Intraosseous access and the emergency nurse
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Abstracts S9 episodes of bypass and off-stretcher times; improve clini- cal handover and relationships between wards and ED; and increase documentation compliance Significance: The PAH ED sees 46,000 patients/year (09/10) with 36% admitted to hospital. With 41% of patients waiting >8 h to be admitted this is a risk to patient safety and decreases patient satisfaction Strategy and implementation: Using lean-thinking the current state was mapped, patients ready for admission were tracked, staff were surveyed and documentation audited. After analysing the results the strategy was to have clinical unit nursing staff manage the admission of the patient instead of ED staff. Implementation included a marketing campaign to all staff. This included A3 posters, general media communication, screen savers, tours to ED, presenting at all staff forums leading up to the imple- mentation. Development of 24-h communication links for management of patients to be admitted. This included generic email address, designated hotline phone number. Implementation of a green (READi) line on the floor to act as a visual cue to direct staff to the collection point in ED. Development and implementation of checklists, workplace guidelines outlining roles and responsibilities of each mem- ber of the team. Finally the development of daily and weekly feedback loops and an evaluation processes Evaluation: The average time for a patient to leave ED once identified as ready to leave significantly improved by an average 32 min (p = 0.000). Documentation demon- strated improvement in most components including clinical documentation and patient property with significance from p = 0.000—0.003. There is a daily saving on average of 10 h additional emergency nursing time related to not being out of department on ward transfers. Implications for practice: READi has shown that stream- lining systems to improve the journey of patients from ED to the clinical unit has significantly improved patient care and reduced risk of harm. It has fostered a whole of hospital approach to management of ED capacity and throughput of patients. It has significantly improved the nursing time spent in ED directly related to not being on ward transfers. doi:10.1016/j.aenj.2011.09.024 Intraosseous access and the emergency nurse Kane Guthrie Sir Charles Gairdner Hospital, 2/115 Lockhart Street, Como, WA, 6152, Australia Keywords: Intraosseous; Difficult access; Intraosseous route; Christchurch earthquake disaster E-mail address: [email protected]. The use and role of intraosseous access in the adult patient has dramatically changed over the past decade. Originally used in the child with difficult vascular access, is now readily supported by literature highlighting its effec- tive use in the adult patient. The humble manual needle device as a means of access has come a long way when com- pared to current intraosseous devices consisting of power driven bone injection guns that can insert an intraosseous catheter in under 10 s with first pass success rates between 92 and 97%. Recently published case reports have demon- strated successful administration of fibrinolysis in a STEMI patient, massive transfusion of blood products in the resus- citation of massive obstetric haemorrhage, and successful administration of computed tomography contrast in a multi trauma patient all via the intraosseous catheter route. The intraosseous catheter has changed the way we look at vas- cular access in the difficult vascular access patient in both emergent and non-emergent situations, and should be a core component in every emergency nurses’ armamentarium. The presentation will cover: • Review of the literature surrounding intraosseous use in the adult patients. • Notable published case reports demonstrating the effec- tiveness of intraosseous access. • The indications for intraosseous use in adult patients. • The role of the emergency nurse in insertion and manage- ment of the intraosseous device. doi:10.1016/j.aenj.2011.09.025 Christchurch earthquake disaster. The lived experience AUSMAT deployment February 2011 Rob McDonald E-mail address: [email protected]. 12:51 h New Zealand time, a 6.3 magnitude Earthquake struck the second largest city in New Zealand. Christchurch suffered large scale destruction, injury and loss of life. A state of civil Emergency was declared and the New Zealand Government made a request to Emergency Management Australia for medical assistance. Emergency Management Queensland in conjunction with Queensland Health were tasked to provide an AUSMAT team to respond to the health needs of the affected people of Christchurch. A 24 person team comprising of Medical, Nursing and Administration specialists were deployed and landed in Christchurch within 36 h. This team aligned themselves with a 6 person Queensland Ambulance Service, Special Operations Response Team (SORT) and established a ‘Field Hospital’ in the eastern suburbs of Christchurch — a low socioeconomic area with vast cultural diversity that was significantly impacted by the earthquake with no running water, sewage, power and limited access to medical assis- tance. This presentation will focus on the lived experience of the staff responding to a disaster for the first time. It will reflect on the Emergency Nurses ability to adapt and respond to new situations. It will also detail challenges faced, what was achieved and consider the emotions felt and individual preparedness when being deployed to a disaster for the first time. Another member of the AUSMAT nursing team will explore the dynamics of the mission, the lessons learnt, and propose a way forward for future AUSMAT teams in disaster zones. doi:10.1016/j.aenj.2011.09.026
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Transcript of Intraosseous access and the emergency nurse
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the dynamics of the mission, the lessons learnt, and proposea way forward for future AUSMAT teams in disaster zones.
