Canadian Journal of Emergency Nursing (CJEN)
Not a member yet
391 research outputs found
Sort by
Research to Action: Nurse Practitioners in the Emergency Department, Emergency Department Transition Clinic and Intravenous Therapy Clinic at Strathcona Community Hospital
Get PDFThis article is about nurse practitioners effectiveness working in the Strathcona emergency department (ED), as well as the efficacy of two NP led clinics that run parallel to the ED. Prior to opening Strathcona Community Hospital in 2014, site leadership were tasked with developing an innovative care model with the aim of improved patient safety and quality of care delivered, incorporating a nurse practitioner (NP) model. There are NPs in three areas at Strathcona Community Hospital. NPs work directly in the ED, assessing and treating patient autonomously and with emergency physician collaboration. They also complete diagnostic and microbiology review and perform triage liaison nurse practitioner (TLNP) duties. There is also an NP led Emergency Department Transition Clinic (EDT) for urgent or emergent follow up patients from the ED. Lastly, the NP led Intravenous Therapy Clinic was developed to see patients previously attended through the ED for IV antibiotic and other IV non-antibiotic treatments, while supporting increased community access to IV treatments. Evaluation of the 3 areas was completed using qualitative and quantitative methods over the period of 2015-2018. Statistical analysis was completed by the Alberta Health Services workforce team. Outcomes included reduced patient return visits, decreased wait times and patients leaving without treatment (LWOT), and high patient satisfaction. Other results included improved staff satisfaction, facilitation of continuity of care and avoiding unnecessary ED visits. 
Procainamide for the acute management of atrial fibrillation and flutter in the emergency department: a systematic review
Get PDFIntroduction: Chemical or electrical cardioversion are utilized for acute atrial fibrillation or flutter (AFF) management in the emergency department (ED). Procainamide is a common chemical agent used in Canada; however, there are substantial practice variations.
Method: Systematic search of five databases and grey literature completed. Randomized controlled trials (RCTs) and prospective controlled cohort studies including adults with acute AFF comparing procainamide with other cardioversion strategies were eligible. Two independent reviewers performed study selection and data extraction. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. The protocol was registered with PROSPERO (CRD42019142080).
Results: From 3847 potential citations, 6 studies were included (four RCTs and two cohort studies). Procainamide was less effective in achieving conversion to normal sinus rhythm (NSR) at 1st attempt compared to other chemical (RR 0.76; 95% CI: 0.65 to 0.90) and electrical (RR 0.72; 95% CI: 0.56 to 0.92) options. Procainamide in a drug-shock approach was as effective as electrical cardioversion alone in restoring NSR (RR 1.04; 95% CI 1.00 to 1.08). The occurrence of hypotension was higher in patients receiving procainamide compared to electrical cardioversion (RR 1.87; 95% CI: 1.14 to 3.06). Deaths and strokes were not well-reported.
Conclusion: Procainamide is less effective than other chemical options and electrical cardioversion strategies to restore NSR. The efficacy of procainamide in a drug-shock approach is similar to electrical alone at restoring NSR. The evidence shows that hypotension is a common procainamide adverse effect suggesting that electrical cardioversion as a first approach is preferable
Simplifying wound care options in the ED: An initiative to enhance familiarity with dressing selections
No full textOptimizing patient outcomes by improving STEMI target times
Get PDFIt is widely recognized that delays in STEMI identification and treatment can negatively affect patient outcomes. Early intervention to achieve reperfusion of the blocked vessel is crucial in minimizing myocardial damage and optimizing patient outcomes.
In April 2017, the Southern Alberta STEMI program identified a delay in SHC ED achieving STEMI target times as outlined by the American College of Cardiology and the American Heart Association.
Of all walk-in STEMI patients presenting to SHC ED between October 2016 and October 2017 requiring urgent transfer to FMC cardiac cath lab:
24% met the ‘Triage to 1st ECG target’ of ≤ 10 mins
6% met the ‘Door in-Door out target’ of ≤ 30 mins
A multi-disciplinary project team was formed to examine barriers to both targets and begin implementing strategies aimed at improving these times
Implementing a multi-site cardiac arrest quality improvement initiative
Get PDFBackground:
Medical cardiac arrest care in Edmonton Zone Emergency Departments does not undergo structured quality monitoring or continuous improvement. Prior to this work, quality indicators had not been selected, nor had tracking or reporting activities been undertaken. This work brings the Edmonton Zone EDs to the forefront of the continuous quality improvement recommendations made by Heart and Stroke Canada and the American Heart Association that are believed to improve both patient outcomes and overall system performance.
For this project quality indicator development and implementation takes three perspectives: patients and families, frontline staff and the health care system. This work is informed by the Institute for Healthcare Improvement, the National Institute of Science and the International Liaison Committee on Resuscitation’s work on Systems of Care and Continuous Quality Improvement for Emergency Cardiovascular Care. This work is motivated by the desire to improve patient/family experience and outcome, provider experience while improving system performance.
Implementation:
An iterative process identified the lowest resource/highest impact areas for improvement. This process was informed through a Delphi survey conducted by the Alberta Cardiac Arrest Stakeholders group and stakeholder engagement. Four areas for improvement were identified: support of patients and families, support of staff, improvement in care metrics, and system level interventions. Support of patients and families was accomplished through the development of an advisory network, by linking families with existing supports, and through the implementation of a bereavement package. Supporting staff was accomplished through the development of a formal and informal debriefing processes. Improving clinical care was accomplished through the integration of chest compression feedback devices into clinical care. Improvements at the system level will be accomplished through the creation of a cardiac arrest registry.
Evaluation Methods:
Mixed methods approaches are used to evaluate this project. Post cardiac arrest quality track forms are being filled out. Chest compression feedback device data was obtained through simulated patient-care scenarios, staff experiences were obtained through a structured survey. Clinically chest compression data was collected from the feedback devices by Clinical educators, through tracking forms, and pre-and-post surveys of frontline staff measuring burnout and occupational stress are underway. Data is being collected in a local registry to generate accurate incidence and survival rates. Eventual post-implementation interviews with providers, survivors and families will be conducted.
Results:
A patient/family advisor network has been established. Survivor and families can be connected with the Bystander Support Network and the Heart and Stroke Foundation portal through the bereavement packages being offered at one of the QI sites. Two sites have developed staff debriefing processes: an interdisciplinary Critical Incident Stress Management (CISM) team at one site, and referral to an existing CISM team at two other sites. Chest compression feedback is being used at two sites, staff feedback has been positive. One site is tracking resuscitation metrics which are being used to guide and evaluate the interventions: continued improvement in chest compression quality has been noted. Data analytics are being used at all sites to identify additional opportunities to improve resuscitation care and efforts are underway to expand data collection to other sites and to unify pre-hospital and in-hospital cardiac arrest data.
Advice and Lessons Learned:
Pre-intervention data would have allowed for more meaningful comparisons in patient care. Efforts should be put into identifying what these measures could be.
High levels of staff engagement at one site appear to have influenced the uptake of chest compression feedback. Effort should identify key stakeholders and gain buy in to increase uptake
There are significant barriers to unifying pre-hospital and in-hospital cardiac arrest data. It is our belief that a continuous record offers some greatest opportunity to collect data on resuscitation care. Efforts should focus on building a linkage between these data sources and creating a shared data set
