Emergency Medicine Commons^™

Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Taste & Smell), Marietta Sperry, Kimberly Kohlieber

2021 Providence Nurse Research Conference

Background: Anosmia, or the loss of taste and smell, is an important symptom for nurses to screen for among patients, as this can result in a poor appetite which impairs healing. In the early stages of the COVID19 pandemic, anosmia was not a known symptom indicative of infection with the virus. Yet, one Registered Nurse who was working in an Emergency Room received a positive COVID test following a workplace exposure to the virus while wearing personal protective equipment, and began to complain of anosmia shortly thereafter. Because the anosmia persisted, his spouse conducted blind taste test on him …

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

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 …

Improving Patient Experience And Staff Workflow During Ed To Inpatient Interfacility Transfers, Jonathan Nakagawa

Master's Projects and Capstones

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project …

Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly

Posters

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.


Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.


Design/Methods: We built a …

Simulation Based Clinical Systems Testing In The Pediatric Emergency Department To Prepare For Covid-19 Pandemic, Christopher S. Kennedy, Marc Sycip, Lisa Ell, Shautonja Woods

Posters

Background: The COVID-19 prompted pediatric emergency departments (PED) to prepare for a surge in patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done. In situ simulations could identify gaps and help to mitigate errors. Simulation-based clinical systems tests (SbCSTs) can detect latent safety threats (LSTs) in systems design.


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test hospital system modifications for ED preparation. This method represenst a new application of SbCSTs. The research questions were in 2 frames: 1. Can rapidly deployed SbCSTs identify LSTs and recommendations for …

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins

Student Scholarly Projects

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies.

PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation?

Evidence: …

Barriers To Healthy Births At Nigerian Hospitals, Caroline Johnston

Senior Theses

Maternal mortality is a problem everywhere, but it is especially dangerous in Nigeria where the average woman experiences pregnancy six times during her lifetime (Population Reference Bureau, 2001). Many researchers focus on the medical complications associated with labor, such as hemorrhage, eclampsia, or infection. Although these birth complications are the direct sources of maternal death, it is also important to recognize how maternal mortality is a multifaceted issue influenced by local cultural groups, religions, politics, poverty level and the absence of basic infrastructures. Although maternal mortality is interconnected with social and geographical elements, my paper concentrates on Nigerian hospitals and …

Knowledge About Continuous Positive Airway Pressure Machine Usage Among Nurses At A Tertiary Hospital In Tanzania, Wilson Paulo Lomnyack, Tumbwene Mwansisya, Stewart Mbelwa, Kahabi Isangula, Zephania Saitabau Abraham

School of Nursing & Midwifery, East Africa

Introduction: Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP.

Method: A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented …

Statins And Women, Debra Schulte

Rural Health Professions Projects

Low-density lipoprotein (LDL) elevation is a primary risk factor for atherosclerotic cardiovascular problems such as heart disease and stroke. Heart disease is the leading cause of death in the United States and stroke is the fifth leading. Earlier LDL reduction improves morbidity and mortality. Literature indicates fewer women start statin medications compared to men.

Effect Of Emergency Severity Index (Esi) Annual Competency Assessment On Mistriage Rates, Stefanie Hoffman

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: In order to accurately assign an Emergency Severity Index (ESI) acuity level to patients who present to the emergency department (ED) triage area, it is essential triage nurses remain competent in the ESI triage tool. In addition, effective use of the ESI triage tool is critical in preventing patients from being mistriaged.
Objective: The purpose of this quality improvement project was to determine the effect of an ESI annual competency assessment in an ED for triage trained registered nurses (RNs).
Methods: Triage trained RNs completed an ESI competency assessment composed of 25 patient scenarios in competency assessment A, and …

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …

Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir

School of Nursing & Midwifery

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …

Nurse-Initiated Protocols For Chest Pain In The Emergency Department, Matthew Hodges

Student Scholarly Projects

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes.

PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks?

Evidence: The reviewed literature supported the evidence of …

Family Presence During Resuscitation, Brittany Whistle

Scholars Week

Background:

Families want more involvement in their loved one’s care than they did just twenty years ago. Especially, in the matter of resuscitation efforts, this involvement remains controversial.

Evidence and Findings:

Based on research, theories, and multiple educated opinions, family presence during resuscitation (FPDR) needs to be implemented in hospitals. Theories by Kolcaba and Helvie demonstrate a need for comfort and positive energy around patients to enhance the healing process. Evidence has shown multiple benefits of FPDR. The patient receives a holistic approach of care, the family gains closure and feeling of participation of care, and provides a plan for …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

All Nursing Boot Camp Posters

Background:

Infection, related to febrile neutropenia, in patients receiving chemotherapy for cancer remains a common complication and is a medical emergency. Fever is often the only sign of severe underlying infection in neutropenic patients due to the patient’s immunosuppressed state (Butts, et.al, 2017). Vigilant nursing assessment and immediate medical attention for neutropenic fever (NF) is imperative because the rate of major organ complication and mortality is as high as 30% and 11% respectively (Freifield et.al, 2011 & Taplitz et.al, 2018). In the setting of severe sepsis or septic shock the mortality rate may be as high as 50% (Taplitz et.al, …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

Books, Presentations, Posters, Etc.

No abstract provided.

C. Blind Taste Testing: A Case Study Of An Emergency Room Rn With Covid-19 Anosmia & Hypogeusia (Loss Of Smell & Taste), Marietta Sperry, Kimberly Kohlieber

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

Decreasing Inappropriate Usage Of The Emergency Department (Creating Alliances To Deliver Population Health To Seasonal Workforce), Olivia Foster, Lynley Steele-Miller

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No abstract provided.

Moral Distress To Moral Courage, A Pathway To Success For Resident Nurses, Melinda Furrer

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No abstract provided.

Creating An Effective Poster: Research Versus Evidenced-Based Practice Projects, The Ena Institute For Emergency Nursing Research Advisory Council

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Purpose Provide information regarding the: Advantages/disadvantages of a poster presentation, Differences between a research and evidence-based poster, and Key elements of a research and evidenced-based poster. Advantages of a Poster Presentation Allows the emergency nurse to communicate innovative and useful information to peers on a one-to-one basis. ENA conference poster sessions are scheduled over several days so that posters are available for previewing and then interested persons can prepare questions and meet the presenter later Allows the audience to view the poster at their own pace. Presented as “stand alone” or with narrative from presenter who remains with the poster. …

Trauma Pause, Melissa Leighty, Carol Reed, Lance Somerfield, Dawn Rohrbach

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No abstract provided.

Improving Ed Sepsis Bundle Compliance, Jen Selby

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No abstract provided.

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

A Protocol Driven Stroke Code's Impact On Door-To-Needle Times, Jesse Osborne

Electronic Theses and Dissertations

Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke …

Solving The Sepsis Puzzle: Every Minute Counts, Jamie Roney, Amber Cline

Articles, Abstracts, and Reports

SPEMS Pre-Conference Course Sepsis Class

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Surviving Sepsis: A Treatment Process Improvement In High Volume Emergency Departments, Brittney Burns

Doctor of Nursing Practice

Sepsis is the 3rd leading cause of death in the United States, accounting for approximately 270,000 deaths annually (CDC, 2017). It is the number one cause of death in hospitals, the number one cause of hospital readmissions, and the costliest diagnosis in the hospital setting (Fingar & Washington, 2015; Torio & Andrews, 2015). This quality improvement project aimed to increase the percentage of antibiotics administered within 1 hour for sepsis patients. Mortality rates significantly decrease when this goal is met (Howell & Davis, 2017). There is an 8% increase in mortality risks with every hour that passes with elevated lactic …