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A learning pathway for critical care nurses
3rd National Conference for Emergency Nurses Triage decisions impact considerably on both individual patients and also emergency department patient flow. Many authors have investigated the decision making process and investigating inter-rater consistency of triage decision in both adult and paediatric emergency departments. This paper will outline a novel approach used by our hospital to identify individual triage performance. Individual triage nurses are provided with feedback about their triage performance including percentages of triage categories, admission data for categories and standard deviation of same. This is then able to be compared with departmental triage data as well as peer groupings and mode of arrival. The individual triage nurse is then able to gain insight on their triage decision-making process. doi:10.1016/j.aenj.2008.09.054 Trauma in the Top End: Introduction of trauma services to NT Bronte Douglas RDH Trauma Service, National Critical Care & Trauma Response Centre, Royal Darwin Hospital, Casuarina, NT, Australia Review of all significant Trauma related admissions to Royal Darwin Hospital over a 6-month introduction period of Trauma Services to the “Top End” Northern Territory. Data and trends will be examined to identify common Demographics, Mechanisms & Patterns of Injury, Ethnicity, Location of Incidents and Outcomes. doi:10.1016/j.aenj.2008.09.055 Disaster education and training of emergency nurses in South Australia Karen Duong South Australia has a population of 1.1 million, the majority of whom reside in metropolitan Adelaide. Presently South Australia has been lucky enough to avoid a major incident that has involved mass casualties or a large scale response from the health care system. Currently there is no structured disaster education for emergency nurses in South Australia. The only formal training is the Major Incident and Medical Management and Support (MIMMS) 3-day course, of which six emergency nurses have now completed. This implies a significant gap in disaster education and awareness among the emergency nurses of South Australia. As the largest group in the multidisciplinary team, nurses in the emergency department play an important role in executing the department disaster plan and can be potentially deployed to disaster sites. Combined with the potential threat of mass casualty incidents, it is imperative that all emergency nurses, particularly on a senior clinical level, have disaster education. For this to occur it is essential to increase awareness and to introduce disaster education. The plan is to implement a standardised approach to disaster education within the state. This could be started by circulating a questionnaire and creating a database
213 of emergency nurses including any disaster education and experience they have. Determining if the Introduction of a 1-day MIMMS course to the state, has been beneficial. In the future, introduction of more formalised education to the state through the university system would be appropriate. doi:10.1016/j.aenj.2008.09.056 I have my diploma in Emergency Nursing, now what and so what? A discussion Geraldine Lee 1 , Lisa Kuhn 2,∗ 1
La Trobe University/Alfred Clinical School of Nursing, Alfred Hospital, Melbourne, VIC, Australia 2 St Vincent’s/ACU National Centre for Nursing Research, ACU National, Melbourne, VIC, Australia Background: Emergency nursing is now a wellestablished specialty. The last decade has seen an increasing number of universities, in collaboration with clinical partners, offering Emergency-specific post-graduate nursing programs. Due to the increasing numbers of patient presentations, with higher levels of acuity, increased co-morbidities and rising patient expectations, the accountability of ED nurses is now increasingly in the public domain, including via the media. With a worldwide shortage of specialist nurses and demands such as the avoidance of ambulance by-pass and reduction of waiting times, workforce recruitment and retention has never been more important. Method: From this, the question arises; are postgraduate emergency nursing programs meeting ED demand? Discussion: From our experience, we know that emergency nurses either follow the clinical, educational, managerial, or research pathways, or alternatively leave nursing altogether. There are a number of important questions that need to be asked, yet little workforce data is available. More data is needed regarding retention rate of graduates within Emergency Nursing, factors that influence retention and attrition, the proficiency of newly qualified ED nurses, and the maintenance of proficiency subsequent to graduation. Conclusion: Given that ED nursing is constantly evolving, we advocate a survey of Australian ED nurses to measure the impact an ED nurse has on patient outcomes and examine whether it will be affected by any future change in the hospital or university structure. doi:10.1016/j.aenj.2008.09.057 A learning pathway for critical care nurses Leann Lancaster, Ailsa Colclough, Tanya Critchlow The College of Nursing, Burwood, NSW, Australia Clinical specialty pathways have long been part of a nursing career. Recent changes within the healthcare arena has seen the demolition of critical care boundaries/walls, the learning pathway for critical care nurses is seen as a way to prepare nurses for this role and encourage a more proactive approach to lifelong learning and professional development.
