clinical poster summaries from the ena 2001 annual meeting

430 JOURNAL OF EMERGENCY NURSING 27:5 October 2001

C L I N I C A L A B S T R A C T S

There was a tremendous response this year to the call for the submission of“clinical posters.” The following posters were presented at the 2001 ENAAnnual Meeting in Orlando, Florida. The clinical posters selected reflect awide variety of topics of interest to clinicians and managers in emergencypractice. Topics ranged from competency validation and multidisciplinaryteams for pain and trauma care to innovative concepts such as communityconsortiums and ethical forums. Take the opportunity to contact the pri-mary author of these projects as a means to network and improve care inyour emergency department. Next year, consider submitting clinical projectsthat are being implemented in your emergency department. You can con-tact the Department of Research and Professional Services at ENA for moreinformation on guidelines for submission; phone: (800) 900-9659 ext.4119; E-mail: [email protected]; or visit our Web site at www.ena.org.—SueBarnason, PhD, RN, CEN, CCRN, Section Editor

1. ED Imaging and Culture Follow-up: An Innovative QualityImprovement Program Utilizing Nurse Practitioners. KristiVaughn, Anne Hedger, Dawn Rondeau. Oregon Health SciencesUniversity, UHN-52, Department of Emergency Medicine, 3181 SamJackson Park Rd, Portland, OR 97201.Clinical topic: Emergency care practitioners order numerous imag-ing studies and cultures to assist in the diagnosis of medical andtraumatic conditions. The final radiology reading and culturereports are seldom available prior to final diagnosis and disposition.Emergency departments must have a quality improvement (QI)mechanism for follow-up of final reports. This project describes theuse of ED nurse practitioners (NPs) to manage this program.

Implementation: Initially, this QI program consisted of an emer-gency medicine resident or faculty member who inconsistentlyreviewed positive cultures forwarded by the laboratory and alldiscordant radiographic findings by the staff radiologist. Withthe addition of NP faculty in 1997, a core group was available toregularly review these discordant cases. In the case of positive cul-tures, the NP reviews the chart to determine whether an appro-priate intervention was initiated during the initial ED evaluation.The NP completes the process by contacting the patient and thepatient’s primary care provider and initiating additional treat-ment as indicated.

Outcomes: During the past 3 years, the NPs have managed this QIprogram with the goal of following up on positive results within 24

Clinical Poster

Summaries from the ENA 2001

Annual Meeting

J Emerg Nurs 2001;27:430-6.

Copyright © 2001 by the Emergency Nurses Association.

0099-1767/2001 $35.00 +0 18/3/118491doi:10.1067/men.2001.118491

Section Editor: Susan Barnason, PhD, RN, CEN, CCRN

October 2001 27:5 JOURNAL OF EMERGENCY NURSING 431

CLINICAL ABSTRACTS

hours. Only 0.4% of the imaging studies had discordant readingsthat required a change in management. The majority of significantmissed studies were extremity films (65%), followed by chest films(17%) and spine films (11%). There was an average of 2 positiveculture studies per day, of which fewer than 1% required a changein treatment. This program has lead to more rapid and correctivemanagement of positive results.

Recommendations: As emergency departments become busier,patient follow-up tends not to occur in a timely manner. In this QIprogram, NPs have consistently kept primary care providers in thecommunication loop, improved collegiality with the radiologydepartment, and provided more timely patient contact. NP facultycan consistently manage and provide timely intervention for dis-cordant radiology readings and positive laboratory cultures.

2. Disaster, a Plan for Our Future. Darlene Bradley. UCI MedicalCenter University of California, Irvine, 101 The City Drive, Route 128,Orange, CA 92868.Clinical topic: Emergency departments commonly focus on anemergency preparedness plan that meets compliance criteria foraccreditation standards. This clinical project has a twofoldapproach. First, it is designed to ensure the rescue efforts and safetyof ED staff. Secondly, an integrated emergency response compo-nent is created to deal with the threat of weapons of mass destruc-tion (WMD).

Implementation: The project was implemented through the fol-lowing steps: (1) a process was outlined to simultaneously managevarious aspects of service, including the environment, communi-cation systems, patient care, staffing functions, equipment, andsupplies; (2) job aids were created to standardize and direct staffapproach into an organized Hospital Emergency IncidentCommand System; (3) protocols for WMD were organized intoan emergency response system; (4) a decontamination cart wascreated to include personal protective equipment, patient treat-ment aids, and practice guidelines; (5) the department-specificplan and the WMD protocols were integrated into the hospital-wide emergency preparedness plan; and (6) educational programscompleted the process.

