Canadian Journal of Emergency Nursing (CJEN)
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Transport determinants for continuing care residents assessed by an EMS urgent response team: A retrospective observational study
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Emergency Department Nurses Attitudes Toward Barcode Medication Administration
No full textAbstract
Background: Barcode medication administration (BCMA) has been widely implemented in the inpatient setting of hospitals throughout the United States, resulting in lower medication administration errors. Understanding nurses’ attitudes toward BCMA in the Emergency Department (ED) may assist administrators with creating implementation strategies that will improve medication administration process turnaround time and remove barriers to use ensuring increased compliance and improved patient safety.
Methods: The aim of this descriptive research study was to identify Emergency Department nurses’ attitudes towards acceptance of this technology, based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Data collection was carried out using an online, cross-sectional survey of nurses (n=55) who were members of the National Emergency Nurses Association of Canada.
Results: The results demonstrated that two-thirds of those surveyed had approximately one year of experience with using BCMA technology. More positive attitudes were found in the following domains: behavioral intent, anxiety, and self-efficacy. Neutral attitudes were perceived regarding facilitating conditions, social influence, and effort expectancy. The most negative attitudes were expressed regarding attitude toward technology and performance expectancy.
Conclusions: The results of this study allow us to conclude that the ED nurse perceived BCMA as easy to master and use and not intimidating or anxiety producing; however, they do not perceive it as useful nor do they perceive it to improve their proficiency or productivity. It is recommended that future studies be conducted on larger samples and also on participants that have had more experience using this technology.
Keywords: Barcode Medication Administration, Emergency Department, Medication Administration, Attitudes.
 
Research Review: Emergency nurses’ knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study.
No full textThis article is a research review of the study: Harley, A., Johnston, A., Denny, K., Keijzers, G., Crilly, J., & Massey, D. (2019). Emergency nurses’ knowledge and understanding of their role in recognizing and responding to patients with sepsis: A qualitative study. International Emergency Nursing, 43, 106–112. https://doi.org/10.1016/j.ienj.2019.01.00
Translating clinical experience into action: Developing an educational protocol to improve intimate partner violence screening by Emergency Department nurses
Get PDFThis article provides the reader with a thoughtful example of an emergency nurse-led intervention to improve emergency department patient screening for domestic violence. Background information is provided along with the development of educational tools. Example ID badge cards and posters are also provided. Finally, helpful takeaways fare provided to aid in the implementation of similar projects in other emergency departments. 
Ultrasound guidance for pediatric vein cannulation: an emergency nurse quality improvement initiative and registry
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Between 10 and 25 percent of pediatric patients present to the emergency department (ED) with difficult to cannulate veins. Recent RCT evidence suggests that in pediatric patients assessed at being a predicted difficult IV start (by DIVA score of 3 or more), ultrasound guided catheter placement decreased the number of IV attempts, decreased time to successful IV placement, and improved first pass success, patient satisfaction, and catheter dwell time. Our QI project examines the specific learnings around ultrasound guided peripheral IV in pediatric patients and suggests opportunity for non-pediatric specialist hospitals to consider with the overall aim of minimizing IV attempts on all pediatric patients within our EDs.
Building on a RCT led by Dr Curtis in pediatrics patients conducted at the Stollery from 2012-2014, a standardized ultrasound guided nurse performed procedure was implemented in 2016 at the University of Alberta and Stollery EDs, and expanded to the Royal Alexandra ED in 2017 and the Misericordia ED in 2019. Using the same education package and QI study methodology as previously reported in adult patients this study focused specifically on pediatric patients.
Methods
A quality improvement (QI) registry was utilized to track complications and success of pediatric patients at all sites. The aim was to assess for program success, and improve education, training, and procedural success as required. Staff who had achieved independent practice voluntarily completed a tracking form whenever an ultrasound procedure occurred. Completed forms were assessed on a continual basis for any opportunities for improvement. Qualitative feedback was also obtained from informal interviews, a focus group, and a survey of the trained nurses. Feedback was thematically analyzed and grouped into themes for reporting.
