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Case sharing by an Emergency Nurse Practitioner student—A patient presenting with a swollen and red leg
S22 Case sharing by an Emergency Nurse Practitioner student—–A patient presenting with a swollen and red leg
Increasing early recognition and response to deteriorating patients in emergency departments
Elaine W.L. Sun 1,∗ , Josephine Y.M. Chung 2 , Serena P. Li 1
Julie Considine 1,∗ , Elspeth Lucas 2 , Bart Wunderlich 2
1
Accident and Emergency Department, United Christian Hospital, Hong Kong Hospital Authority, 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong 2 Accident and Emergency Department, Prince of Wales Hospital, Hong Kong Hospital Authority, 30-32 Ngan Shing Street, Sha Tin, N.T., Hong Kong Keywords: Emergency Nurse Practitioner; Hong Kong
1 Deakin University-Northern Health Clinical Partnership, c/- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood 3125, Victoria, Australia 2 The Northern Hospital, Northern Health, 185 Cooper St, Epping, Victoria 3076, Australia Keywords: Patient safety; Risk management; Clinical deterioration
E-mail addresses: tigger [email protected] (E.W.L. Sun), [email protected] (J.Y.M. Chung), [email protected] (S.P. Li).
E-mail addresses: [email protected], [email protected] (J. Considine), [email protected] (E. Lucas), [email protected] (B. Wunderlich).
The role of Emergency Nurse Practitioner (ENP) has been introduced to Hong Kong for three years. The scope of practice of the ENP role is still evolving. This extended role of nursing may become a new workforce of the emergency departments and make a positive impact to the emergency service as a whole. The first local training program has been commenced this year for preparing experienced emergency nurses to become ENPs in Hong Kong. The role transition to ENPs is a great challenge for the first group of emergency nurses. During the training the ENP students should demonstrate their competence in history taking, physical examination, making diagnosis and providing appropriate treatment to patients. Adequate knowledge and clinical skills are essential for ENP to provide holistic care to patients. In this presentation, a problem-based learning approach is used to describe how an ENP student managed a patient who presenting with a swollen and red leg in the emergency department. From the sequence of history taking, physical examination and ordering specific investigations, all possible differential diagnosis were ruled out one by one. Wells Score was adopted to rule out the possibility of deep vein thrombosis and confirmed the diagnosis of cellulitis for the patient. The holistic patient care including appropriate treatment care and health education were given to the patient. The whole process demonstrated the critical thinking and professional — judgment of an ENP student.
Early warning systems have been used to increase recognition and response to deteriorating inpatients for more than a decade, however a standardised approach to recognition and response to clinical deterioration in emergency department (ED) patients is lacking. The aim of this study was to evaluate the implementation of Clinical Instability Criteria (CIC) in the ED at The Northern Hospital, Victoria, Australia. There were 1522 CIC activations from May 09 to December 2010: 10% of activations per month were randomly selected for this audit (n = 147). The median age of patients requiring CIC activation was 65 years, 65% arrived by ambulance, 45% were triaged to ATS category 2 and 42% triaged to ATS category 3. Only 14% patients went home and the remainder required hospital admission: of these, 5 patients required ICU admission and 6 patients were admitted to CCU. Nurses activated 90% of CIC calls and the median time to CIC activation after documented abnormalities was 5 min. The most common reasons for CIC activation were hypotension (31%) and tachycardia (28%) and the most common interventions were intravenous fluids (40%) and supplemental oxygen (21%). In 72% of patients, clinical instability was resolved however the median duration of clinical instability was 45 min. Structured implementation of revised ED CIC has increased reporting of, and response, to clinical deterioration in ED patients. In addition, ED CIC has formed the basis of an integrated patient safety system to support early recognition and response to deteriorating ED patients.
doi:10.1016/j.aenj.2011.09.056 doi:10.1016/j.aenj.2011.09.057
Increasing early recognition and response to deteriorating patients in emergency departments
Elaine W.L. Sun 1,∗ , Josephine Y.M. Chung 2 , Serena P. Li 1
Julie Considine 1,∗ , Elspeth Lucas 2 , Bart Wunderlich 2
1
Accident and Emergency Department, United Christian Hospital, Hong Kong Hospital Authority, 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong 2 Accident and Emergency Department, Prince of Wales Hospital, Hong Kong Hospital Authority, 30-32 Ngan Shing Street, Sha Tin, N.T., Hong Kong Keywords: Emergency Nurse Practitioner; Hong Kong
1 Deakin University-Northern Health Clinical Partnership, c/- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood 3125, Victoria, Australia 2 The Northern Hospital, Northern Health, 185 Cooper St, Epping, Victoria 3076, Australia Keywords: Patient safety; Risk management; Clinical deterioration
E-mail addresses: tigger [email protected] (E.W.L. Sun), [email protected] (J.Y.M. Chung), [email protected] (S.P. Li).
E-mail addresses: [email protected], [email protected] (J. Considine), [email protected] (E. Lucas), [email protected] (B. Wunderlich).
The role of Emergency Nurse Practitioner (ENP) has been introduced to Hong Kong for three years. The scope of practice of the ENP role is still evolving. This extended role of nursing may become a new workforce of the emergency departments and make a positive impact to the emergency service as a whole. The first local training program has been commenced this year for preparing experienced emergency nurses to become ENPs in Hong Kong. The role transition to ENPs is a great challenge for the first group of emergency nurses. During the training the ENP students should demonstrate their competence in history taking, physical examination, making diagnosis and providing appropriate treatment to patients. Adequate knowledge and clinical skills are essential for ENP to provide holistic care to patients. In this presentation, a problem-based learning approach is used to describe how an ENP student managed a patient who presenting with a swollen and red leg in the emergency department. From the sequence of history taking, physical examination and ordering specific investigations, all possible differential diagnosis were ruled out one by one. Wells Score was adopted to rule out the possibility of deep vein thrombosis and confirmed the diagnosis of cellulitis for the patient. The holistic patient care including appropriate treatment care and health education were given to the patient. The whole process demonstrated the critical thinking and professional — judgment of an ENP student.
Early warning systems have been used to increase recognition and response to deteriorating inpatients for more than a decade, however a standardised approach to recognition and response to clinical deterioration in emergency department (ED) patients is lacking. The aim of this study was to evaluate the implementation of Clinical Instability Criteria (CIC) in the ED at The Northern Hospital, Victoria, Australia. There were 1522 CIC activations from May 09 to December 2010: 10% of activations per month were randomly selected for this audit (n = 147). The median age of patients requiring CIC activation was 65 years, 65% arrived by ambulance, 45% were triaged to ATS category 2 and 42% triaged to ATS category 3. Only 14% patients went home and the remainder required hospital admission: of these, 5 patients required ICU admission and 6 patients were admitted to CCU. Nurses activated 90% of CIC calls and the median time to CIC activation after documented abnormalities was 5 min. The most common reasons for CIC activation were hypotension (31%) and tachycardia (28%) and the most common interventions were intravenous fluids (40%) and supplemental oxygen (21%). In 72% of patients, clinical instability was resolved however the median duration of clinical instability was 45 min. Structured implementation of revised ED CIC has increased reporting of, and response, to clinical deterioration in ED patients. In addition, ED CIC has formed the basis of an integrated patient safety system to support early recognition and response to deteriorating ED patients.
doi:10.1016/j.aenj.2011.09.056 doi:10.1016/j.aenj.2011.09.057