Abstracts
episodes of bypass and off-stretcher times; improve clini-cal handover and relationships between wards and ED; andincrease documentation compliance
Significance: The PAH ED sees 46,000 patients/year(09/10) with 36% admitted to hospital. With 41% of patientswaiting >8 h to be admitted this is a risk to patient safetyand decreases patient satisfaction
Strategy and implementation: Using lean-thinking thecurrent state was mapped, patients ready for admissionwere tracked, staff were surveyed and documentationaudited. After analysing the results the strategy was tohave clinical unit nursing staff manage the admission ofthe patient instead of ED staff. Implementation included amarketing campaign to all staff. This included A3 posters,general media communication, screen savers, tours to ED,presenting at all staff forums leading up to the imple-mentation. Development of 24-h communication links formanagement of patients to be admitted. This includedgeneric email address, designated hotline phone number.Implementation of a green (READi) line on the floor to actas a visual cue to direct staff to the collection point in ED.Development and implementation of checklists, workplaceguidelines outlining roles and responsibilities of each mem-ber of the team. Finally the development of daily and weeklyfeedback loops and an evaluation processes
Evaluation: The average time for a patient to leave EDonce identified as ready to leave significantly improvedby an average 32 min (p = 0.000). Documentation demon-strated improvement in most components including clinicaldocumentation and patient property with significance fromp = 0.000—0.003. There is a daily saving on average of 10 hadditional emergency nursing time related to not being outof department on ward transfers.
Implications for practice: READi has shown that stream-lining systems to improve the journey of patients from EDto the clinical unit has significantly improved patient careand reduced risk of harm. It has fostered a whole of hospitalapproach to management of ED capacity and throughput ofpatients. It has significantly improved the nursing time spentin ED directly related to not being on ward transfers.
doi:10.1016/j.aenj.2011.09.024
Intraosseous access and the emergency nurse
Kane Guthrie
Sir Charles Gairdner Hospital, 2/115 Lockhart Street,Como, WA, 6152, AustraliaKeywords: Intraosseous; Difficult access; Intraosseousroute; Christchurch earthquake disaster
E-mail address: [email protected].
The use and role of intraosseous access in the adultpatient has dramatically changed over the past decade.Originally used in the child with difficult vascular access,is now readily supported by literature highlighting its effec-tive use in the adult patient. The humble manual needle
device as a means of access has come a long way when com-pared to current intraosseous devices consisting of powerdriven bone injection guns that can insert an intraosseouscatheter in under 10 s with first pass success rates betweend
S9
2 and 97%. Recently published case reports have demon-trated successful administration of fibrinolysis in a STEMIatient, massive transfusion of blood products in the resus-itation of massive obstetric haemorrhage, and successfuldministration of computed tomography contrast in a multirauma patient all via the intraosseous catheter route. Thentraosseous catheter has changed the way we look at vas-ular access in the difficult vascular access patient in bothmergent and non-emergent situations, and should be a coreomponent in every emergency nurses’ armamentarium.
The presentation will cover:
Review of the literature surrounding intraosseous use inthe adult patients.Notable published case reports demonstrating the effec-tiveness of intraosseous access.The indications for intraosseous use in adult patients.The role of the emergency nurse in insertion and manage-ment of the intraosseous device.
oi:10.1016/j.aenj.2011.09.025
hristchurch earthquake disaster. The lived experienceUSMAT deployment February 2011
ob McDonald-mail address: [email protected].
12:51 h New Zealand time, a 6.3 magnitude Earthquaketruck the second largest city in New Zealand. Christchurchuffered large scale destruction, injury and loss of life. Atate of civil Emergency was declared and the New Zealandovernment made a request to Emergency Managementustralia for medical assistance.
Emergency Management Queensland in conjunction withueensland Health were tasked to provide an AUSMAT teamo respond to the health needs of the affected people ofhristchurch.
A 24 person team comprising of Medical, Nursing anddministration specialists were deployed and landed inhristchurch within 36 h. This team aligned themselvesith a 6 person Queensland Ambulance Service, Specialperations Response Team (SORT) and established a ‘Fieldospital’ in the eastern suburbs of Christchurch — a lowocioeconomic area with vast cultural diversity that wasignificantly impacted by the earthquake with no runningater, sewage, power and limited access to medical assis-
ance.This presentation will focus on the lived experience of
he staff responding to a disaster for the first time. It willeflect on the Emergency Nurses ability to adapt and respondo new situations. It will also detail challenges faced, whatas achieved and consider the emotions felt and individualreparedness when being deployed to a disaster for the firstime.
Another member of the AUSMAT nursing team will explore
oi:10.1016/j.aenj.2011.09.026