Results
There were no reported pediatric UGIV placed at the MCH and RAH during the study period. At the Stollery 126 cases were reported. Immediate insertion complications were noted in three cases as ‘pain or swelling at site’, and ‘unable to advance catheter’. In the first and second years of data collection the average number of traditional IV attempts prior to UGIV attempt decreased from 3.9 to 2.8; first ultrasound pass success increased from 65% to 86%; overall ultrasound success improved from 85% to 97.6% respectively. Increasing nurse skill was significant with a linear increase of first pass and overall success seen with increasing number of ultrasound starts: From 6-20 starts (54% first pass 64% overall success) through to >150 starts (97% first pass and 100% overall). QI staff feedback included ensure adequate pediatric specific supplies such as longer length small gauge catheters, and a procedural focus of patient, provider, and assistant set up. Location of IV placement was noted to change in a number of cases from hand and A/C to forearm.
Advice and Lessons Learned
The key for staff to transition to procedural competance was to ensure initial and ongoing oportunities to place many ultrasound guided IVs (i.e. when time allows in all patients with non-optimal IV placement locations or with non-easy predicted tradititional IV starts)
Further work is required at non specilaist hospitals with trained staff to increase ultrasound guided use in pedatric patients
At all particapting sites work continues on unit level QI to minimize the number of IV attempts on all pedatric patients as well as work towards a cohort of available staff that are comforable and competent with ultrasound that can provide 24/7 unit coverage. (with limited numbers of trained staff there is increase burden on these staff to assist others while also completing their own nursing assignment
RADAR: A rapid detection tool for signs of delirium (6th vital sign) in emergency departments
Get PDFMixed methods analysis of an automated email audit and feedback intervention for fostering (emergency) physician reflection
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physician refelection requires personalized, timely and growth-oriented feedback. Iterative learning from multiple low-pressure events can be personalized to target areas of weakness and show sequential growth. Since emergency physicians typically work individually to deliver episodic care, opportunities for them to obtain iterative feedback on their clinical performace is often limited. Our study sought to evaluate whether physician reflection is facilitated through the 72hr re-admission alert received by emergency physicians in the Calgary zone.
Implementation
The 72-hr readmission alert is already part of feedback received in the Calgary Zone. Our study was specifically looking at understanding the utility of these alerts to emergency physicians through qualitative interviews. Our team of two interviewers (DA and CP) collected and banked the data through anonymized one-on-one interviews. Themes from these interviews will be used to guide future adjustments made to the alert and dictate it’s future role in emergency physician feedback. Current changes based on preliminary data have included the ability to customize re-admission alert time-frames based on personal preference. We are currently in the process of analyzing the themes that will shape further improvements made to the alert.
Evaluation Methods
This mixed methods realist evaluation consisted of two sequential phases: an initial quantitative phase examining the general features of 72-hr readmission alerts sent over a 1-year period (4024 alerts from May 2017-2018) and a subsequent qualitative phase involving 17 semi-structured interviews to generate “context-mechanism-outcome” (CMO) statements to guide refinement of our program theory.
Results
CMO statements revealed emergency physician stakeholders were concerned that the alert impacted personnel decisions, changed patient return expectations and didn’t involve consulting services. Physicians, who didn’t believe alerts were involved in personnel decisions, were more likely to pursue balanced reflection/acquisition after each alert when receiving illness related returns. Conversely, physicians, who believed alerts were involved in performance assessment/hiring decisions, were more likely to defensively change their practice. Commonly cited areas of improvement were the ability to personally adjust time criteria for alerts and involving consulting services in feedback.
Advice and Lessons Learned
It is essential to partner with local departments who can use formal (newsletters) and informal (word of mouth) avenues to encourage participation in the study. Participant anonymity must be emphasized when recruiting for qualitative interviews in order to receive the full scope of perspectives.
Clear and concise scripts highlighting the objective of each question can ensure the quality of responses received and help interviewers probe further into the topic when necessary.
When performing quality improvement studies on formal feedback mechanisms, faculty leadership buy-in is essential in order to ensure a safe environment for all participants