Medicine and Health Sciences Commons^™

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Pediatric Sepsis-Development Of A Clinical Pathway For The Pediatric Emergency Department, Roslyn Lampkin-Smiley

Student Scholarly Projects

Globally, various researchers have suggested that sepsis is one of the most prominent causes of infant fatalities. Since 2004, countless guidelines have been developed to assist in the early identification and management of sepsis. The PICOT question that guided this project was: Does the implementation of a pediatric sepsis clinical pathway, compared with the standard protocol in emergency departments, decrease delays in treatment times of patients presenting with sepsis? Researchers have suggested that early recognition and interventions for septic patients can result in decreased mortality rates. A pediatric sepsis clinical pathway was implemented during this project. The pathway alerted staff …

Measuring Serum Lactate In Sepsis, Ouafae Bouziane

Dissertations

Problem: Sepsis is the leading cause of hospitalized deaths in the United States and the leading cause of hospital readmissions. Each year, approximately 1.7 million Americans develop sepsis, and nearly 270,000 die due to sepsis. The purpose of this quality improvement project was to evaluate the acquisition time of initial and repeat lactate levels once a sepsis bundle was activated.

Methods: This quality improvement project used an observational, descriptive design utilizing a retrospective medical record review and the Plan-Do-Study-Act (PDSA) to evaluate code sepsis activations in a Midwestern, suburban, Level II trauma ED from November 1^st, 2020, through …

Impact Of Psychotropic Medications On Electrical Cardiac Conduction In The Emergency Department: A Best Practice Review, Juliann Hatt

Doctor of Nursing Practice Final Manuscripts

Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency …

Nurses' Perspectives On Pain Management In The Emergency Department, Elizabeth Fitzgerald

Seton Hall University Dissertations and Theses (ETDs)

Over 130 million people seek care in emergency departments (ED) in the United States annually. Most patients who seek treatment in emergency departments are experiencing a painful condition, and as such, ED nurses should have a deep understanding of pain management in the ED. There is limited qualitative research which explores pain management from the nurses’ perspective. The purpose of this study is to describe pain management from the nurse’s perspective. Thorne’s (2005) method of Interpretive Description guided this qualitative inquiry. New knowledge describing the nature of pain management in the ED provides insight into elements which support and impede …

Suicide Mortality Of Emergency Department Patients, Briony Marie Dubose Mhi, Rn, Lss, Bb

Dissertations

Purpose The purpose of this retrospective comparative study is to describe relationships among biological, psychological, sociocultural factors and emergency department (ED) care among discharged ED patients and describe the association of these variables with subsequent suicide mortality.

Rationale Identifying patients who are most at risk of suicide mortality post ED discharge can focus resources, refine interventions, and prevent suicide. Additionally, recognizing patterns of ED care including ordering of a psychiatric evaluation and disposition status can provide data for potential practice changes.

Background Suicide is the 10th leading cause of death in the United States and has been since 2008. Suicide …

The Evaluation Of The Brøset Violence Checklist (Bvc) And Interventions To Reduce Patient Violence Incidents Occurring In The Emergency Department, Grace D. Yoon, Dnp, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Patient violence in healthcare is an issue across many departments, but many staff members in the emergency department (ED) are directly affected by violent incidents.

Objectives: Three primary purposes determined the success of this Quality Improvement (QI) project: 1) to evaluate the effectiveness of utilizing the Brøset Violence Checklist (BVC) and implementing appropriate interventions to reduce the number of physical assault occurrences against healthcare providers in the ED; 2) to assess if there was an increase in reporting patient violence incidents; and 3) to assess for any improvements in perceived safety in the ED among the nurses.

Methods: Adult …

Health Care Initiative To Evaluate The Impact Of A Nurse Practitioner Led Community Wound Care Service On Emergency Department Utilization, Sherry Morrell

Electronic Thesis and Dissertation Repository

Nurse Practitioners (NP) diagnose and treat wounds and wound-related conditions based on their advanced scope of practice. An NP with graduate-level wound care education (NP(W)) gains additional knowledge and clinical experience to provide comprehensive wound care.

