DOCSLIB.ORG

Implementation of an Ultrasound-Guided Peripheral Vascular Access Device Insertion Program

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Implementation of an Ultrasound-Guided Peripheral Vascular Access Device Insertion Program Implementation of an Ultrasound-Guided Peripheral Vascular Access Device Insertion Program Kevin Arnold, DNP, MSN, BBA, BS, BSN, RN November 4th, 2018 9:00AM Conflict of Interests Disclosure • No conflict of interest exists Introduction • Ultrasound guidance for peripheral vascular access device insertion has been shown to benefit many stakeholders. While barriers exist to implementing this practice, six themes in the literature surface aiding efforts to advance these programs. In this presentation, we will discuss these major themes, current evidence, and the process for setting up a training program. Background of the Problem • History-Present • The challenges with inserting PIVs have been abundant for decades.1 • Difficulty in access is present. 2 Repetitive attempts, declining patient satisfaction, and a reduction in productivity. 3 • Advanced skill with typically limited use • Benefits demonstrated Exploring Themes in the Literature • Success of Use (SU) • success deltas • nurse driven & other disciplines • training methods • Patient Benefits (PB) • difficult stick patients • yield on demand for central venous catheters • patient satisfaction SU: Success Deltas • Quantifying the delta of improvement can add tangible value that may be associated with patient outcomes and traditional staff nursing demands. SU: Success Deltas Helpful Articles: 4 Adhikari, Blaivas, Morrison, and Lander Comparison of infection rates among ultrasound-guided versus traditionally placed 2010 peripheral intravenous lines. 5 Edwards and Jones Development and Implementation of an Ultrasound-Guided Peripheral Intravenous 2018 Catheter Program for Emergency Nurses. Feinsmith, Huebinger, Pitts, Baran, and Outcomes of a Simplified Ultrasound-Guided Intravenous Training Course for 2018 6 Haas Emergency Nurses. 2 Gosselin, Lapre, Lavoie, and Rhein Cost Effectiveness of Introducing A Nursing-Based Programme of Ultrasound Guided 2017 Peripheral Venous Access in A Regional Teaching Hospital. 7 Kantor, Su, Milliren, and Conlon Ultrasound-guidance and Other Determinants of Successful Peripheral Artery 2016 Catheterization in Critically Ill Children. 8 Moore An emergency department nurse-driven ultrasound-guided peripheral intravenous 2013 line program. 9 Scoppettuolo et al. Ultrasound-Guided 'Short' Midline Catheters for Difficult Venous Access in the 2016 Emergency Department: A Retrospective Analysis. 10 Seto et al. Real-Time Ultrasound Guidance Facilitates Transradial Access: RAUST (Radial 2015 Artery Access With Ultrasound Trial). 11 Tan, et al. Cost-Effectiveness Analysis of Ultrasound-Guided Seldinger Peripherally Inserted 2016 Central Catheters. SU: Success Deltas Insertion success: 12 • 2.17 1.31 Vitto M., Myers, Vitto C., and Evans (2016) 3 • 1.15 Duran-Gehring et al. (2016) 13 • 1.4 Dargin, Rebholz, Lowenstein, Mitchell, and Feldman (2010) 14 • 1.37 Keyes, Frazee, Snoey, Simon, and Christy (1999) 15 • 1.5 Rose and Norbutas (2008) 16 • 1.35 Schoenfeld, Boniface and Shokoohi (2011) 8 • 1.22 Moore (2013) 17 • 1.3 Moore (2014) 1 • 1.25 Brannam, Blaivas, Lyon, and Flake (2006) 18 • 3.3 1.6 Bauman, Braude, and Crandall (2009) 19 • 1.4 Au, Rotte, Grzybowski, Ku, and Fields (2012) • 1.57 Scoppettuolo et al. (2016) 9 • 6.9 3.1 (Peripheral arterial line) Kantor, Su, Milliren, and Conlon (2016) 7 • 3.4 1.65 (Transradial cardiac catherization) Seto et al. (2015) 10 SU: Success Deltas Infection Prevention: • 7.8 5.2 Adhikari, Blaivas, Morrison, and Lander (2010) 4 Time to Completion: • 74.8 min 26.8 Bauman, Braude, and Crandall (2009) 18 • 108 sec to 88 sec (Transradial cardiac catherization) Seto et al. (2015) 10 • 8.8 min to 8.1 min (Peripheral art line) Kantor, Su, Milliren, and Conlon (2016) 7 Cost Effectiveness: • 59.18% 89.29% Tan et al. (2016) 11 • 37 Article review: few attempts Weiner, Geldard, and Mittnacht (2013) 20 SU: Success Deltas Influenced outcomes: • operator skill level • previous experience Common findings of ultrasound guidance: • Improved success rate • Improved first attempt success • Fewer attempts and complications • Reduction in time to completion • Reduction in infection rates SU: Nurse Driven vs. Other Disciplines Helpful Articles: 18 Bauman, Braude, and Crandall (2009) "Ultrasound-guidance vs. standard technique in difficult vascular access 2009 patients by ED technicians." McKay and Weerasinghe (2018) created an "Can we successfully teach novice junior doctors basic interventional 2018 21 article called ultrasound in a single focused training session?" 22 Olivira and Lawrence (2016) "Ultrasound-guided peripheral intravenous access program for emergency 2016 physicians, nurses, and corpsmen (technicians) at a military hospital." Reusz and Csomos (2015) created an article "The Role of Ultrasound-Guidance for Vascular Access." 2015 23 called 24 Shoenfeld, Shokoohi, Boniface (2011) "Ultrasound-guided peripheral intravenous access in the emergency 2011 department: Patient-centered survey." SU: Nurse Driven vs. Other Disciplines RN: • Ample studies, high cofounding variables, variety of endpoints, use of mean (average) LVN: • Additional studies needed. MD (Residents): • Ample studies, veeeeerrrry brief training models. • 99% learned with 73% competency. 21 ED Technicians: • Success 97.5%, first attempt 86.8%, mean 1.15. 3 • Higher complication rate and arterial puncture. 16 • Additional studies needed. SU: Nurse Driven vs. Other Disciplines Influenced outcomes: • Training program • User setting: RN, MD, Tech Common findings: • PIVs, Midlines, PICCs, Peripheral art lines, Transradial cardiac catherization SU: Training Methods Helpful Articles: 25 Baddoo, Djagbletey, and Owoo "A Simple Tissue Model for Practicing Ultrasound Guided Vascular Cannulation." 2014 26 Erickson et al. "Ultrasound-Guided Small Vessel Cannulation: Long-Axis Approach is Equivalent to Short- 2014 Axis in Novice Sonographers Experienced with Landmark-Based Cannulation." Gottlieb, Sundaram, Holladay, and "Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of 2017 27 Nakitende Evidence-Based Best Practices." 28 Griffiths et al. "A Randomised Crossover Study to Compare the Cross-Sectional and Longitudinal 2017 Approaches to Ultrasound-Guided Peripheral Venepuncture in a Model." Jaffer, Normahani, Singh, Aslam, "Randomized Study of Teaching Ultrasound-Guided Vascular Cannulation Using a 2015 29 and Standfield Phantom and the Freehand Versus Needle Guide–Assisted Puncture Techniques." 17 Moore "Ultrasound First, Second, and Last for Vascular Access." 2014 30 Primdahl et al. "Validation of the peripheral ultrasound-guided vascular access rating scale." 2018 31 Rice et al. "An Assessment Tool for the Placement of Ultrasound-Guided Peripheral Intravenous 2016 Access." 32 Rippey, Blanco, and Carr "An Affordable and Easily Constructed Model for Training in Ultrasound-Guided Vascular 2015 Access." 33 Thomas and Moore "The Vanishing Target Sign: Confirmation of Intraluminal Needle Position for Ultrasound 2013 Guided Vascular Access." 