Trust Me...I'm a Trauma Nurse
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Session J presented Saturday, September 16, 2017
Purpose: There is a large number of staff in the Emergency Department, high turnover rates, many different areas of focus which lead to inconsistencies in the care and documentation of care for trauma patients. The goal was to develop a small group of specially trained Emergency Department nurses to care for trauma patients and initiate the quality improvement process at the bedside.
Design: Course content was researched, developed and approved by both the trauma service and the emergency department. The content was based on evidence-based practice found in current literature, including American College of Surgeons requirements and hospital policy. Highlights of the lectures included: standardization of trauma care, trauma activation criteria, damage control resuscitation, documentation, quality improvement, and communication. In addition, a bedside trauma quality form was developed and utilized to begin quality improvement at the bedside.
Setting: The setting was a 408 bed metropolitan Level 1 trauma center. We admit over 2200 trauma patients per year. The Emergency Department has 85 staff nurses and 128 total staff. The ED has 41 beds and 3 trauma bays.
Participants/Subjects: The participants were thirty Emergency Department nurses who work across all shifts interested in being dedicated to trauma care.
Methods: We created and implemented a SMART goal to track and achieve our outcomes. Chart review was used for documentation compliance. The bedside trauma quality form was also used to collect data for compliance.
Results/Outcomes: There have been dramatic improvements in trauma care since beginning the trauma nurse program. The standardization of care with the use of PPE and lead aprons has improved from 0% in August 2016 to above 90% compliance in December 2016. Charting compliance has improved. Specific documentation measures with improvements are: prehospital c-spine care from 91.1% to 97.7%, location of event from 95.8% to 97.7%, 1st set of vital signs from 94.2% to 97.7%, primary assessment from 94.2% to 100%, time to CT 90% to 100%, nursing notes from 96.3% to 100%, c-spine clearance from 85.2% to 92.9%. The team developed and implemented a new trauma flowsheet to improve the capture of required data elements. Feedback from the trauma surgeons has been that there is greater consistency with care, increasing their comfort level with the nursing staff. There has been an overall decrease in the turnover rate for ED staff as a whole from 14.8% to 6% and the turnover rate for the core trauma nurse team has been 0% since its inception. Nurses on the team have initiated projects to improve care and flow for trauma patients.
Implications: Developing a core trauma nurse program has created a specialized group of nurses who are invested in providing high quality care for every trauma patient, every time. There has been increased compliance with charting, which ensures accurate data collection. Future plans include additional classes for nurses, development of a trauma specialty for ED techs. The team will continue bimonthly meetings with education provided by the trauma surgeons and residents.