214 As part of moving forward in our approach to providing post graduate nurse education The College of Nursing has developed a learning pathway for critical care nurses. This poster articulates this pathway for the clinical specialties of emergency, cardiac, cardiothoracic intensive care and intensive care nursing. The pathway starts with an introductory module which lays the foundation for the nurse to then move along the learning pathway where students can exit with a graduate certificate or ultimately completing at Masters level. The learning pathway embodies the ethos that lifelong learning and professional development enables nurses to provide patient centred care regardless of physical location within the health service. The modules build on each other to equip the nurse with the knowledge and ability to recognise the early signs of physical deterioration, assess the individuals’ immediate needs, and facilitate care needs in a timely manner. The nurse can enrol in a Continuing Professional Development (CPD) framework or a Graduate Certificate framework which will then articulate with a variety of Masters programmes offered at universities throughout Australia. This allows The College of Nursing to meet the individual student needs and successfully facilitate their learning and professional development. doi:10.1016/j.aenj.2008.09.058 Who doesn’t have a General Practitioner? A snapshot from one Emergency Department G. Lee 1,∗ , N. Jennings 2 , G. Lowe 2 , J. Bushell 3 , J. Samers 4 1
La Trobe University/Alfred Clinical School of Nursing, Alfred Hospital, Prahran, Melbourne, VIC, Australia 2 Emergency Department, Alfred Hospital, Prahran, Melbourne, VIC, Australia 3 GP Liaison, Bayside Health, Prahran, Melbourne, VIC, Australia 4 GP Consultant, Alfred Hospital, Prahran, Melbourne, VIC, Australia Background: Anecdotally, one of the problems observed at the triage desk is a patient who presents for treatment and state that they do not have a General Practitioner (GP). Aim and method of the study: Following consultation between ED and the GP Liaison team at The Alfred, it was decided to carry out a survey to examine GP registration amongst the presenting ED patients. A brief survey was devised to administer at the triage desk and examine GP registration. Results: Data was collected on a total of 503 patients over 1 week. The majority reported having a GP (n = 371, 74%) with 109 patients (21.7%) having no GP and in a further 23 cases, staff were unable to obtain this information from patients (4.6%). When patients were asked why they did not have a GP, the answers were: (i) recently moved (n = 31, 6.2%), (ii) unable to get a GP appointment (n = 20, 4%), (iii) did not know where to find a GP (n = 13, 2.6%), (iv) other reason (not specified) (67, 13.3%) and one attendee was a staff member (0.2%). Examining the postcodes of the whole sample revealed that the majority lived within a 5 km radius to The Alfred.
Abstracts Reasons given for using ED were “ED is a cheap pharmacy” and others perceived themselves as healthy and not needing a GP. Conclusion: One quarter of this convenient sample did not have a regular or current GP. The reasons for not having a GP varied. Given these findings, plans have been made to circulate information throughout the community highlighting GP services and registration information. doi:10.1016/j.aenj.2008.09.059 Quick paediatric ALS drug reference Andrew Simmons ∗ , Annette Blythman, Anita Raymond Latrobe Regional Hospital, Traralgon, VIC, Australia Latrobe Regional Hospital is a 257 bed regional referral centre located 180 km east of Melbourne, Victoria. The Emergency Department comprises 2 resuscitation cubicles, 12 beds and a 6 bed short stay unit, and is currently undergoing expansion. The Emergency Department provides services to both paediatric and adult patients; with paediatric presentations accounting for approximately 20% of the total number of presentations. The Emergency Department has an annual presentation of approximately 28,000 patients, with numbers increasing annually by an average of 4.5%, and the department is staffed by Division 1 and Division 2 nurses of differing skill levels. Calculating paediatric advanced life support drug doses and dilutions is time consuming, requiring great precision on the part of the practitioner to ensure that correct doses are administered. A review of some of the literature regarding the incidence of medication errors suggests that blaming of individuals is of no benefit, but indicates that instigation of adequate, well-managed and accessible systems is more likely to reduce the number of errors when administering medications to the paediatric population. In order to minimise adverse events and guide nursing and medical personnel with regard to accurate paediatric dilutions and doses of advanced life support medications, a poster was developed incorporating a grid table for quick reference. The poster was developed in consultation with senior pharmacists, paediatricians and clinical nurse educators. doi:10.1016/j.aenj.2008.09.060 Project to improve training of resuscitation nurses Megan Wake, Carla Zampatti ∗ Royal Adelaide Hospital, Emergency Department, SA, Australia Carla is an Associate Clinical Service Coordinator (formally known as a Clinical Nurse). Megan Wake is the ED Nurse Educator. Together they have worked at the Royal Adelaide Hospital for many years and have had a professional and fulfilling working career in the Emergency Department. We both have a passion and obsession with resuscitation education. This has progressed into a great working relationship and the development of education workbooks for our department.
