Likely chem exposure? Do this immediately
Although ED nurses at Saint Louis University Hospital didn't wind up caring for victims of a recent chemical exposure directly — the only patient they received went directly to the intensive care unit — nurses did the following to prepare for patients:
- Security was put on alert, stationed at the ambulatory entrance. "They made sure that anyone who may have been exposed did not enter the building," says Jeanne Fogarty, RN, BSN, MBA, the ED's patient care manager. "Security is always in direct contact with both the triage and charge nurse. Immediate assistance is readily available."
- Decontamination equipment was pulled out and set up in the hallway, ready to be pulled outside at a moment's notice.
- Staff trained in decontamination were on standby in the ED.
- All appropriate managers were notified, on standby and ready to respond if needed.
ED nurses learned two lessons from the event, says Fogarty. "As with any event, real or drill, there is always room for improvement with communication," she says.
Too many staff members, both on duty and off duty, used the ED as the source of information. "There were too many phone calls," says Fogarty. "This creates problems when the ED needs to keep providing patient care and prepare for the event. We will need to continue to educate staff."
Also, the chain of command was not always followed, and staff received conflicting instructions. "Information should be coming from one source and one source only, and that is the command center or the nursing supervisor," says Fogarty. "The ED cannot take on that responsibility. We want all ED staff to concentrate on the task at hand: caring for the influx of patients. This will be addressed in our next drill."
Make supplies accessible
The ED also learned that storage areas for decontamination supplies need to be more easily accessible. In addition to the ED's indoor decontamination shower, there is an outdoor decontamination area right outside in the ambulance bay. "We have it set up so that maintenance will respond and hang the curtains, as well as turn on the mixer for the water," says Fogarty. "The person working the off shift was not familiar with where the curtains were stored, which resulted in extra phone calls and a bit of a delay in getting things ready."
One possible solution is to permanently hang the curtains in a recessed storage container, so all staff need to do is open the container. Another suggestion came from an ED technician: to obtain a bug-spraying device to fill with the detergent used for decontamination. This item would be added to the boxes used to store decontamination equipment at triage.
"We can then spray the victim down first, which will shorten the decon time," says Fogarty.
Although ED nurses at Saint Louis University Hospital didn't wind up caring for victims of a recent chemical exposure directly the only patient they received went directly to the intensive care unit nurses did the following to prepare for patients:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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