Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association最新文献

Advanced clinical practitioners (ACPs) have become an established part of the emergency medicine workforce in the UK. However, despite increasing numbers of ACPs working in emergency medicine, there is little evidence regarding their impact on care in this area and a lack of metrics available to assess their performance. To inform national benchmarking and comparisons between organisations, the authors of this article calculated the seven-day unplanned re-attendance rate for patients seen by ACPs at two emergency departments (EDs) in the UK and compared it with the rate for patients seen locally by all other clinicians and with the overall rate in England. Over a 12-month period, the seven-day unplanned re-attendance rate for ACPs was 5.9%, versus 6.7% for all other clinicians and 8.2% nationally. As a measurable and meaningful indicator of the quality of care, the seven-day unplanned re-attendance rate could be integrated into routine data collection and used constructively in the appraisal process and professional development of ACPs.

The emergency department (ED) may be the first place where a child and young person who has been subject to abuse or neglect comes into contact with healthcare professionals. CWILTED ('concern', 'witness', 'incident', 'location', 'time', 'escort', 'demeanour') is a tool designed to enhance the quality of information relevant to safeguarding that is documented by triage nurses about children and young people attending the ED. In 2024, CWILTED was introduced at an ED in Dorset, England, following an audit which had shown that there was room for improvement in the documentation of safeguarding information. A second audit was then conducted, which showed that the introduction of the tool had had positive effects. This article reports on the second audit's findings, making comparisons with previous data where possible. It discusses human factors that influence triage and stresses the need to communicate information about a child's ED attendance to the GP to ensure that no safeguarding issues are missed.

Rationale and key points: Safety netting in the emergency department (ED) is provided to patients when their presenting complaint has not completely resolved but they can be safely discharged home. Safety netting involves providing patients, and/or their parents, family members or carers, with verbal and written information about where to go and/or who to contact should they develop any concerning signs and symptoms or if their condition does not resolve as expected. Nurses providing safety netting must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Safety netting should cover the patient's current health status, the expected course of their condition, concerning signs and symptoms, and how and where to seek further medical advice if needed. • Effective safety netting can help to ensure that the patient is equipped to safely monitor their condition at home and act appropriately if it deteriorates. • Nurses should summarise the advice and information discussed and check that the patient has understood them, for example by using the teach-back method. • Online and digital resources are increasingly used to support safety netting and nurses must ascertain that the patient has the required equipment and digital literacy before signposting them to such resources. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when providing safety netting in the emergency department. • How you could use this information to educate nursing students or your colleagues on the appropriate procedure and evidence base for providing safety netting in the emergency department.

Evidence suggests that using a standardised triage system that categorises patients into levels of severity or acuity to prioritise their care can provide the greatest levels of patient safety. The use of a web-based app to record patient triage data can support operational decision-making, reduce the risk of errors and standardise the time it takes to record the data required for accurate triage. This article details one aspect of a three-stage research project undertaken in Thailand which aimed to improve the quality of nurse triage, reduce errors in triage decisions and decrease the time spent on triage through implementation of a patient triage app. The patient information input into the app at initial triage is automatically uploaded into the electronic patient record. The authors report the results of the third stage of the project, which aimed to analyse the feasibility of using the app by evaluating completion of patient records and user satisfaction levels.

Ankle fracture-dislocation is a serious injury that requires prompt and appropriate management. The proximity of various neurovascular structures around the ankle joint means there is a risk of nerve or blood vessel damage. Initial management in the emergency department (ED), therefore, includes the realignment and repositioning of the dislocated joint to its normal anatomical position, referred to as reduction. This article details a case study of a 42-year-old woman who presented to an ED in Ireland with a suspected ankle fracture-dislocation following a fall while playing sport. Following triage and initial pain management, the patient's care was managed by an advanced nurse practitioner, in collaboration with medical colleagues, which involved history taking and physical assessment, reduction of the dislocation and splinting of the ankle under procedural sedation, monitoring during and after procedural sedation, and radiological imaging.

Nurses and other clinical staff working in emergency departments (EDs) are frequently required to care for patients who attend following suicidal behaviour, but ED staff often feel unequipped to do so. Many of these patients also report negative experiences of care. This article reviews and discusses patients' lived experiences under four themes: conflicting feelings around death and dying; feelings of shame and stigma; feelings of hopelessness; and the impact of person-centred moments. The authors also provide suggestions that nurses can consider to enhance their professional practice and the care they provide to this patient group.

Referrals to mental health services, and mental health-related presentations to emergency departments (EDs), among children and young people (CYP) have increased over the last decade. In the UK, national guidelines and standards recommend that CYP who present to an ED with mental health issues should receive a psychosocial assessment, while evidence suggests that the use of a psychosocial assessment tool can enhance the management of this patient cohort. However, it can be challenging for ED healthcare professionals to undertake a formal psychosocial assessment due to a range of factors. This article reports the results of a service evaluation, undertaken in two children's EDs in a large NHS trust in England. The evaluation involved a review of 308 ED clinical records of CYP who presented to the EDs with mental health issues, to assess the extent to which this cohort was receiving a structured psychosocial assessment. The results showed that only a small proportion (34%, n=104) of the clinical records contained evidence of some form of psychosocial assessment, while the use of a psychosocial assessment tool was documented in only 22 (7%) of these 104 clinical records. The results have informed a wider quality improvement project to enhance practice in this area.

Patients diagnosed with cancer or suspected cancer during an emergency department (ED) presentation are often signposted back to their GP for urgent referral to cancer services. However, this can result in delays in patients receiving specialist support, confirmation of diagnosis and, vitally, starting treatment. A quality improvement initiative that aimed to address these issues through the introduction of an ED suspected cancer diagnosis pathway was implemented by the acute oncology service in two EDs in Oxford University Hospitals NHS Foundation Trust in April 2023. Data collected during the first year of implementation of the pathway show there has been a significant increase in the numbers of patients meeting the NHS England 62-day referral to treatment standard and in the numbers of patients receiving support from an acute oncology named cancer clinical nurse specialist from the point of discharge from the ED. This article details the initiative, which is ongoing, and shares some of the results from the first year of data collection.

Although the phenomenon of crowding in emergency departments (EDs) is not new, it remains a significant problem for patients, ED staff and the wider healthcare system. Crowding in EDs, which is also called overcrowding, has been widely explored in the literature, but there are relatively few studies of the subject from an emergency nurse perspective. This article reports the findings of a literature review that aimed to explore the effects of crowding on nurses working in EDs. Four key themes were identified from a synthesis of 16 articles included in the review: staffing and skill mix; inadequate care and the effect on nurses' well-being and stress levels; violence in the ED; and hospital metrics and patient flow. Further research is required to explore in more depth the effects of ED crowding on emergency nurses and to address the multiple factors that perpetuate the phenomenon.

Sepsis is a potentially life-threatening condition triggered by infection that is responsible for an estimated 48,000 deaths in the UK each year. Its pathophysiology is complex, its symptomology non-specific and its clinical presentations extremely varied. Despite numerous campaigns to raise awareness of sepsis, it still goes undetected. In 2024, the National Institute for Health and Clinical Excellence revised its guideline on sepsis and the UK Sepsis Trust published the seventh edition of its Sepsis Manual. This article discusses the pathophysiology of sepsis and how emergency nurses should assess and manage patients with suspected sepsis. It describes the tools available to them, including the National Early Warning Score 2 and the Sepsis 6, and emphasises the importance of early antibiotic administration, serial lactate measurements, source control and antimicrobial stewardship.