Nurses Can Resuscitate

2020 ◽  
Author(s):  
Cheryl Cooper ◽  
Amalia Cochran ◽  
Rebecca Coffey
Keyword(s):  
Real Time ◽  
Fluid Resuscitation ◽  
Multidisciplinary Approach ◽  
Burn Shock ◽  
Nurse Specialist ◽  
Data Collection Tool ◽  
Clinical Nurse ◽  
Burn Resuscitation ◽  
Parkland Formula

Abstract Fluid resuscitation in the first 48 hours postburn is crucial in the management of burn shock. The primary purpose of this study was to evaluate nurses’ adherence to a nurse-driven fluid resuscitation protocol at one adult burn center. Their secondary goal was to establish that the use of a nursing-driven protocol did not result in over resuscitation. Following implementation of a nurse-driven burn resuscitation protocol, a 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses. All resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow-up with nursing staff was done in real time by the clinical nurse specialist following each burn resuscitation. Twenty-two patients requiring formal fluid resuscitation were included in the review. Patients had a median age of 36.5(IQR: 38.74) years and were predominantly male. They found that in the first 24 hours that patients received 3.47 ml/kg/hr and then in the next 24 hours they received an average of 2.68 ml/kg/hr. All 22 patients’ resuscitation was initiated using the Parkland formula in the emergency department, and nurses were successful in consistently adjusting fluid infusions consistent with the protocol. Using a multidisciplinary approach and preparatory and real-time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow-up in real time can improve the process.

39 Nurses Can Resuscitate

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S26-S27
Author(s):  
Cheryl Cooper ◽  
Amalia Cochran ◽  
Rebecca Coffey
Keyword(s):  
Data Collection ◽  
Real Time ◽  
Fluid Resuscitation ◽  
Urine Output ◽  
Data Collection Tool ◽  
Surgical Intensive Care ◽  
Improvement Project ◽  
Resuscitation Guidelines ◽  
Burn Resuscitation

Abstract Introduction Fluid resuscitation in the first 48 hours post burn is crucial in the management of burn shock. Hourly titration of fluids is needed to avoid complications of over or under resuscitation which can increase morbidity and mortality. Historically these titrations have been driven by the burn physician; we hypothesized that given protocols with specific resuscitation parameters the burn nurse can accurately resuscitate the burn patient without complications. Methods This quality improvement project at our ABA verified adult Burn Center tracked performance of a nurse-driven protocol for all inpatients with burns who underwent formal fluid resuscitation. Education regarding the nursing-driven protocol was provided to 90 surgical intensive care nurses. Badge buddies with both the Parkland formula and the Modified Albumin formula were made for the staff. Burn order sets were updated to reflect burn resuscitation guidelines with fluid adjustment parameters. A 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses and all resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow up and education reinforcement was done in real time by the clinical nurse specialist following each burn resuscitation. Results Over a one-year period, 23 patients’ resuscitations were tracked and reviewed by the burn quality team. One patient was excluded because of early transition to comfort care. After the initial three tracked resuscitations, the data collection tool was evaluated and modifications made to more effectively capture relevant findings. Mean age of patients was 45.1 (18–82) with a mean TBSA burn injury of 32.5 (15–42.5) In the first 24 hours patients (n=22) received a mean volume of 3.47 ml/kg/%TBSA (0.66 – 8.39) with a mean urine output of 0.95 mL/kg/hr (0.30 – 2.16 ml/kg/hr). For patients who remained on resuscitation during the second 24 hours (n = 16), they received a mean volume of 2.68ml/kg/%TBSA (0.56- 8.44) and had a mean urine output of 1.31 mL/kg/hr (0 .30–2.16). There were no complications related to fluid administration. Appropriate hourly fluid adjustments were made in 21 of the 22 patients. The one patient who did not have fluids titrated appropriately was attributed to resident physician education because the resident failed to provide the burn order set that includes the fluid resuscitation protocol. Conclusions Using a multidisciplinary approach and preparatory and real time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow up in real time can improve the process. Applicability of Research to Practice The use of nurse-driven protocols can improve outcomes for burn patients.