34 White, Lopez, and Stone Developing and Sustaining an Ultrasound-Guided Peripheral Intravenous Access Program 2010 for Emergency Nurses SU: Training Methods Didactic: • Components - physics, equipment, scanning, and procedure 34 • Note worthy - “The Vanishing Target Sign” by Tomas and Moore 33 Simulation: • Simple tissue pork belly and a longitudinal shaped balloon 25 • Common practice gel blocks • High-fidelity simulator 32 SU: Training Methods Cross-sectional vs. Longitudinal: • Better results with cross-sectional 28 • Long-axis attempts were 32% faster than short-axis attempts 26 • Inconclusive which is best Freehand vs. Need guide: • Lower rate of posterior-wall punctures and fewer skin punctures 29 • Additional studies needed SU: Training Methods Influenced outcomes: • Hours of class/training • Setting • End user (RN, MD, etc.) Common findings: • Yielded better outcomes: user of simulation, longer training program, mentorship PB: Difficult Stick Patients Helpful Articles: 1 "Emergency nurses’ utilization of ultrasound-guidance for placement of Brannam, Blaivas, Lyon, and Flake 2004 peripheral intravenous lines in difficult-access patients." 3 "Ultrasound-guided peripheral intravenous catheter training results in physician- Duran-Gehring et al. 2016 level success for emergency department technicians." L. Stolz, U. Stolz, Howe, Farrell, and "Ultrasound-Guided Peripheral Venous Access: A Meta-analysis and Systemic 35 2015 Adhikari Review." 36 Sou et al. "A clinical pathway for the management of difficult venous access." 2017 Vezzani, Manca, Vercelli, Braghieri, and "Ultrasonography as a Guide During Vascular Access Procedures and in the 37 2013 Magnacavallo Diagnosis of Complications." 12 "Perceived difficulty and success rate of standard versus ultrasound-guided Vitto, M., Myers, M., Vitto, C. and Evans 2016 peripheral intravenous cannulation in a novice study group." "Single-operator ultrasound-guided intravenous line placement by emergency 38 Weiner, S. et al. nurses reduces the need for physician intervention in patients with difficult-to- 2013 establish intravenous access." PB: Difficult Stick Patients Costs Savings: • Reduction in hospitalization time and time to treatment 2 • Reduction in need for physician intervention 38 Success: • Many studies support successful outcomes in defined population of patients with difficult vascular access. • Lowered first stick success for after hours support team 36 PB: Difficult Stick Patients Common findings: • Clinicians should make every attempt to acquire the skills
Load more

Recommended publications
  • Emergency Care
    P: Emergency Care Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. 141 Major Competency Area: P Emergency Care Competency: P-1 Date: January 16, 2017 Emergency Nursing **LPNs will not independently triage/Canadian Triage Assessment Scale (CTAS) patients, this process must be done in collaboration with the inter-professional team** A Licensed Practical Nurse will: P-1-1 Demonstrate knowledge and ability to apply critical thinking and critical inquiry throughout the nursing process in emergency nursing. P-1-2 Demonstrate knowledge and ability to perform a comprehensive health assessment. P-1-3 Demonstrate knowledge and ability to perform nursing procedures and interventions in an emergency setting as defined by scope of practice and according to agency policy. P-1-4 Demonstrate knowledge and ability to obtain, assess and monitor diagnostic tests and lab values according to agency policy. P-1-5 Demonstrate knowledge and ability to communicate, collaborate and consult with emergency care team. 142 Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. Competency: P-1 Page: 2 Emergency Nursing A Licensed Practical Nurse will: P-1-6 Demonstrate knowledge and ability to obtain additional education and certification in emergency assessment, intervention and care including: emergency assessment certifications o cardiac life support o emergency neonatal care o emergency nursing o emergency pediatric nursing o pediatric life support o trauma nursing additional certifications
    [Show full text]
  • Journal of Emergency Nursing
    Journal of Emergency Nursing Volume 31, Issue 6, Pages 515-612 (December 2005) 1. Table of Contents • CONTENTS LIST Pages A3-A8 2. Editorial Board • EDITORIAL BOARD Pages A11-A12 3. Author Guidelines • MISCELLANEOUS Pages A15-A16 4. Info for Readers • MISCELLANEOUS Page A20 President's Message 5. A Time for Giving • ARTICLE Page 515 Patricia Kunz Howard Editorial 6. Happy Holidays! • EDITORIAL Page 516 Gail Pisarcik Lenehan Letters 7. Head for the Hill • CORRESPONDENCE Page 517 Peter Kamon 8. Nurse/Victim: The Fallacy of the Divide • CORRESPONDENCE Page 518 James MacColl Research 9. A Descriptive Study of the Perceptions of Workplace Violence and Safety Strategies of Nurses Working in Level I Trauma Centers • ARTICLE Pages 519-525 Martha Catlette Clinical 10. Emergency Response to the Gulf Coast Devastation by Hurricanes Katrina and Rita: Experiences and Impressions • ARTICLE Pages 526-547 Iris C. Frank 11. The Creation of a Behavioral Health Unit as Part of the Emergency Department: One Community Hospital's Two-Year Experience • ARTICLE Pages 548-554 Christina Lewis, Gina Sierzega and Diana Haines Case Review 12. A 4-year-old Boy With Pulmonary Hemosiderosis and Respiratory Distress Requiring Use of a Cuffed Endotracheal Tube • SHORT COMMUNICATION Pages 555-557 Emily Colyer CEN Review Questions 13. Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination • MISCELLANEOUS Pages 558-559 Carrie A. McCoy Clinical Notebook 14. Allow Natural Death: A More Humane Approach to Discussing End-of-Life Directives • SHORT COMMUNICATION Pages 560-561 Crissy Knox and John A. Vereb 15. A Percutaneous Coronary Intervention Kit and Program and PCI Kit: Reducing Door-to-Cath Lab Time • SHORT COMMUNICATION Pages 562-563 Julie Bunn and Elizabeth Coombes 16.
    [Show full text]
  • Nursing Workforce Standards for Type 1 Emergency Departments
    Nursing Workforce Standards for Type 1 Emergency Departments October 2020 Contents Foreword Foreword 3 Patients depend on acute care delivered in our Emergency Departments (EDs). We Scope 4are the frontline of the NHS. An appropriate Glossary of Nursing Roles in the Emergency Department 5 ED workforce is the most important factor for providing safe, effective, high quality Nursing Workforce Standards for emergency care in a timely, cost-effective Type 1 Emergency Departments 7and sustainable manner. This requires a balanced team of nurses, doctors, allied Converting the nursing workforce model health professionals and support staff, with into a Whole Time Equivalent (WTE) number 14 appropriate knowledge and skills. Determining the financial cost of the total WTE nursing workforce 15 Over time a number of organisations have endeavoured to make recommendations References 16 regarding the nursing workforce in EDs [1,2]. However, specific standards have Professor Dame Donna Kinnair Appendix - Approaches that may be used Chief Executive and General Secretary never previously been established. of the Royal College of Nursing to determine the nursing workforce 17 Authors and acknowledgments 18 Therefore, in the collective interests of patient safety and quality of care, the Royal College of Nursing (RCN) Emergency Care Association (ECA) and the Royal College of Emergency Medicine (RCEM) have collaborated to define, for the first time, the nursing workforce standards for Type 1 EDs. This collaboration represents something greater than just a workforce standard – it represents a recognition that the ED team is truly multidisciplinary. Dr Katherine Henderson President of the Royal College of Emergency Medicine 2 3 Scope Glossary of Nursing Roles in the Emergency Department Adapted from the RCN ECA National Foundation Staff Nurse: A Registered Nurse who This document details the nursing These standards are not intended for use Curriculum and Competency Framework is either newly qualified, or new to emergency workforce standards for Type 1 EDs.
    [Show full text]
  • Lee Patient ED Nursing Lead Transformation Tom Sagdahl ED Matron
    The Impact of Implementing ‘Fast-Track’ Streaming for Complex Walk-in Patients in an Emergency Department Lee Patient ED Nursing Lead Transformation Tom Sagdahl ED Matron Background Mean initial assessment times Jun-15 Jul-15 Apr-15 Many EDs have now developed Rapid Assessment and Treatment (RAT) models. This is the process of undertaking a rapid patient assessment and determining what investigations and immediate treatment is needed (1). This approach takes advantage of time efficiencies from parallel processing. Studies suggest there are advantages of this process including a reduction 20 in time to treatment, length of stay, left without being seen rates (3) and improved patient care 19 and experience (4). 18 17 16 At St Thomas’ (as in many ED’s), RAT is undertaken in the Major treatment area and walk-in 15 patients are assessed using a traditional nurse triage/assessment process. For patients with 14 complex needs, this can often mean there is a considerable delay in reaching the appropriate 13 12 treatment area and having a RAT assessment. At St Thomas’, walk-in patients were streamed 11 as they arrived which aimed to risk assess patients and direct to the most appropriate care. 10 This process however was only in operation from 10.00 to 20.00 each day. 9 (minutes) 8 7 6 5 Case for Change 4 At St Thomas’ ED work was undertaken by the emergency nursing team working with the Trust time assessment initial Mean 3 2 Transformation team and 20:20 to review the initial assessment process. It was found that Process for Walk-In Patients 1 although the overall mean initial assessment time was 12 minutes, there was a wide variation in 0 the mean time particularly in the evening.
    [Show full text]
  • US States and Territories Modifying
    U.S. States and Territories Modifying Licensure Requirements for Physicians in Response to COVID-19 (Out-of-state physicians in-person practice; license renewals) Last Updated: September 15, 2021 States with Waivers: 22 + DC + GU + USVI States with Waivers, not allowing new applications: 0 States without Waivers (or closed waivers): 28 States allowing OOS physicians long-term or permanent privileges: 4 + CNMI + PR On January 28, 2021, HHS announced the fifth amendment to the Public Readiness and Emergency Preparedness (PREP) Act, authorizing any healthcare provider who is licensed or certified in a state to prescribe, dispense, or administer COVID-19 vaccines in any other state or U.S. territory. The amendment also authorizes any physician, registered nurse, or practical nurse whose license or certification expired within the past five years to partake in the immunization effort, but first must complete a CDC Vaccine Training and an on-site observation period by a currently practicing healthcare professional. State Note Citation • The Alabama Board of Medical Examiners and the Medical Licensure Commission have adopted emergency administrative rules and procedures allowing for the emergency ALBME Press Release licensing of qualified medical personnel. These measures will allow physicians and physician assistants who possess full and unrestricted medical licenses from appropriate medical licensing agencies to apply for and receive temporary emergency licenses to Board of Med Guidance practice in Alabama for the duration of the declared COVID-19 health emergency. • Re: renewals - The Board and Commission recognize the difficulty licensees may have meeting the annual continuing medical education requirement in 2020 due to the public Temporary Emergency health emergency.
    [Show full text]
  • Position Description
    POSITION DESCRIPTION POSITION TITLE: LICENSED PRACTICAL NURSE DEPARTMENT: ACUTE CARE & PERSONAL CARE HOME PROGRAM CLASSIFICATION: LICENSED PRACTICAL NURSE UNION: MNU REPORTING RELATIONSHIPS POSITION REPORTS TO: CLINICAL TEAM MANAGER, MANAGER, SUPERVISOR, CLINICAL RESOURCE NURSE POSITIONS SUPERVISED: The following classifications may report to the incumbent: Health Care Aides Unit Clerks Other LPN’s & Nurse II’s when the LPN is assigned charge responsibilities POSITION SUMMARY The Licensed Practical Nurse provides comprehensive nursing care to patients/ residents/ clients in accordance with established standards, policies, and procedures. Licensed Practical Nurses recognize and fulfill their Professional responsibilities by practicing within the scope of practice of the Licensed Practical Nurses Act, the approved College of Licensed Practical Nurses of Manitoba (CLPNM) Scope of Practice and Entry–Level Competencies, provincial and federal legislation and within the guidelines of professional ethics. The position of Licensed Practical Nurse functions in a manner consistent with, and supports the Mission, Vision and Values of the Interlake-Eastern Regional Health Authority. ESSENTIAL FUNCTIONS AND DUTIES Function and duties include but are not limited to the following: IERHA – Licensed Practical Nurse Page 1 of 9 Responsibilities: 1. The LPN is required to practice in accordance with the following to their level of scope of practice, expertise, training and experience The Licensed Practical Nurses Act of Manitoba The CLPNM Standards
    [Show full text]
  • The Role of Emergency Nurses in Emergency Preparedness and Response
