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Education: Pediatric Trauma Nurse Leader Implementation
560 consistent education on proper medication use and appropriate activities for those with asthma. View a PDF of this poster presentation. http://dx.doi.org/10.1016/j.pedn.2016.06.011
Education: Pediatric Trauma Nurse Leader Implementation Regina Christensen BSN, RN, NE-BC, CPN, Claire Wise-Hassler MSN, RN, CPN, Tiffany Simon BSN, RN, CCRN Children's Hospital & Medical Center
Trauma patient throughput was identified as an obstacle for the emergency department team at a children's hospital. Multiple circumstances contributed to delayed disposition of the trauma patient. To mitigate the negative impact of delays in acquiring necessary care, the trauma nurse leader (TNL) program was implemented. This program will ensure the best possible care is delivered to the trauma patient, while safely and effectively expediting decisive trauma care across the system. An identified outcome would be a decrease in time from triage to disposition for all level two-trauma patients with a disposition of admission to hospital. The TNL team benchmarked other institutions, which utilize a TNL program to obtain baseline knowledge regarding the process. This served as a starting point to create the qualifications, responsibilities and competencies of the TNL and curriculum while adjusting to the needs of the pediatric population. The TNL program was offered to all emergency department registered nurses who met the qualifications described. The first TNL course consisted of one hour of electronic medical record documentation review, two hours of didactics and one hour of hands on scenario and equipment overview in the trauma bay. Upon completion of the first TNL course, the first three, level-two trauma activation patients were selected to view triage to disposition times. Activations were limited to patients that were admitted in-patient within the hospital. The Trauma Process Improvement and Patient Safety Committee (TPIPS) set the expectation that level-two trauma patients will have a triage to disposition in less than 180 min (TPIPS, 2015). TNL were empowered to serve as the co-leader in a pediatric trauma, alongside the pediatric surgeon to provide a safe, calm, and dynamic environment. TNL were also tasked to oversee that trauma patients were safely set to their disposition in the allotted time frame. Enhanced education, review of policies and procedures and hands on education of trauma processes and equipment prepares the TNL for a successful trauma outcome. These outcomes will be achieved upon completion of the TNL course at a pediatric hospital. View a PDF of this poster presentation. http://dx.doi.org/10.1016/j.pedn.2016.06.012
Clinical Practice: Should They Stay or Should They Go? A Checklist Approach to Improving Patient Safety Darlene E. Acorda MSN, APRN, CPNP-PC, Mayra Villalta MSN, APRN, FNP Texas Children's Hospital
Background: The 2000 Institute of Medicine's report “To Err is Human” reported that communication breakdowns were at the root of 60% of adverse patient events. As a result, The Joint Commission continues to prioritize improving staff communication as part of their yearly National Patient Safety Goals. At the beginning of fiscal
Selected Abstracts from the 2016 SPN Conference year 2014, an increased in the number of patients transferring back to the step-down intensive care unit prompted an investigation that revealed insufficient handoffs as a major cause. A process change was implemented using a pre-transfer checklist to guide nurses in assessing for appropriateness of transfer. Methods: Patients who are ready to transfer out of intensive care often wait days for bed availability, during which medical status may change while transfer orders are still in place. A transfer checklist was implemented as a “hard-stop” prior to transfer. A multidisciplinary group formulated questions that address common barriers to transfer to prompt communication between the providers. The checklist was piloted for three months and “bounce-backs” were tracked. Nurses were required to sign and return the checklist during the pilot period to ensure consistency of practice. Results: Ten months post implementation, six patients transferred back out of 1,053 transfers out compared to 23 out of 1343 transfers out ten months prior. The checklist has also increased nursing awareness of patient status prior to transfers and has facilitated communication between nursing and providers. Conclusion: The transfer checklist empowered nurses with a tool to efficiently assess patients and prompt a dialogue with the transferring provider to ensure patient safety. Handoffs between the transferring and receiving nurse also included the “hard-stop” questions to ensure agreement. An important implication for nursing practice is that a simple checklist can be effective in improving patient safety outcomes. View a PDF of this poster presentation. http://dx.doi.org/10.1016/j.pedn.2016.06.013
People's Choice Poster Award Winners Clinical Practice: Using a Best Evidence Sepsis Scoring Tool to Identify and Manage Pediatric Patients With Severe Sepsis in the Emergency Department Celeste Calhoun RN, CPEN, Raquel Hancock BSN, RN, CPEN, Gabriela Chavez BSN, RN, CPEN, CPN, Jennifer Quisenberry BSN, RN, CPN, CPEN, Collin Main BSN, RN, Denise Doherty MSN, BSN, RN, Cam Brandt MS, RN, CEN, CPEN, CPN, Ean Miller PharmD, BCPPS Cook Children's Medical Center
Severe sepsis and septic shock are leading causes of pediatric morbidity and mortality, resulting in prolonged hospitalization and increased healthcare costs. 1,2 Delays in recognition of sepsis, vascular access, and administration of fluids and antibiotics are major barriers within pediatric emergency departments (ED). 3,4 Severe sepsis is defined as symptoms suspicious of infection plus signs of organ dysfunction or tissue hypoperfusion. 5 A sepsis trigger tool at triage can identify vital sign abnormalities of severe sepsis, alert ED resources, and rapidly begin the sepsis protocol. 3 Annually, almost 100,000 pediatric patients present to the ED with signs of severe sepsis. 6. Using the concept of “PIRO” (predisposition, infection, response, and organ dysfunction), the sepsis tool was adapted to identify pediatric patients at risk for sepsis with signs of infection, age-related abnormal vital signs, and signs of organ dysfunction. With 5 or greater score (maximum score of 16), a “sepsis alert” was paged. A multidisciplinary team was mobilized: ED nurse, ED paramedic, physician, respiratory therapist, and child life specialist.
Education: Pediatric Trauma Nurse Leader Implementation Regina Christensen BSN, RN, NE-BC, CPN, Claire Wise-Hassler MSN, RN, CPN, Tiffany Simon BSN, RN, CCRN Children's Hospital & Medical Center
Trauma patient throughput was identified as an obstacle for the emergency department team at a children's hospital. Multiple circumstances contributed to delayed disposition of the trauma patient. To mitigate the negative impact of delays in acquiring necessary care, the trauma nurse leader (TNL) program was implemented. This program will ensure the best possible care is delivered to the trauma patient, while safely and effectively expediting decisive trauma care across the system. An identified outcome would be a decrease in time from triage to disposition for all level two-trauma patients with a disposition of admission to hospital. The TNL team benchmarked other institutions, which utilize a TNL program to obtain baseline knowledge regarding the process. This served as a starting point to create the qualifications, responsibilities and competencies of the TNL and curriculum while adjusting to the needs of the pediatric population. The TNL program was offered to all emergency department registered nurses who met the qualifications described. The first TNL course consisted of one hour of electronic medical record documentation review, two hours of didactics and one hour of hands on scenario and equipment overview in the trauma bay. Upon completion of the first TNL course, the first three, level-two trauma activation patients were selected to view triage to disposition times. Activations were limited to patients that were admitted in-patient within the hospital. The Trauma Process Improvement and Patient Safety Committee (TPIPS) set the expectation that level-two trauma patients will have a triage to disposition in less than 180 min (TPIPS, 2015). TNL were empowered to serve as the co-leader in a pediatric trauma, alongside the pediatric surgeon to provide a safe, calm, and dynamic environment. TNL were also tasked to oversee that trauma patients were safely set to their disposition in the allotted time frame. Enhanced education, review of policies and procedures and hands on education of trauma processes and equipment prepares the TNL for a successful trauma outcome. These outcomes will be achieved upon completion of the TNL course at a pediatric hospital. View a PDF of this poster presentation. http://dx.doi.org/10.1016/j.pedn.2016.06.012
Clinical Practice: Should They Stay or Should They Go? A Checklist Approach to Improving Patient Safety Darlene E. Acorda MSN, APRN, CPNP-PC, Mayra Villalta MSN, APRN, FNP Texas Children's Hospital
Background: The 2000 Institute of Medicine's report “To Err is Human” reported that communication breakdowns were at the root of 60% of adverse patient events. As a result, The Joint Commission continues to prioritize improving staff communication as part of their yearly National Patient Safety Goals. At the beginning of fiscal
Selected Abstracts from the 2016 SPN Conference year 2014, an increased in the number of patients transferring back to the step-down intensive care unit prompted an investigation that revealed insufficient handoffs as a major cause. A process change was implemented using a pre-transfer checklist to guide nurses in assessing for appropriateness of transfer. Methods: Patients who are ready to transfer out of intensive care often wait days for bed availability, during which medical status may change while transfer orders are still in place. A transfer checklist was implemented as a “hard-stop” prior to transfer. A multidisciplinary group formulated questions that address common barriers to transfer to prompt communication between the providers. The checklist was piloted for three months and “bounce-backs” were tracked. Nurses were required to sign and return the checklist during the pilot period to ensure consistency of practice. Results: Ten months post implementation, six patients transferred back out of 1,053 transfers out compared to 23 out of 1343 transfers out ten months prior. The checklist has also increased nursing awareness of patient status prior to transfers and has facilitated communication between nursing and providers. Conclusion: The transfer checklist empowered nurses with a tool to efficiently assess patients and prompt a dialogue with the transferring provider to ensure patient safety. Handoffs between the transferring and receiving nurse also included the “hard-stop” questions to ensure agreement. An important implication for nursing practice is that a simple checklist can be effective in improving patient safety outcomes. View a PDF of this poster presentation. http://dx.doi.org/10.1016/j.pedn.2016.06.013
People's Choice Poster Award Winners Clinical Practice: Using a Best Evidence Sepsis Scoring Tool to Identify and Manage Pediatric Patients With Severe Sepsis in the Emergency Department Celeste Calhoun RN, CPEN, Raquel Hancock BSN, RN, CPEN, Gabriela Chavez BSN, RN, CPEN, CPN, Jennifer Quisenberry BSN, RN, CPN, CPEN, Collin Main BSN, RN, Denise Doherty MSN, BSN, RN, Cam Brandt MS, RN, CEN, CPEN, CPN, Ean Miller PharmD, BCPPS Cook Children's Medical Center
Severe sepsis and septic shock are leading causes of pediatric morbidity and mortality, resulting in prolonged hospitalization and increased healthcare costs. 1,2 Delays in recognition of sepsis, vascular access, and administration of fluids and antibiotics are major barriers within pediatric emergency departments (ED). 3,4 Severe sepsis is defined as symptoms suspicious of infection plus signs of organ dysfunction or tissue hypoperfusion. 5 A sepsis trigger tool at triage can identify vital sign abnormalities of severe sepsis, alert ED resources, and rapidly begin the sepsis protocol. 3 Annually, almost 100,000 pediatric patients present to the ED with signs of severe sepsis. 6. Using the concept of “PIRO” (predisposition, infection, response, and organ dysfunction), the sepsis tool was adapted to identify pediatric patients at risk for sepsis with signs of infection, age-related abnormal vital signs, and signs of organ dysfunction. With 5 or greater score (maximum score of 16), a “sepsis alert” was paged. A multidisciplinary team was mobilized: ED nurse, ED paramedic, physician, respiratory therapist, and child life specialist.