A new approach to managing follow-up patients with sino-nasal disorders: the rhinology panel

2020 ◽  
Vol 26 (3) ◽  
pp. 88-93
Author(s):  
Abdulaziz Abushaala ◽  
Helen Sargent ◽  
Jennifer McLean ◽  
Deborah Grech-Marguerat ◽  
Hisham Khalil
Keyword(s):  
Patient Safety ◽  
Waiting List ◽  
Nurse Specialist ◽  
Review Panel ◽  
Clinical Nurse ◽  
New Approach ◽  
Specialist Registrar ◽  
Face To Face ◽  
Clinical Records

Background/aims There is a growing backlog of patients with sino-nasal disorders waiting for a follow-up appointment. This study aimed to identify rhinology patients on the outpatient follow-up list who could be removed from the waiting list for a face to face follow-up appointment and instead either given a phone consultation by a clinical nurse specialist or discharged from the service. Methods The clinical records of patients on the waiting list for a follow-up appointment at a nasal disorders clinic were reviewed by a panel comprising a consultant rhinologist, a rhinology fellow, a specialist registrar and two nurse specialists. Results A total of 300 clinical records of patients on the follow-up list of the Rhinology clinic were identified, of which 253 were found to have a sino-nasal disorder. Of these, 137 patients (54%) were discharged from the rhinology face to face follow-up clinics, while 116 patients (46%) were given face to face review appointments. Conclusions A multi-professional rhinology review panel is an effective way of managing the waiting list of an outpatient rhinology clinic and providing nurse-led telephone consultations could decrease the strain on resources while maintaining patient safety.

scholarly journals 099 Do clinical nurse specialist led stroke follow-up clinics reduce post-stroke hospital readmissions and recurrent vascular events?

2019 ◽  
Vol 90 (e7) ◽  
pp. A32.2-A32
Author(s):  
Alex Kao ◽  
Jeremy Lanford ◽  
Lai-Kin Wong ◽  
Anna Ranta
Keyword(s):  
Hospital Readmission ◽  
Readmission Rate ◽  
Clinical Nurse Specialist ◽  
Vascular Event ◽  
Nurse Specialist ◽  
Vascular Events ◽  
Clinical Nurse ◽  
One Year ◽  
The One

IntroductionPost-discharge stroke follow-up clinics have been associated with improved outpatient care and reduced readmission. Pre-2014 there was no consistent follow-up care offered at Wellington Hospital. Our aim was to determine whether the establishment of a clinical nurse specialist (CNS) follow-up clinic reduced the readmission 12-monthrate.MethodsThis is a sequential comparison of patient admitted with stroke one year prior and one year after the clinic was established in 2013. The primary outcome was hospital 12-month hospital readmission rate; main secondary outcome was recurrent vascular event. Patients were identified from the hospital discharge records and underwent detailed electronic chart review. Results were adjusted for differences in baseline characteristics.ResultsWe identified 874 patients; 439 pre- and 435 post-nurse clinic implementation. There was no significant difference between the one-year readmission rate after the establishment of the stroke follow up clinic (adjusted OR=1.06; 95% CI, 0.85–1.64; p=0.804) and no difference in recurrent composite vascular events at one-year (adjusted OR=1.20; 95% CI, 0.68–2.11; p=0.528). The median (IQR) time to follow-up to clinic after discharge was 85 (63–98.5) days. There was a trend towards a reduction in vascular events when limiting the analysis to patients who actually attended clinic, but this trend disappeared when adjusting for baseline inter-group differences.ConclusionsThere was no reduction in the one-year hospital readmission or vascular event recurrence rate for patients with stroke following the establishment of a nurse specialist led stroke follow up clinic. Earlier timed follow-up and the psychosocial value offered by these clinics requires further evaluation.