Outcomes: The effectiveness of the project was demonstrated ina countywide mass casualty drill. A Sarin attack occurred in alarge entertainment center. The following benefits were observed:(1) an organized approach with job aids ensured the effectivenessof each role played; (2) in a crisis, staff were able to plan, managecare, and decontaminate appropriately based on the WMD pro-tocol designed; (3) antidote alternatives were retrievable forWMD; (4) coordinated community and state resources weremobilized to support the mass casualty incidence; and (5) a com-prehensive educational program assisted staff in appropriateemergency response and a detailed understanding of potentialthreats for WMD.

Recommendations: All health care institutions should prepare formass casualty incidents that may include threats of terrorism withWMD. Facilities should develop an in-depth approach to dealingwith terrorist acts. There is a great potential for devastation if the

medical care facility were to be contaminated or threatened withWMD. Research in this area is essential. Widespread education forstaff and the community may be beneficial in preventing panic andthe spread of injury or disease.

3. Retaining and Training Nurses’ Talent in the EmergencyDepartment in an Era of Nursing Shortage! The IncrementalTraineeship Program for Emergency Nurses. Megan Murphy,Diane Presley, Gail Robinson. Seton Medical Center, 1201 W 38thSt, Austin, TX 78749.Clinical topic: In response to the national shortage of nurses in allspecialties, the emergency department developed the IncrementalTraineeship Program. This program addressed the needs of newgraduates and inexperienced ED nurses through a highly structuredorientation program, interspersed with classroom and practicallearning. Our goal was to reduce vacancy rates and turnover andminimize training costs.

Implementation: The program was developed as a result of a com-mitment to consistently deliver quality patient care by staffing withtrained and certified emergency nurses. Presentations of thePrinciples and Practice of Emergency Nurses in the TreatmentTraining Manual was taken from Sheehy’s Emergency Nursing,Principles and Practice, fourth edition, published by the EmergencyNurses Association. Appointed RN preceptors ensured that clinicalexperiences paralleled classroom learning. The program coordina-tor, a senior emergency nurse in charge of the initiative, evaluatedand gave feedback to trainees weekly. Testing of students wasaccomplished with use of 2 texts: The CEN Review Manual andCritical Thinking in Medical-Surgical Setting: A Case Study Approach.The traineeship was completed over a 2-year period, allowing newgraduates to integrate learning by following the instruction insequenced sections of the treatment, acute, and triage areas. Uponcompletion of the program, novice nurses will have achieved train-ing and experience equivalent to the Certified Emergency Nurseand have knowledge and skills required to provide care to allpatients who come to the emergency department.

Outcomes: The pilot initially had 6 students, with a 50% attritionrate. One student did not pass boards and chose to leave, anotherbelieved the environment was too stressful, and one did not meetperformance requirements. All the trainees had a clear sense of theirperformance and personal development plans, which outlined edu-cational goals to meet core requirements. Staff nurses’ satisfactionincreased as a result of their involvement in this positive process thatreduced turnover, improved practice, and fostered professionaldevelopment in staff and trainees. The cost per student for 9months is approximately $26,520, which is budgeted into emer-gency services nonproductive time. The program is feasible and apositive alternative to continued use of traveler nurses, who do notprovide a stable or cost-effective unit.

Recommendations: It is recommended that emergency depart-ments establish recruitment/training programs to allow new nursesto precept into our specialty; improve systems and training, whichinvolves current staff to strengthen a quality program; and create along-term solution to the nursing shortage.


CLINICAL ABSTRACTS

4. Developing a Community Consortium for Emergency NursingEducation. Laura M. Criddle. Oregon Health Sciences University,3181 SW Sam Jackson Park Rd, Mail Code UHS-8Q, Portland, OR97201.Clinical topic: To educate inexperienced nurses, emergencydepartments throughout northern Oregon were individually pro-viding didactic programs of varying intensity and duration for newstaff members. To maximize resources, standardize learning, reducecosts, and provide more frequent class opportunities, educatorsfrom several institutions joined together to form the ENA PortlandArea Emergency Nursing Consortium.