213 of emergency nurses including any disaster education and experience they have. Determining if the Introduction of a 1-day MIMMS course to the state, has been beneficial. In the future, introduction of more formalised education to the state through the university system would be appropriate. doi:10.1016/j.aenj.2008.09.056 I have my diploma in Emergency Nursing, now what and so what? A discussion Geraldine Lee 1 , Lisa Kuhn 2,∗ 1
La Trobe University/Alfred Clinical School of Nursing, Alfred Hospital, Melbourne, VIC, Australia 2 St Vincent’s/ACU National Centre for Nursing Research, ACU National, Melbourne, VIC, Australia Background: Emergency nursing is now a wellestablished specialty. The last decade has seen an increasing number of universities, in collaboration with clinical partners, offering Emergency-specific post-graduate nursing programs. Due to the increasing numbers of patient presentations, with higher levels of acuity, increased co-morbidities and rising patient expectations, the accountability of ED nurses is now increasingly in the public domain, including via the media. With a worldwide shortage of specialist nurses and demands such as the avoidance of ambulance by-pass and reduction of waiting times, workforce recruitment and retention has never been more important. Method: From this, the question arises; are postgraduate emergency nursing programs meeting ED demand? Discussion: From our experience, we know that emergency nurses either follow the clinical, educational, managerial, or research pathways, or alternatively leave nursing altogether. There are a number of important questions that need to be asked, yet little workforce data is available. More data is needed regarding retention rate of graduates within Emergency Nursing, factors that influence retention and attrition, the proficiency of newly qualified ED nurses, and the maintenance of proficiency subsequent to graduation. Conclusion: Given that ED nursing is constantly evolving, we advocate a survey of Australian ED nurses to measure the impact an ED nurse has on patient outcomes and examine whether it will be affected by any future change in the hospital or university structure. doi:10.1016/j.aenj.2008.09.057 A learning pathway for critical care nurses Leann Lancaster, Ailsa Colclough, Tanya Critchlow The College of Nursing, Burwood, NSW, Australia Clinical specialty pathways have long been part of a nursing career. Recent changes within the healthcare arena has seen the demolition of critical care boundaries/walls, the learning pathway for critical care nurses is seen as a way to prepare nurses for this role and encourage a more proactive approach to lifelong learning and professional development.
