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Make sure staff wash their hands consistently. It sounds simple enough, and it's necessary to comply with The Joint Commission's National Patient Safety Goal to prevent deadly health care-associated infections due to multiple drug-resistant organisms. But it's anything but easy for most EDs to do this.
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A patient involved in a motor vehicle accident was alert with stable vital signs when he arrived at an ED. Three hours later, a nurse from the step-down unit came to transfer the patient for continued monitoring. She saw that he no longer was opening his eyes and didn't respond to verbal commands.
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ED nurses at the University of California Medical Center Irvine use a protocol for handoffs that involves giving verbal reports to the accepting unit using the SBAR (Situation-Background-Assessment-Recommendation) format. Sanna K. Henzi, RN, MSN, trauma injury prevention coordinator, gives this example of an incomplete report:
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Do all pediatric asthma patients receive relievers, corticosteroids, and a home management plan in your ED? These are three measures of care for which The Joint Commission is collecting data.
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When a woman came to the ED at Christiana Care Health System in Wilmington, DE, complaining of nausea, vomiting, and diarrhea, she was initially triaged as low acuity. "But when the ED nurse saw how uncomfortable the patient was, she decided to do an EKG on her," says Kelly Powers, RN, an ED nurse at the hospital.
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At Loma Linda (CA) University Medical Center, ED nurses have decreased door-to-EKG time to 11 minutes from almost an hour a year ago, reports Teri D. Reynolds, RN, BSN, clinical educator in the Department of Emergency Services.
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Shelley Calder, RN, CEN, MSN, clinical nurse specialist for the ED at Beth Israel Deaconess Medical Center in Boston, has partnered with her hospital's critical care nurses to give ED nurses tips to prevent hospital-acquired infections when patients are held for long periods. Some examples:
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The number of cases of Clostridium difficile-associated disease (CDAD) doubled between 2001 and 2005 to 301,200, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).
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(Editor's note: This is the second of a three-part series on trauma care in the ED. This story covers neurological assessments in motor vehicle accidents. Last month, we covered violence-related trauma including suspected abuse. