Trauma Nursing

The Year Ahead No abstract available

Ethics at Work: What Nurses Really Do on the Job No abstract available

Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending. The complexity of elderly trauma care and the need to evaluate the efficacy of management provided by NPs led to the development of the current study. Accordingly, this study endeavored to compare outcomes in elderly patients whose care was coordinated by trauma NP (TNP) versus nontrauma NP (NTNP) services. Patients under the care of TNPs had a 1.22-day shorter duration of hospitalization compared with that of the NTNP cohort (4.38 ± 3.54 vs. 5.60 ± 3.98, p = .048). Decreased length of stay in the TNP cohort resulted in an average decrease in hospital charges of $13,000 per admission ($38,053 ± $29,640.76 vs. $51,317.79 ± $34,756.83, p = .016). A significantly higher percentage of patients admitted to the TNP service were discharged home (67.1% vs. 36.0%, p = .002), and a significantly lower percentage of patients were discharged to skilled nursing facilities (25.7% vs. 51.9%, p = .040). These clinical and economic outcomes have proven beneficial in substantiating the care provided by TNPs at the study institution. Future research will focus on examining the association of positive outcomes with specific care elements routinely performed by the TNPs in the current practice model.

Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients No abstract available

Implementation of a Health Literacy Universal Toolkit to Improve Postdischarge Care at an Urban Trauma Center Topic: Low health literacy impacts the financial burden of hospitals up to $238 billion annually. A trauma center located on the East Coast implemented a Transitional Care Management (TCM) model targeting individuals at risk for readmission, but not every patient receives this service. Purpose: A gap analysis of the facility's discharge process identified a deficit in the formal evaluation of health literacy upon discharge. The purpose of this project was to implement a Health Literacy Universal Toolkit to assess and improve medication education for low literacy patients. Included in the toolkit were the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an evidence-based health literacy screening tool, and 2 interventions, additional education on their inpatient or discharge medication list, and a Brown Bag Medicine Review of medications at a postdischarge clinic appointment. Conclusion: Seventy-one patients were screened using the REALM-SF. Sixty-two percent (n = 44) of patients scored at a high school reading level, 30% (n = 21) scored at a seventh- to eighth-grade reading level, and 8% (n = 6) scored at or below a sixth-grade reading level. Eight percent of patients scored as having low health literacy, 30% scored as having marginal health literacy, and 62% scored as having adequate health literacy. Twenty patients received additional medication education with My Medicines Form or a Brown Bag Medicine Review. Key Points: Regardless of literacy level, patients appreciated the additional medication education interventions. Health care providers should observe universal health literacy precautions regardless of literacy level.

Hypocalcemia and Massive Blood Transfusions: A Pilot Study in a Level I Trauma Center Trauma is a leading cause of death in the United States, and uncontrolled hemorrhage is often the primary cause of mortality. Massive transfusions provide lifesaving treatment for the bleeding trauma patient; yet, this is not a benign intervention. Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient's endogenous calcium when blood products are administered, rendering calcium inactive. As a result, undesirable physiological effects can occur. Although there is a plethora of evidence reporting the negative effects of hypocalcemia during resuscitation, the research for standardization of calcium monitoring and replacement during a massive transfusion event is less robust. Consequently, monitoring and replacement of this vital electrolyte are often overlooked. Trauma department employees at an urban academic hospital were given a pretest to assess their knowledge of calcium monitoring and replacement during a massive transfusion. On the basis of test results and a need for staff education, a short, animated video was designed and distributed for viewing. Following the educational video, a posttest was administered and yielded higher scores when compared with the pretest (p = .001). Lack of knowledge and national standards may be root causes for hypocalcemia. Educational interventions such as innovative, brief videos can be effective for enhancing staff members' knowledge and improving patient care.