Implementation: Managers, directors, and educators from morethan 20 area emergency departments were invited to attend aninformational session. The Oregon State Council of ENA offered toserve as the organizing body and be the corporate entity responsiblefor the Consortium. Memberships were offered for an initial feedetermined by facility size. Contracts were developed, a bankaccount was opened, job descriptions were written, and appoint-ments were made for the Chair, Schedule Coordinator, NotebookCoordinator, Day Coordinator, and Point Keeper. To stimulateinvolvement and minimize a cash outlay, a simple point system wasdeveloped. Members earned points by holding positions, lecturing,providing classrooms, attending meetings, and taking minutes.Points are then used to “purchase” future student placements. Thosewithout sufficient points, non-Consortium members, could use acash option. Once the membership and structure were defined, theeducational program itself was developed. The course consisted of 8days (2 days per week for 4 weeks) of didactic lecture coveringentry-level emergency nursing information. Lectures are providedon a volunteer basis by local content experts at locations rotatedamong the membership’s various facilities.

Outcomes: The Consortium currently has 11 members, which rep-resent 16 emergency departments. In its first year, the Consortiumoffered 3 full courses and provided 56 hours of basic emergencynursing education to more than 60 area nurses. Program evalua-tions have been generally positive. The group has continued tofunction cohesively and profitably and has recently expanded tooffer 1-day sexual assault and triage classes for experienced emer-gency nurses. Senior nursing students have also been invited toattend the basic course.

Recommendations: The formation of an educational consortiumcan dramatically improve access to quality emergency nursing edu-cation and simultaneously can set a community standard, reduceeducational costs, decrease the workload of individual educators,and enhance interfacility cooperation.

5. Staff-driven Cardiac Care: Revamping the Old, Creating theNew. Deborah D. Smith, Georgeanne Mullis, Kathy Finch. DukeUniversity Medical Center, 107 Mosswood Court, Chapel Hill, NC27516.Clinical topic: The goal of the Cardiac Committee was to get tothe “heart” of inconsistencies, delays, and decreased quality of careof patients with acute coronary syndrome (ACS) from triage to dis-charge or admission. Areas for improvement were identified

through QI data, multidisciplinary staff feedback, and observation.Despite “chest pain protocols” and acute care algorithms, nursingstaff were uncomfortable with the latest treatment strategies andresearch protocols.

Implementation: We implemented the following initiatives: (1)development of a cardiac triage assessment form; (2) developmentof an extended triage form to encompass all care of patientsthroughout their ED stay, including prompts to follow the protocoland capture quality improvement parameters by documentingenzymes, serial EKGs, drug therapies, and required assessments; (3)collaboration with cardiology researchers to support a researchnurse in the emergency department with a focus on patient studyenrollment and staff education; (4) design of an 8-hour CORECardiac Class with a didactic component to include an update onACS care, mock arrest scenarios, cardiac assessment, and documen-tation; (5) establishment of dialogue/work groups with ED and car-diology physicians to review cardiac issues and improve registerednurse/physician communication; and (6) the securing of a nursingresearch grant to develop a streamlined Acute Coronary SyndromeTriage Assessment Tool.

Outcomes: Our positive initiatives accomplished the following: (1)recruitment of newer staff to the cardiac committee; (2) better com-munication between cardiology and ED staff, with monthly reviewof cardiac issues; (3) decreased length of stay by early identificationof requests for cardiac care unit admissions, telemetry; (4) increasedstaff comfort levels in caring for ACS patients, particularly withresearch protocols and newer drug therapies; (5) improved time totreatment; (6) increased staff accountability and pride in caring forthese patients; (7) acquisition of valuable quality improvement datawith use of the new form; and (8) facilitation of protocol changesand quality care.

Recommendations: Recommendations from our committeeinclude: (1) staff-driven committee action to tackle issues andstreamline care; (2) critical, ongoing review by staff of your cur-rent system; (3) collaboration between cardiology and emergencydepartments with registered nurse/physician teams; (4) imple-mentation of nurse-driven initiatives; and (5) research to improveidentification and treatment of patients with ACS in the emer-gency department.

6. A Competency Validation Method to Assess Technical,Critical Thinking and Interpersonal Domains. Jessie M.Moore, Kathleen M. Barta. MidState Medical Center, 435 LewisAve, Meriden, CT 06451.Clinical topic: The intent of this clinical project was to develop adynamic method of ongoing competency validation for staff in theemergency department that encompassed the clinical/technical,critical thinking, and interpersonal domains.

