Critical care knowledge smooths transport woes
Stat nurse program reduces risk
As the burgeoning field of interventional radiology increases treatment options, it also means more patients are transported to specialized radiology suites to undergo diagnostic tests and therapies. And for a critical care patient, this can be a dangerous journey. Some studies report an adverse incident rate as high as 75% for these transport patients.
But by using specially trained intensive care nurses to transport, monitor, and stabilize patients, hospitals can minimize the risks, says Harold Stearley, RN, BSN, CCRN, a former nurse at University of Missouri Hospitals and Clinics in Columbia.
Nine years ago, Stearley pioneered the medical center's stat nursing program, in which specially trained intensive care nurses transport patients undergoing specialized radiological procedures.
"During transport, as well as during the procedure itself, any number of life-threatening complications can happen," he says. "Medication can be delayed. Vital signs can change significantly; catheters can become dislodged. Oxygen supply can be exhausted. There's also the potential for unplanned extubation and cardiopulmonary arrest."
Two years ago, Stearley evaluated six months of data from the intrahospital transportation records of 237 intensive care patients to determine how the stat program was affecting adverse outcomes. The diagnoses or medical conditions of the patients involved included peripheral vascular disease, chronic obstructive pulmonary disease, grafts for peripheral artery or coronary artery bypass, multiple traumas with head injuries, and hip fractures.
Before patients were transported to radiology, the stat nurse recorded a set of baseline vital signs of heart rate, blood pressure, intracranial pressure, and oxygen saturation.
All patients receiving mechanical ventilation were accompanied by a respiratory therapist in addition to the stat nurse. If a patient was in unstable condition, the resident physician was also a part of the transport team.
"We used flow sheets to record patients' vital signs, vent status, IV fluids and medications, and any sedatives or paralytics administered during the transport," he says. "We also noted all changes in the patient's condition, along with any responses to intervention."
In addition to monitoring and intervening, the stat nurse also gave scheduled medication and therapies while the patient was out of the intensive care unit.
To measure outcomes consistently, a team of ICU staff nurses, clinical nurse specialists, and a board-certified interventional radiologist defined the parameters and criteria by which complications would be classified. (See table, below)
Stearley found that patients moved by stat nurses had a 15.5% overall complication rate. He also found that:
· 10.2% of the complications were minor ones such as slight elevation of vital signs during movement from stretcher to examining table or during injections of contrast material. "The values of these 24 patients returned to baseline immediately after the precipitating event," he says.
· 2.5% of the complications were moderate. "Of the seven patients who had a moderate elevation in blood pressure during the radiological exam, the stat nurse administered a sedative and the values returned to baseline levels," he explains.
· 2.8% were severe complications that did not respond to interventions. "The physicians considered the seven patients' underlying history of hypertension and decided the benefits of proper diagnosis and treatment outweighed additional risks associated with continuing with the procedure," he says.
· 0.8% had severe complications, and the radiological exam had to be stopped. "One patient had a seizure, and one who was undergoing angiography to rule out a possible aortic tear did indeed have the aortic tear and was rushed to the operating room," he says.
But no patients missed any medication or had any other therapy delayed, he points out. "No IV or catheters were dislodged; no tubes were displaced," says Stearley who says he "never lost a line" during his nine years as a stat nurse.
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