Bridging the Gap: Utilizing a Pediatric Trauma Care Coordinator to Reduce Disparities for Pediatric Trauma Follow-Up Care An American College of Surgeons–verified Level I pediatric trauma center found that some children with severe and complex injuries experienced disruptions in trauma follow-up care because of the lack of centralized care coordination after hospital discharge. A review of the literature identified little guidance to address this issue. A quality improvement project assessed the gaps in care, identified high-risk patients, and developed a novel pediatric trauma care coordinator (PTCC) nursing position to bridge the gap. Enhancements to the trauma registry software helped create a log of family and provider communication events with and interventions by the PTCC. High-risk patients were defined as those with either a traumatic brain injury plus 1 other organ system injury requiring surgical specialist follow-up, or those with 3 or more different organ system injuries requiring follow-up with a surgical specialist. Costly return to health care (CRH), which we defined as emergency department visits for 72 hr or less or unplanned readmissions of 30 day or less after hospital discharge was selected as the primary outcome measure and assessed during the pre- and postimplementation periods. In the 12-month preimplementation period, 14 patients had a CRH rate of 14%, compared with the 12-month postimplementation period in which 18 patients had a CRH rate of 0%. Patients received a mean of 21.2 communication events and 14.1 intervention events from the PTCC in the postimplementation period. This report details the process of developing and implementing a PTCC nursing position, the tasks involved, and the initial results of this novel program.

Comparisons of Trauma Outcomes and Injury Severity Score Trauma is a global health problem and a leading cause of mortality. One of the major predictors of trauma mortality is the Injury Severity Score (ISS). Theoretically, as the ISS increases, the probability of survival decreases; ISS = 75 is considered to be not survivable. Studies have shown that some deaths are preventable and some potentially preventable. Hemorrhagic shock is a potentially preventable cause of trauma mortality. A retrospective database review was conducted of the Mississippi Trauma Registry and point-by-serial correlational analyses were conducted to determine the direction of any significant relations between blood product usage, traditional vital signs, and shock index. Pearson correlation, logistic regressions, and odds ratio calculation results revealed that shock index can signal impending hemorrhagic compromise better than traditional vital signs; thus, facilitating early intervention, specifically, as heart rate and shock index increase, the use of blood products increases, and as blood pressure increases, the use of blood products decreases. Independent t tests for shock index and ISS revealed significant differences in the means with relationship to the subgroups "Dead" and "Alive." Higher ISS were found to correlate with higher shock indices. Evaluation of ISS and survivability demonstrates that ISS = 75 is survivable and should not lead one to reflexively assume otherwise. A total mortality finding of only 1.58% (n = 2,010) was unexpected but very encouraging.

Trauma Team Activation: Accuracy of Triage When Minutes Count: A Synthesis of Literature and Performance Improvement Process Accuracy and timeliness of trauma activations are vital to patient safety. The American College of Surgeons mandates the trauma surgeon's presence within 15 min of the patient's arrival to the emergency department (ED) 80% of the time. In 2015, at this Level II Pediatric Trauma Center, average mean activation times were approximately 16 min and activation accuracy (over- and undertriage) affected 27% of the trauma patient activations. This evidence-based quality improvement project set out to determine the most efficient method of Emergency Medical Services (EMS) intake. Communication Center (Com. Center) recordings were carefully reviewed to identify time when EMS notifies the Com. Center and actual time of trauma activation page. A timeline was formulated with assessment of time to activation and patient triage accuracy. An educational curriculum was developed as an intervention for the Com. Center staff. Education included a decision tree for trauma activations and the development of templates for our electronic health record and prompts to improve accurate activations. After additional focus groups analyzed present ED performance and the industry standard, a policy requiring only paramedic-trained staff was put in place. After implementation of the aforementioned intervention, the Com. Center performance revealed reduction in incorrect activations from 27.3% to 10.7% from 2015 to 2016. Mean activation time in January 2015 was 48.5 min before the intervention and 4.71 min postintervention in December 2016; this is a staggering reduction in activation times of 90%!

Trauma Response Nurse: Bringing Critical Care Experience and Continuity to Early Trauma Care Multitrauma patients can benefit significantly from specialized care. Prior to mid-2016, this hospital's trauma team did not include a surgical intensive care unit (SICU) nurse. As the value of bringing this expertise to the patient upon arrival was realized, the role of the trauma response nurse (TRN) was developed. The TRN role was designed to provide a dedicated SICU nurse to care for trauma patients from emergency department (ED) arrival through disposition. The integration of the TRN role into the trauma team sought to improve quality and safety, as well as communication and collaboration, and enhance continuity of care. The primary responsibilities of the TRN were to assist with clinical interventions, transport patients fromthe ED to tests and procedures, and assume care through disposition. Additional TRN duties included education, community outreach, and performance improvement. TRNs now respond to all trauma activations that occur on weekday day shift. This role has improved collaboration between nursing disciplines, improved the overall function of the trauma team, and enhanced the safety of trauma patients during transport. TRNs make valuable contributions to the education and outreach missions of the trauma program and ensure that patients are receiving the highest level of trauma care.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com