    The Role of Emergency Nurses in Emergency Preparedness and Response Description Hospitals, and especially emergency departments (EDs), are an essential link in the medical system for emergency preparedness planning, response, and recovery.1 As a result, emergency nurses may routinely encounter patients who have been exposed to hazardous materials or infectious diseases, who are victims of no-notice events, or who are evacuees from an immediate threat to life. These patients may present via the emergency medical system, by private vehicle, or without prior notification and unrelated to a disaster.2–5 Disaster affected patients might also present to the ED in large volumes, creating a surge in patient visits, which can paralyze EDs that are not prepared. The United States Department of Homeland Security’s National Response Framework describes a disaster as “… any natural or manmade incident, including terrorism, which results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, or government functions.”16(p1) The increased risk associated with climate change and the need for coordination across the healthcare community to respond to the health effects of climate-related emergencies have been highlighted by the World Health Organization (WHO). Both the increased risk and the need for coordination requires focus as disaster plans are developed.6 Over the past decade more severe weather events associated with climate change have resulted in loss of life, injuries, and public health impacts.7 Optimal care for disaster patients is best achieved using a systematic, standardized approach across all facets of the healthcare system.1,8 A leading method for preparing to manage all types of disaster events is an all-hazards, capability-based approach to preparedness.
    [Show full text]
  • A Qualitative Study of Workflow and Information Systems Within Emergency Departments in the UK
    A qualitative study of workflow and information systems within Emergency Departments in the UK. By: Eliza M Mazlan A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy The University of Sheffield Faculty of Social Sciences Information School JANUARY 2017 TABLE OF CONTENTS CONFERENCE PAPERS AND POSTER ................................................................. i DOCTORAL CONSORTIUM ............................................................................... i LIST OF FIGURES .............................................................................................. ii LIST OF TABLES ............................................................................................... iv LIST OF APPENDICES ........................................................................................ v GLOSSARY OF ACRONYMS ............................................................................. vii GLOSSARY OF TERMS ...................................................................................... x FLOW CHART DIAGRAM KEYS ........................................................................ xv ACKNOWLEDGMENT .................................................................................... xvi ABSTRACT ................................................................................................... xvii CHAPTER 1: INTRODUCTION ............................................................................1 1.1. Overview .................................................................................................................................
    [Show full text]
  • Effects of a Telephone Follow-Up Call on Patient Satisfaction in the Emergency Department
    Running head: PATIENT SATISFACTION 1 Effects of a Telephone Follow-Up Call on Patient Satisfaction in the Emergency Department Kathryn McCary, Cynthia Hestermann, and Abby Richardson Creighton University PATIENT SATISFACTION 2 Abstract Problem: Patient satisfaction has been identified as a key element of success in a competitive healthcare market, being used as an indicator of quality care as well as reimbursement incentives. Emergency Departments (ED) can have an important impact on patient satisfaction, as the ED can be the initial hospital contact for many patients. The problem identified for this project is the need for high patient satisfaction in the ED setting. Purpose: To determine the effectiveness of a telephone follow up call (TFC) on patient satisfaction. Methods: This study was conducted at two EDs within a multi-hospital, non-profit system. Sampled patients received a follow up call from a trained registered nurse within 72 hours of discharge, based on previously established hospital protocol. The sample inclusion criteria consisted of: (1) a patient in the ED of one of two study hospitals, (2) an adult over 19 years of age correlating with Nebraska state law, (3) English speaking, (4) access to a working telephone, and (5) verbal consent to participate in the study. Patients were asked to participate in a satisfaction survey following the initial follow-up call. Participants were asked 3 questions for the survey and demographically categorized by gender and age. Results: One hundred three patients were included in the study. Of these patients, 68.9% were female, 31.1% were male. Twenty-two point 3 percent of the patients contacted were between 19-29 years old, 19.4% of the patients were between 30-39 years old, 13.6% of the patients were between 40-49 years old, 15.5% of the patients were between 50-59 years old, 9.7% of the total patients were between 60-69 years old, 9.7% of the patients were between 70-79 years old, and 9.7% of the patients were over the age of 80.