Implementation: Planning and implementation included the fol-lowing steps: (1) selection of the registered nurse (RN) role for ini-tial implementation; (2) multilevel emergency staff (staff RN, qual-ity improvement RN, clinical nurse specialist, nurse managers,nurse educator, nursing director, and medical director) identifica-tion of all competencies related to policy or procedure changes, new


CLINICAL ABSTRACTS

policies/procedures, high-risk areas, and problematic areas; (3) pri-oritization of the list and incorporation of institution and depart-ment goals; (4) development of objective criteria to measure eachcompetency; (5) selection of appropriate methodologies; and (6)development of staff accountability for completion of competencyassessment tools. The large list of competencies was then prioritizedby group consensus, with any issue that appeared in more than onecategory (high risk–low volume, problematic, new procedure)weighted more heavily. The group also agreed to focus on a maxi-mum of 10 competencies per year. The first year’s set were: pediatricresuscitation, cardiac electrical therapy, medication administration,patient triage, skin assessment, customer service, care of the patientwith chest pain, care of the patient who has been sexually assaulted,teamwork, and documentation. Methodologies included case stud-ies, skill demonstration, chart audits, direct observation, self-audits,peer review, and submission of exemplars. Education was presentedto all staff regarding the new process, and each staff member wasgiven the responsibility for completing their assessment tool by thetarget date.

Outcomes: The effects that the new process had on the departmentincluded: (1) objective measurement of staff ability to performcompetencies; (2) increased staff awareness of specific departmentgoals and problem areas; (3) increased staff satisfaction and confi-dence in their ability to meet patient standards; and (4) use of somemethodologies adopted by other hospital areas. The competenciesinvolving technical and critical thinking skills were readily achievedand completed; however, assessing competency in the areas of inter-personal skills was less easily achieved and demonstrated by manystaff members.

Recommendations: Recommendations for this project include thefollowing: (1) more gradual implementation of methodologychanges over a period of time; (2) reassessment of competency listand modification on an annual basis; (3) continued education andcoaching for competencies that were problematic for staff, such asdemonstration of customer service and teamwork; and (4) expan-sion of the process to include other levels of department staff.

7. Development of an ED Patient Follow-up Care Process. LeasaMcGill, Bruce A. MacLeod, Gail Pupo, Susan Rolniak. MercyHospital of Pittsburgh, 1400 Locust St, Pittsburgh, PA 15219.Clinical topic: The purpose of this process is to facilitate mecha-nisms that ensure optimal, safe, and reliable follow-up care afterpatient discharge from the emergency department.

Implementation: This process has been progressively developedduring the past 10 years. First, an experienced emergency nurse (1full-time equivalent) was dedicated to develop and implement a fol-low-up care program for discharged ED patients. In addition to theresponsibilities of patient follow-up care, this nurse assists with datacollection, trending, and reporting of patient concerns brought tothe emergency department by patients, families, and other depart-ments. Following a literature search, a model was identified that wasthen further modified and enhanced to meet the needs of our levelI trauma center (43,000 annual census). Our needs included fol-low-up of laboratory results that were pending upon patient dis-charge, unexpected final radiology readings, patients discharged

with high-risk complaints, reinforcement of discharge instructions,and assistance in scheduling follow-up appointments or schedulingtests. An ED patient follow-up care documentation tool was devel-oped and further modified and became a permanent part of themedical record. Collaboration with laboratory medicine, radiology,and risk management departments resulted in identification ofpatients who required follow-up and improved communication(including mechanisms) between departments. A patient medicalrecord “fax back” program was recently developed and implement-ed to meet the needs of the primary care physician for more timelyinformation about patient’s ED visit and instructions.

Outcomes: By defining a comprehensive process for ED patientfollow-up care, which includes all of the Department of EmergencyMedicine staff, a patient is certain to have follow-up care 365 daysa year. The effects of this program have decreased medical risks forpatients and legal risks for the hospital by defining a process thatensures that all reports of tests/x-rays that are not completed untilafter the patient is discharged are reviewed to assess any change intreatment. It has provided a safety net for physician and nursingstaff regarding high-risk or complicated patients or for patients whomay require assistance after discharge. The program has provided anopportunity for patients to receive assistance following dischargeinstructions and to make appointments for tests and doctor visits.Patients are appreciative of a follow-up call from the Department ofEmergency Medicine staff.

Recommendations: We hope to expand the population of patientswe routinely call back and continue to evaluate this program toobtain feedback from patients and physicians via formal writtensurvey to determine the benefits.