The multidisciplinary approach to management

2012 ◽  
Keyword(s):  
Young People ◽  
Rheumatic Disease ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Transitional Care ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Children And Young People ◽  
Holistic Management

The multidisciplinary team 378The role of the clinical nurse specialist 380The role of the physiotherapist 382The role of the occupational therapist 384The role of the podiatrist 385Transitional care 387• The experienced MDT is integral to the holistic management of children and young people with rheumatic disease with the patient and family at the centre (...

scholarly journals Peer buddy mentoring project for nurses’ career development

2017 ◽  
Vol 5 (4) ◽  
pp. 82 ◽  
Author(s):  
Lauretta Luck ◽  
Harrison Ng Chok ◽  
Lesley Wilkes
Keyword(s):  
Career Development ◽  
Survey Design ◽  
Low Cost ◽  
Nurse Specialist ◽  
Effective Strategy ◽  
Mutual Support ◽  
Clinical Nurse ◽  
Face To Face ◽  
Qualitative Survey

Objective: The aim of the paper is to describe the implementation of a peer buddy mentoring model to support the career development of Registered Nurses (RNs) seeking Clinical Nurse Specialist (CNS) positions.Methods: A qualitative survey design was used to collect data during the workshops, with follow-up semi-structured telephone or face-to-face interviews. Data were also collected via the researchers’ notes.Results: A total of 32 participants attended the program and 31 completed the surveys. The participants’ reported needing more support when applying for a CNS position. Despite these issues, the participants recommend the use of peer buddy mentoring as a motivational, supportive and instructive model.Conclusions: Peer buddy mentoring, and facilitated workshops, is a relatively low cost and effective strategy to support nurses aspiring to advance their careers. Participants valued the development of the peer buddy relationship and the mutual support and motivation it engendered.

scholarly journals P18 Audit on pre-methotrexate screening in a paediatric rheumatology centre

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Rebecca Foster ◽  
Samundeeswari Deepak ◽  
Kishore Warrier ◽  
Satyapal Rangaraj ◽  
Nikki Camina
Keyword(s):  
Conflicts Of Interest ◽  
Digital Health ◽  
Routine Practice ◽  
Nurse Specialist ◽  
Health Records ◽  
Clinical Nurse ◽  
Risk Patients ◽  
Lost To Follow Up ◽  
Positive Results

Abstract Background The BSPAR section council consensus-based guidance is the most widely used guideline on the use of methotrexate. This recommends that varicella immunity status is checked prior to commencing methotrexate and to consider immunisation if the child is non-immune. It also suggests considering checking measles status and testing for TB in high risk patients. We aim to evaluate our practice of screening paediatric rheumatological patients prior to commencing them on methotrexate. All patients in our centre have methotrexate teaching with a clinical nurse specialist prior to commencing treatment. Methods This study included paediatric patients who were prescribed methotrexate in all forms (subcutaneous, intravenous and orally) for rheumatological conditions and uveitis during a 2-year period (2016 – 2018) regardless of when it was first commenced. Digital health records were accessed to obtain the data retrospectively. Patients were excluded if they had been started on methotrexate prior to joining our centre, or were lost to follow up during the study period or if the required data was unavailable. Results 123 patients were identified to have been prescribed methotrexate during the 2-year study period and 102 patients were included in the study. 28 patients were commenced on methotrexate during 2016 /17 and others were commenced anytime between 2008 -2015. 91 (89%) patients had their varicella status checked prior to commencing methotrexate and 7 patients were checked after treatment was commenced. It was not checked in 4 patients (1 sample rejected and not repeated). Of those checked 20 patients were non-immune and 16 were vaccinated. 57 patients had had measles serology checked, 31 of these prior to commencing methotrexate. 35 patients had TB Quantiferon checked prior to methotrexate being started and 39 after. There were no positive results and 6 (8%) indeterminate of which 5 were repeated and 4 were negative. Of the indeterminate results 4 samples were taken prior to commencing methotrexate and 2 after. Conclusion This study shows that local adherence to checking varicella status prior to commencing methotrexate and vaccinating non-immune patients is good. Routine practice for checking measles, hepatitis and TB is varied. The data was captured over a 2-year period but actually included practice of methotrexate commencement over 9 years and thus time span and change in doctors will have contributed to the variation in practice. We believe some results from outreach clinics were not captured. All four tests are often carried out if it is felt the patient is likely to go on to require biologics. An updated guideline would help streamline the pre-DMARD screening and may limit the number of unnecessary investigations. Conflicts of Interest The authors declare no conflicts of interest.

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