    [Show full text]
  • Nursing Documentation in the Emergency Department: Nurses’ Perspectives
    Title Page NURSING DOCUMENTATION IN THE EMERGENCY DEPARTMENT: NURSES’ PERSPECTIVES by Paula Caroline Grainger A thesis submitted to Victoria University of Wellington, New Zealand in partial fulfilment of the requirements for the degree of Master of Nursing (Clinical) Victoria University of Wellington 2007 Grainger (2007) Nursing Documentation In The Emergency Department: Nurses’ Perspectives Abstract Nursing documentation is a required aspect of care, but for various reasons it can be curtailed. Nursing records are a critical aspect of communication and without them coordinated and safe care can be difficult to achieve. Study aim: To explore emergency nurses’ perspectives and practices about the quality, importance and value of emergency nursing documentation in relation to their personal beliefs, past experiences and preferred systems of documentation; the practical and contextual factors that influence documentation practices within an emergency department (ED); their interests in documentation tools or systems; and their interests in relation to further development of documentation practices and systems. Methodology and design: A qualitative descriptive study (informed by Sandelowski). Ten emergency nurses from one ED in New Zealand were recruited. Participants were interviewed using interactive interview methods, and completed a Likert scale to identify the relevance of internationally recognised general influences on documentation to their own practices in the context of an ED. Findings: The participants’ practices were influenced by factors in the workplace including competing priorities for time e.g. care provision vs. documentation, competition for access to patient records, and extant culture in relation the purpose, content and frameworks for documentation. Documentation practices were influenced by the participant’s own clinical histories, philosophies, familiarity with particular frameworks and education.
    [Show full text]
  • Ultrasound Guided Intravenous Access by Nursing Versus Resident Staff in a Community Based Teaching Hospital: a (Noninferiority) Trial
    Hindawi Publishing Corporation Emergency Medicine International Volume 2015, Article ID 563139, 4 pages http://dx.doi.org/10.1155/2015/563139 Clinical Study Ultrasound Guided Intravenous Access by Nursing versus Resident Staff in a Community Based Teaching Hospital: A (Noninferiority) Trial Thomas Carter,1 Chris Conrad,1 J. Link Wilson,1 and Godwin Dogbey2 1 Emergency Department, Southern Ohio Medical Center, Portsmouth, OH 45662, USA 2CORE Research Office, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, USA Correspondence should be addressed to Thomas Carter; [email protected] Received 28 May 2015; Revised 15 July 2015; Accepted 19 August 2015 Academic Editor: Wen-Jone Chen Copyright © 2015 Thomas Carter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs. Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years’ experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented.
    [Show full text]
  • N: Emergency Care
    N: Emergency Care College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 123 Major Competency Area: N Emergency Care Competency: N-1 Date: June 1, 2015 Emergency Nursing A Licensed Practical Nurse will: N-1-1 Demonstrate knowledge and ability to apply critical thinking and critical inquiry throughout the nursing process in emergency nursing. N-1-2 Demonstrate knowledge and ability to perform a comprehensive health assessment: cardiovascular endocrine eye, ear, nose and throat integumentary gastrointestinal medications neurological obstetrics/gynecology orthopedic pediatrics psychiatric renal/genitourinary respiratory sexual assault/domestic violence trauma N-1-3 Demonstrate knowledge and ability to perform nursing procedures and interventions in an emergency setting as defined by scope of practice and according to agency policy. N-1-4 Demonstrate knowledge and ability to obtain, assess and monitor diagnostic tests and lab values according to agency policy. N-1-5 Demonstrate knowledge and ability to communicate and collaborate with emergency care team. 124 College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. Competency: N-1 Page: 2 Emergency Nursing A Licensed Practical Nurse will: N-1-6 Demonstrate knowledge and ability to obtain additional education and certification in emergency assessment, intervention and care including: emergency assessment certifications o cardiac life support o emergency neonatal care o emergency nursing o emergency pediatric nursing
    [Show full text]