This research aimed to explore community patients’ access to wound care in Southwestern Ontario (Canada). A quality improvement project was initiated utilizing stakeholder feedback to develop and implement a 12-week pilot NP(W)-Led community-based wound care service; the NP(W) wound care practices, clinical outcomes, and adverse events were described. One hundred twelve participants attended the service over 117 visits. The NP(W) services included prescribing and …

Case Management Of Primary Care Patients, Bernadette Webster

Doctor of Nursing Practice Projects

Case management (CM) offered in primary care is a collaboration, guided by the registered nurse, working to coordinate all aspects of care for the patient and the family. The purpose of this quality improvement/assurance project was to provide nurses in primary care with the education and methods of CM to assist in more effectively managing care for a patient after testing positive for COVID-19. An intervention was delivered to registered nurses (RN) in the primary care setting designed to improve knowledge and skill with case management for patients with high care needs or recently diagnosed with COVID-19. A templated note …

Evaluation Of The Effectiveness Of Emergency Department Through-Put Based On Provider Type In A Critical Access Hospital, Deanna Faye Dingus Hamilton

DNP Projects

Abstract

Purpose: To evaluate effectiveness and timeliness of through-put in the emergency department based on provider type in a rural critical access hospital in eastern Kentucky.

Design: A retrospective, observational review was conducted at a small critical access hospital. Descriptive statistics including Mann Whitney and Chi square were performed to evaluate significance.

Methods: Pre-intervention 552 charts were abstracted and 1656 post-intervention charts were abstracted. Arrival time to triage, triage to provider and provider to disposition times in minutes were collected. A prospective survey regarding comfort level with performing advanced practice skills was given to the advanced providers who were working …

A Retrospective Analysis Of Integrative Group Medical Visits For Low-Income Patients With Anxiety Disorders In Primary Care, Annamma Udaya Thomas

Walden Dissertations and Doctoral Studies

High utilization of the emergency department (ED) by patients with anxiety symptoms has brought attention to mental health access disparities among low-income racially/ethnically diverse populations. The health system in this study attempted to increase access to mental health care with integrative group medical visits (IGMVs), a nonpharmacological intervention with biomedical care consultation, health education, and peer support. The purpose of this retrospective comparative analysis, guided by integrative health equity in primary care framework, was to determine whether patients with diagnoses of anxiety who attended four or more IGMVs had reduced nonemergent ED utilization, reduced prescribed doses of benzodiazepine (BZD), and …

A Clinical Practice Guideline: Hospice Care In The Emergency Room, Samer Saad

Walden Dissertations and Doctoral Studies

Hospice patients use the emergency department (ED) for the management of symptoms, making it necessary for ED nurses to be equipped with the knowledge and skills to care for hospice patients. EDs should have staff specially trained to address end-of-life needs due to ED staff’s minimal knowledge of treating and managing hospice patients. When healthcare organizations fail to provide clinical practice guidelines (CPG) and collaborate with significant stakeholders adequately, gaps in care delivery can occur, and hospice care is often not delivered safely. Standardized guidelines on end-of-life care in the ED should provide adequate guidance for ED nurses in bridging …

Pediatric Emergency Department Nurse’S Knowledge And Attitudes Of Pediatric Fluid Resuscitation, Tannah Kimberly O'Brien, Kerry Nolte Phd, Fnp-C, Denise Downey Msn, Rn-Bc, Cpen, Debra Lajoie Jd, Phd, Msn, Rn, Esq., Allison Ivers Msn, Rn, Cnl, Kathleen Sultan Bsn, Rn, Cpen

Honors Theses and Capstones

Background: Rapid fluid resuscitation is essential to the management of pediatric shock, but there are many barriers to published guideline adherence. Limited evidence describing emergency department (ED) nurse’s knowledge and attitudes of fluid resuscitation exists. This study described pediatric ED nurse’s knowledge and attitudes of fluid resuscitation.

Methods: This single-site descriptive study used survey methodology. A 23-question survey was distributed to nurses in the ED at Boston Children’s Hospital. The survey measured nurse’s knowledge, attitudes, and perceived barriers to fluid resuscitation.

Results: Findings suggested gaps found between actual and perceived knowledge consistent with prior evidence. There was a 50.9% response …