8. ED Pain Management Improvement Process. ArleneWatrobski, Mary Sitterding, Kim Swindell, Judy Maupin. ColumbusRegional Hospital, 2400 E 17th St, Columbus, IN 47201.Clinical topic: Recognizing pain as a major, largely controllablehealth problem of the ED patient, a decision was made to imple-ment an interdisciplinary pain management improvement process.This decision was greatly influenced by an impending JointCommission on Accreditation of Healthcare Organizations(JCAHO) review and the evaluation of current practice.

Implementation: An interdisciplinary, hospital-wide task force wasformed to evaluate and make recommendations for improvedpatient pain assessment and management. Considering evidence-based information and planning and implementing the EDimprovement process included the following steps: (1) review ofpain philosophy, Patients’ Rights Statement, and ED Standards ofCare on Pain Management; (2) survey of ED nursing knowledgeand attitudes regarding pain; (3) audit of ED records to evaluatecurrent practice; (4) review of current assessment/reassessment pol-icy for ED population in pain; and finally, (5) develop ED-specificstrategies based on recommendations from JCAHO and theAmerican Pain Society.

Outcomes: Implementation and ongoing evaluation of theimprovement process has resulted in: (1) improved evidence of asubjective pain assessment on initial triage; (2) decrease in time


CLINICAL ABSTRACTS

between patient presentation and time of pain management inter-vention; (3) improved evidence of pain management interventionbased on hospital standards; (4) improved evidence of reassessmentwithin 30 to 60 minutes; and finally, (5) increased documentationof pain management education provided on discharge.

Recommendations: To meet new standards, a formal institutionalinterdisciplinary approach to pain management is needed. A site-specific and collaborative approach to pain control is needed in theED setting to include nursing, physician, pharmacy, EMS, andancillary staff. Education on pharmacologic and nonpharmacolog-ic agents cannot be overemphasized for staff, patients, and families.Patients need information about how to describe an accurate painhistory to assist in the subjective assessment. Objective and subjec-tive assessments must include common language throughout theorganization, recognizing the patients’ right to pain management,and respecting personal, cultural, spiritual, and/or ethnic choices oftreatment and management options. Finally, patients and familiesneed discharge instruction, addressing their role in effective painmanagement strategies in the out-of-hospital setting.

9. Ethical Forums Have a Place in the Emergency Department.Susan L. Warchal, MaryJo Cappuccilli, June Guarente.Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129.Clinical topic: The purpose of this clinical project was to imple-ment a process that allows ethical principles and values to be dis-cussed in a free-flowing manner while also providing support to thecaregivers.

Implementation: The process included several steps in the devel-opment and institution of a unit-based ethics group:

1. Development of a proposal2. Nurse Manager approval3. Invitation of key people to assist in the educational plan4. Development of membership plan5. Initiation of Ethics Committee monthly meetings6. Evaluation of the process7. Incorporation of changes to promote participation

Outcomes: Initial meetings covered ethical issues specific to apatient case. It was important that all caregivers participating in thecase have a chance to voice their concerns and ideas. This was notalways possible because of rotations and staffing patterns. As aresult, the topic style was preferred because ethical issues could bediscussed to benefit the larger ED community.

1. Monthly ethical forums are held on specific topics. One exam-ple is ethical issues related to care of the vulnerable patient.This population included the elderly, children, the homeless,and victims of domestic violence.

2. Clinical issues that are identified are referred to other ED com-mittees for action. For example, when resources for the care ofhomeless patients were identified as lacking, the EDCollaborative Practice Committee was accessed and initiatedcommunication with HealthCare for the Homeless, a com-munity resource for the City of Boston.

3. Staff knowledge and comfort in discussing ethical issues specif-ic to the emergency department have increased.

4. Staff morale has improved because there is greater respect fordiscussion among all disciplines, which has a positive impacton patient care.

5. The ED Ethics Forum is an integral part of the entire hospitalcommunity. The chair is a member of the MassachusettsGeneral Hospital Ethics in Clinical Practice Committee as wellas a member of the Pediatric Bioethics Committee. Recently,members have begun to participate in the development of acentralized ethics department.

Recommendations: Establishing a unit-based ethics forum is rec-ommended, because there are many issues specific to ED practice.The forum fosters professional growth, communication, and sup-port in a highly acute and stressful environment. Evaluation of staffconcerns and needs should be ongoing. Research to measure staffsatisfaction and patient outcomes should also be a goal.

