Technique: A simple, nurse initiated method to reduce anterior glenohumeral dislocations Stuart Smith Emergency Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia Within the emergency department where I work, nationally and internationally there is no uniform agreement on the reduction method of choice for patients who have sustained an anterior glenohumeral dislocation. This has led to a vast array of methods being used, often not evidence based and with little scientific knowledge behind their use. The Oxford Chair Technique involves the use of a purpose built chair (though any high backed chair can be used). Patients sit astride the chair and are talked through the simple procedure by the practitioner. A poster has been produced which outlines the technique. Prior to the introduction of this initiative patients with a glenohumeral dislocation required conscious sedation and opiates in order to reduce the dislocation. This carried potential risks to the patient alongside the logistical issues of patient care. The procedure was always performed by a senior doctor in the resuscitation room. This initiative provided an exciting and rewarding development for Emergency Nurse Practitioners to manage a presentation that has traditionally been out of our scope of practice. This is a simple, single person technique. Entonox is given for analgesia. No conscious sedation is required. Over an 18-month period a service evaluation project was undertaken to assess the effectiveness of the Oxford Chair Technique in comparison to the traditional methods of glenohumeral reduction. Six research questions were used. Favourable results to the Oxford Chair Technique compared to traditional methods of glenohumeral reduction were demonstrated. For instance, the average time from arrival to discharge for patients managed with the Oxford Chair Technique was 141 min compared to 254 min for patients treated with traditional methods of reduction. The average time from check X-ray to discharge was 51 min with the Oxford Chair Technique and 119 min for traditional methods of reduction. Overall there was a 75% success rate
1,∗
, Kerry Deakin
2
1 Nursing Clinical Practice, Policy and Research, St John of God Hospital, Murdoch, WA, Australia 2 Emergency Department, St John of God Hospital, Murdoch, WA, Australia
Despite the widespread use of complementary and alternative medicines (CAM) and the well documented interactions between some CAM and prescribed medications there is no Australian research which examines the rate of disclosure of CAM to health professionals in the emergency department (ED). This study aims to identify what proportion of patients who present to our ED use at least one non-medically prescribed CAM and their frequency of usage; and to explore the knowledge of ED nursing staff towards patient use of complementary and alternative medicines. The study is being conducted in two parts. Part 1 is a cross-sectional descriptive study of 371 ED patients at a private Perth ED using a validated self-administered questionnaire. Patients are also requested to provide information about their current CAM usage and attitude towards CAM, their prescription medication usage and CAM disclosure to their medical practitioner. Part 2 invites the permanent ED nursing staff who work at our facility to complete the Nursing Staff Questionnaire which is largely based on the patient questionnaire. It aims to collect information about nurses’ knowledge in relation to CAM. Preliminary results suggest that many patients do currently take CAM which have the potential to interact with their prescription medication. Alarmingly many of these patients do not disclose their CAM usage to either their prescribing doctor or pharmacist. Not only do triage nurses need to be aware of this potential for interaction but both nursing and medical staff require education about the well-documented interactions between CAM and commonly prescription drugs. doi:10.1016/j.aenj.2007.09.062 Identifying and improving staff knowledge of pelvic binder placement Nicholas Santeloudi Emergency Department, The Alfred Hospital, Melbourne, VIC, Australia Major pelvic fractures are associated with a high risk of haemorrhage. However, bleeding can potentially be controlled by appropriate application of a non-invasive pelvic binder. Importantly, the binder must be properly placed to be effective and this requires knowledge of the process. In a retrospective review of trauma series pelvic Xrays from patients with non-invasive pelvic binders in situ, a significant number of incorrectly placed pelvic binders were identified. This meant these patients had not received adequate pelvic binding. The binders had been applied prehospital, in rural hospitals and in a primary trauma centre. A two-phase pilot study was commenced to identify and improve staff knowledge of pelvic binder placement in a
211 major trauma centre. Phase one of the pilot study involved retrospective review of trauma series pelvic X-rays and the delivery of education sessions on pelvic pathophysiology, assessment and non-invasive pelvic binding to the same group of staff. Initial outcomes of the study demonstrated a lack of knowledge by nurses and medical staff of binder placement, pelvic fracture pathology and management. The next phase will involve collection of retrospective trauma series pelvic X-rays to evaluate improvements in binder placement post education. It is hoped this study might be used to generate education on pelvic binder placement cross the state, at all levels of trauma management. Keywords: Pelvic binder; Trauma centre; Trauma series Xrays; Non-invasive doi:10.1016/j.aenj.2007.09.063 The Oxford Chair Technique: A simple, nurse initiated method to reduce anterior glenohumeral dislocations Stuart Smith Emergency Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia Within the emergency department where I work, nationally and internationally there is no uniform agreement on the reduction method of choice for patients who have sustained an anterior glenohumeral dislocation. This has led to a vast array of methods being used, often not evidence based and with little scientific knowledge behind their use. The Oxford Chair Technique involves the use of a purpose built chair (though any high backed chair can be used). Patients sit astride the chair and are talked through the simple procedure by the practitioner. A poster has been produced which outlines the technique. Prior to the introduction of this initiative patients with a glenohumeral dislocation required conscious sedation and opiates in order to reduce the dislocation. This carried potential risks to the patient alongside the logistical issues of patient care. The procedure was always performed by a senior doctor in the resuscitation room. This initiative provided an exciting and rewarding development for Emergency Nurse Practitioners to manage a presentation that has traditionally been out of our scope of practice. This is a simple, single person technique. Entonox is given for analgesia. No conscious sedation is required. Over an 18-month period a service evaluation project was undertaken to assess the effectiveness of the Oxford Chair Technique in comparison to the traditional methods of glenohumeral reduction. Six research questions were used. Favourable results to the Oxford Chair Technique compared to traditional methods of glenohumeral reduction were demonstrated. For instance, the average time from arrival to discharge for patients managed with the Oxford Chair Technique was 141 min compared to 254 min for patients treated with traditional methods of reduction. The average time from check X-ray to discharge was 51 min with the Oxford Chair Technique and 119 min for traditional methods of reduction. Overall there was a 75% success rate