214 As part of moving forward in our approach to providing post graduate nurse education The College of Nursing has developed a learning pathway for critical care nurses. This poster articulates this pathway for the clinical specialties of emergency, cardiac, cardiothoracic intensive care and intensive care nursing. The pathway starts with an introductory module which lays the foundation for the nurse to then move along the learning pathway where students can exit with a graduate certificate or ultimately completing at Masters level. The learning pathway embodies the ethos that lifelong learning and professional development enables nurses to provide patient centred care regardless of physical location within the health service. The modules build on each other to equip the nurse with the knowledge and ability to recognise the early signs of physical deterioration, assess the individuals’ immediate needs, and facilitate care needs in a timely manner. The nurse can enrol in a Continuing Professional Development (CPD) framework or a Graduate Certificate framework which will then articulate with a variety of Masters programmes offered at universities throughout Australia. This allows The College of Nursing to meet the individual student needs and successfully facilitate their learning and professional development. doi:10.1016/j.aenj.2008.09.058 Who doesn’t have a General Practitioner? A snapshot from one Emergency Department G. Lee 1,∗ , N. Jennings 2 , G. Lowe 2 , J. Bushell 3 , J. Samers 4 1
La Trobe University/Alfred Clinical School of Nursing, Alfred Hospital, Prahran, Melbourne, VIC, Australia 2 Emergency Department, Alfred Hospital, Prahran, Melbourne, VIC, Australia 3 GP Liaison, Bayside Health, Prahran, Melbourne, VIC, Australia 4 GP Consultant, Alfred Hospital, Prahran, Melbourne, VIC, Australia Background: Anecdotally, one of the problems observed at the triage desk is a patient who presents for treatment and state that they do not have a General Practitioner (GP). Aim and method of the study: Following consultation between ED and the GP Liaison team at The Alfred, it was decided to carry out a survey to examine GP registration amongst the presenting ED patients. A brief survey was devised to administer at the triage desk and examine GP registration. Results: Data was collected on a total of 503 patients over 1 week. The majority reported having a GP (n = 371, 74%) with 109 patients (21.7%) having no GP and in a further 23 cases, staff were unable to obtain this information from patients (4.6%). When patients were asked why they did not have a GP, the answers were: (i) recently moved (n = 31, 6.2%), (ii) unable to get a GP appointment (n = 20, 4%), (iii) did not know where to find a GP (n = 13, 2.6%), (iv) other reason (not specified) (67, 13.3%) and one attendee was a staff member (0.2%). Examining the postcodes of the whole sample revealed that the majority lived within a 5 km radius to The Alfred.
Abstracts Reasons given for using ED were “ED is a cheap pharmacy” and others perceived themselves as healthy and not needing a GP. Conclusion: One quarter of this convenient sample did not have a regular or current GP. The reasons for not having a GP varied. Given these findings, plans have been made to circulate information throughout the community highlighting GP services and registration information. doi:10.1016/j.aenj.2008.09.059 Quick paediatric ALS drug reference Andrew Simmons ∗ , Annette Blythman, Anita Raymond Latrobe Regional Hospital, Traralgon, VIC, Australia Latrobe Regional Hospital is a 257 bed regional referral centre located 180 km east of Melbourne, Victoria. The Emergency Department comprises 2 resuscitation cubicles, 12 beds and a 6 bed short stay unit, and is currently undergoing expansion. The Emergency Department provides services to both paediatric and adult patients; with paediatric presentations accounting for approximately 20% of the total number of presentations. The Emergency Department has an annual presentation of approximately 28,000 patients, with numbers increasing annually by an average of 4.5%, and the department is staffed by Division 1 and Division 2 nurses of differing skill levels. Calculating paediatric advanced life support drug doses and dilutions is time consuming, requiring great precision on the part of the practitioner to ensure that correct doses are administered. A review of some of the literature regarding the incidence of medication errors suggests that blaming of individuals is of no benefit, but indicates that instigation of adequate, well-managed and accessible systems is more likely to reduce the number of errors when administering medications to the paediatric population. In order to minimise adverse events and guide nursing and medical personnel with regard to accurate paediatric dilutions and doses of advanced life support medications, a poster was developed incorporating a grid table for quick reference. The poster was developed in consultation with senior pharmacists, paediatricians and clinical nurse educators. doi:10.1016/j.aenj.2008.09.060 Project to improve training of resuscitation nurses Megan Wake, Carla Zampatti ∗ Royal Adelaide Hospital, Emergency Department, SA, Australia Carla is an Associate Clinical Service Coordinator (formally known as a Clinical Nurse). Megan Wake is the ED Nurse Educator. Together they have worked at the Royal Adelaide Hospital for many years and have had a professional and fulfilling working career in the Emergency Department. We both have a passion and obsession with resuscitation education. This has progressed into a great working relationship and the development of education workbooks for our department.