10. Patient-focused Care in a Busy Emergency Department.Sandra Bauman, Susan Butler, Michael Whalen, Charles Barbera.The Reading Hospital and Medical Center, Emergency Care Unit, POBox 16052, Reading, PA 19612.Clinical topic: Because of an increasing patient volume (70,000visits annually) and a decrease in both professional and technicalstaff, our community emergency care unit needed to look for amore efficient way to deliver patient care.

Implementation: Our emergency department comprises severalhalls, each with private patient rooms of varying sizes. For years theprocess of assigning patients has been random. As our patient vol-ume increased, it became routine to care for patients in every sectorof the unit. This practice limited continuity of care and increasedthe workload and physical strain for the staff. We needed to inves-tigate a more efficient work design. Initially, a staffing committeeresearched various patient care delivery systems and determined thatthe Patient Focused Care (PFC) model would improve outcomes inthe emergency care unit setting. With the implementation of PFC,our unit was divided into 4 decentralized sections staffed with mul-tiskilled personnel (registered nurses, licensed practical nurses,medics, and patient care assistants). Education for the staff beganwith a discussion of the concept of PFC and its positive benefits.Following these classes, posters were hung on the unit indicating thepods and procedures for communication and patient flow. The useof this system was piloted on the day shift. At the end of the trialperiod, the needs and design of the unit dictated a modification ofthe original system into 2 larger pods with an enhanced use of staff.Evaluations focused on the improvement of patient care and satis-faction for staff. Data obtained by both personal interviews and sur-veys were noted throughout the trial period.

Outcomes: The preliminary effects that the PFC system has had onour department include the following: (1) increased teamworkbetween multiskilled personnel, (2) less physical strain on staff thanin our prior system, (3) improved continuity and accountability forpatient care, (4) improved customer satisfaction, and (5) improvedjob satisfaction for staff. The success of the pilot PFC project for theday shift has made the staff of the other shifts excited for full imple-mentation of this system.


CLINICAL ABSTRACTS

Recommendations: Implementation of PFC in a high-volumeemergency department maximizes efficiency of resources. Throughprioritization and delegation, this system enables the staff to enhancetheir decision-making abilities and subsequently, their accountabili-ty. The overall effect can be very positive for both the staff andpatient and can readily be adapted to many types of units.

11. Development and Implementation of a MultidisciplinaryTrauma Care Committee. Tracy Evans. Norwalk Hospital, 34Maple St, Norwalk, CT 06856.Clinical topic: The intent of this clinical project was to unite nurs-es and allied health professionals caring for trauma patients alongthe continuum from injury to rehabilitation and improve theprocess of delivering care in the institution. It became apparent thatsmall issues, caused mainly by poor communication channelsbetween clinical units providing direct patient care, were hamperingcare and hindering the nurses and allied health care professionalsfrom delivering seamless care to patients.

Implementation: Planning and implementation included the fol-lowing steps: (1) developing a proposal for a MultidisciplinaryTrauma Care Committee; (2) obtaining administrative approvalfrom the managers for each of the subspecialties; (3) selecting teammembers; (4) educating the team members and other hospital pro-fessionals about the goals of the team; (5) developing an agenda; (6)motivating the troops; and (7) putting our findings into action.

Outcomes: Recommendations from this Committee have resultedin: (1) improved patient compliance with wearing cervical immobi-lization devices by finding a long-term collar that is comfortable,dries quickly, and has improved support; (2) addition of sternalintraosseous devices onto the hospital-based paramedic-level ambu-lances and the in-hospital trauma resuscitation carts; (3) quickerphysician clearance of c-spine immobilized patients, resulting inimproved patient satisfaction and reduction in long board–inducedmusculoskeletal pain; (4) purchase of a slide-based fall preventionprogram; and (5) ongoing development of a Critical Incident StressDebriefing team.

Our findings are evidence-based and trialed by the group andare presented to the physicians and administrators responsible forthe area. We have been well-regarded and respected by all levels ofpatient care providers and have met with very little resistance.

Recommendations: Development and implementation of aMultidisciplinary Trauma Care Committee can unite nurses andallied health professionals caring for trauma patients with improvedcommunication and patient care.

