Journal of Emergency Nursing最新文献

Introduction

Substance misuse in the United States has continuously proven to be a public health issue. The impact of substance use disorder and the injury and illness it produces creates challenges in the public health sector. This quality improvement project aimed to increase screening and referral rates in a rural emergency department.

Methods

The CAGE-AID screening tool was implemented into the triage process in the Meditech Expanse system; 1077 patients were included in this quality improvement project. This initiative used Plan-Do-Study-Act cycles, collecting data weekly.

Results

There were 1077 patients available for the new screening process. This included 468 males (43.5%) and 609 females (56.5%). Of the 1077 patients, all (100%) were screened with the leading question. All patients (100%) were subsequently screened with the 4-item CAGE-AID tool if they answered “yes” to the leading question. Of these patients, 962 screened negative (89.3%) and 115 screened positive (10.7%). For those 115 positive screens, 63 denied referrals (54.8%) and 52 (45.2%) accepted referral. Of those 52 who accepted referral, 9 (17.3%) scheduled themselves for a follow-up appointment within 30 days of the new process going live.

Conclusion

It is possible for substance use disorder screening and referral to be implemented in every emergency department across the nation and beyond to help identify patients struggling with substance misuse and refer them to the appropriate treatment upon discharge. Substance use disorder screening and referral are an evidence-based method, and sufficient evidence supports the current practice of emergency departments implementing routine substance use disorder screening and referral as standard of care.

Introduction

Sexual assault nurse examiners are crucial care providers in cases of sexual assault. However, it is not clear whether sexual assault nurse examiner availability differs throughout the 13 states that comprise the Appalachian region of the United States. Therefore, this cross-sectional analysis identified sexual assault nurse examiner availability in 13 states and determined differences in availability by both county-level Appalachian status and county-level rurality status.

Methods

Data were downloaded from 2 public sexual assault nurse examiner registries for the included 13 states. Descriptive statistics of sexual assault nurse examiner certification type and availability by state were calculated. In addition, bivariate analyses of sexual assault nurse examiner availability by rurality and by Appalachian status were performed using 2-sample z-tests for equality of proportions.

Results

State-level sexual assault nurse examiner availability ranged from 0.34 to 0.86 sexual assault nurse examiners per 100,000 residents. Sexual assault nurse examiner availability in these 13 states did not differ by Appalachian status. However, rural areas had significantly lower sexual assault nurse examiner availability than urban areas in these 13 states.

Discussion

These data support previous literature on the need for stronger sexual assault nurse examiner programs in rural areas in the United States. Future research should take sexual assault prevalence into account to determine whether local sexual assault nurse examiner access needs, as well as appropriate support for sexual assault nurse examiners, are being met throughout Appalachian states.

Introduction

Charge nurses are shift leaders whose role includes managing nursing resources and facilitating appropriate patient care; in emergency departments, the charge nurse role requires both clinical and leadership skills to facilitate the flow of patients, while ensuring patient and staff safety. Literature on orientation and specific training is notably sparse. This study aimed to evaluate the content and process of core competency training and identify evaluation and implementation strategies necessary to improve charge nurse performance in United States emergency departments.

Methods

A modified Delphi technique was used in phase 1 and a qualitative content analysis method was used in phase 2 to address specific aims of the study.

Results

In total, 427 emergency nurse managers, directors, educators, and charge nurses responded to the initial survey to identify elements, teaching modalities, and evaluative processes; 22 participated in 1 of 2 focus groups to provide further information about the pedagogical approaches to teaching emergency charge nurse competencies. The top 5 competencies were identified as patient flow management, communication, situational awareness, clinical decision making, and nurse-patient assignment, with understanding that each competency overlapped significantly with the others. Low-fidelity simulation and gamification were identified as a preferred method of both training and evaluation.

Discussion

These findings have the potential to support a standardized approach to emergency charge nurse training and evaluation focusing on communication skills, clinical decision making, and situational awareness to facilitate safe and effective nurse-patient assignment and emergency department throughput.

Cefoperazone (CPZ) is an antibiotic widely used for moderate to severe infections, especially in countries where resources are difficult to access. This case report aimed to draw attention to coagulopathy, a potential side effect of CPZ. This side effect can cause high mortality and morbidity in patients. In the mechanism of CPZ causing coagulopathy, it is reported that effects such as binding to vitamin K, disrupting vitamin K metabolism, and preventing platelet aggregation are responsible. In this presentation, a case who came to the emergency department with the complaint of hematuria caused by coagulopathy after the use of CPZ-containing antibiotics (CPZ + sulbactam) is presented.

Introduction

The Balance Eyes Face Arms Speech Time stroke screening tool may have limitations for Spanish-speaking individuals. The purpose of this study is to identify potential screen failure events during evaluation for intervenable acute ischemic stroke events among Spanish-speaking patients.

Methods

This is a retrospective, observational, single-center study at an urban academic center during 2020. Patients with a positive stroke screen were stratified by Spanish or non-Spanish. We measured last known well, sensitivity, specificity, negative predictive value, and positive predictive value of the emergency department provider’s decision to escalate to complete stroke evaluation with acute ischemic stroke as the outcome of interest.

Results

Among 796 patients (mean age of 52 years, 56% female, 37% Spanish speaking), 30% of patients with positive stroke screen were converted to complete stroke evaluation. For provider escalation to complete stroke evaluation for the outcome of acute ischemic stroke events, prevalence was 13%, sensitivity 81%, positive predictive value 22%, and negative predictive value 97% for the overall sample. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation (25.8% vs 32.8%; 95% for difference CI, 0.57-13.5). Importantly, there was no difference in rate of acute ischemic stroke between Spanish- and non–Spanish-speaking patients.

Discussion

Over 1 year, with 796 patients triggered at triage by Balance Eyes Face Arms Speech Time for positive stroke screens, only 13% resulted in an acute ischemic stroke. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation, but the rate of acute ischemic stroke was not different by language.