12. The DOG BITES Program. Lisa Marie Bernardo, Mary JaneGardner, Joan B. O’Dair, Beth Cohen, Joseph Lucke, Raymond Pitetti.University of Pittsburgh School of Nursing, 415 Victoria Building,Pittsburgh, PA 15261.Clinical topic: The goals of our interdisciplinary project,Documentation Of Growls and Bites In The Emergency Setting(DOG BITES) Program, were to: (1) provide ongoing education toED staff at Children’s Hospital of Pittsburgh (CHP) for document-ing and reporting child, dog, and environment data in dog

bite–related injuries, and (2) evaluate the effectiveness of this ongo-ing education on ED record documentation and mandated healthdepartment reporting through active surveillance from Januarythrough December, 2000. Our previous research at CHP found alack of documenting dog bite data and an underreporting of dogbites to the county health department. Our objectives were as fol-lows: (1) compared with 1999, there would be a 50% increase inour compliance with documenting child, dog, and environmentdata on our ED records, and (2) compared with 1999, there wouldbe a 50% increase in the number of ED patients reported to thecounty health department for dog bites. We chose 50% as a rea-sonable target for improvement.

Implementation: A 30-minute orientation was provided to EDstaff in January 2000 that focused on results of our previousresearch and the program purpose, methods, and outcomes.Study team members retrospectively abstracted child, dog, andenvironment data from ED records (n = 175) for 1999. The samedata were prospectively abstracted from ED records in 2000 (n =211). Data were compared monthly between years and withinyears. Dog bites reported to the county health department werematched with ED patient records. Bimonthly reports were sharedwith the ED staff, illustrating compliance with documentationand reporting between years and within years. Data were ana-lyzed using descriptive statistics.

Outcomes: From 1999 to 2000, an overall improvement in EDdocumentation was found, with calculated compliance percentagesranging from 3% to 32%. A 14% increase was found in reportingdog bites to the local health department. ED staff reported satisfac-tion with the program’s variety of education methods.

Recommendations: Active surveillance is an appropriate methodfor comparing trends in documenting dog bite–related data on EDrecords and reporting these patients to the health department. Theimprovement in ED documentation was below the targeted objec-tive and may have required alternative education strategies orchanges in the ED patient record. The improvement in healthdepartment reporting was small, and methods to improve compli-ance are being explored. The DOG BITES Program methods canbe used to improve documenting and reporting dog bites or otherpatient conditions.

13. “Don’t Let a Fall Get You Down”: Developing a Program toReduce Patient Falls in the Emergency Department. MargaretBarry, Raffaela Pia, Germaine Nelson, Laura Giles, Tara Cortes. NewYork Presbyterian Hospital, Columbia-Presbyterian Center, 622 W168th, New York, NY 10032.Clinical topic: The purpose of this project was to implement a fallprevention program in the ED setting. The specific aims of the pro-ject were: (1) identification of patients at risk for falling in an EDsetting and (2) prevention of patient falls. Two large academic cen-ters identified an increase in patient falls resulting in serious injuries(hip fractures). Reasons for the increase were thought to be a rise inthe number of elderly patients seeking emergency care and longerstays in the emergency department. Patient falls were tracked over a6-month period and a Fall Prevention Program was established. The


CLINICAL ABSTRACTS

Fall Prevention Program included identifying patients at risk forfalling, developing strategies to prevent falls, educating all levels ofstaff, and developing a tool to track patient falls.

Implementation: The following steps were implemented:

1. Two academic urban medical centers with more than 80,000annual visits developed a tool to track patient falls for a 6-monthperiod.

2. Current literature was researched to identify common reasonsfor patient falls.

3. A Fall Prevention Program was initiated with interventions spe-cific to an ED setting.

4. A tool was developed so the staff could easily identify patients atrisk for falling: those who were elderly, intoxicated, confused, orwho had an unsteady gait.

5. All levels of staff were educated about the Fall PreventionProgram. The focus of the program was to identify the patientsat risk for falling and implement strategies to prevent falls.

Outcomes: Initial data indicated that 50% of patient falls wereamong elderly patients. In addition, another subset of patients alsowere identified as being at high risk for falling. Overall, a 20%reduction in patient falls occurred after the implementation of theFall Prevention Program.

Recommendations: Other emergency departments could benefitfrom the development of a Fall Prevention Program to targetpatients at high risk for falls, which includes specific strategies toreduce patient falls and a methodology to track occurrence ofpatient falls. Ongoing education needs to be implemented to sus-tain and continue to improve fall risk and reduction of actualpatient falls.

clinical poster summaries from the ena 2001 annual meeting

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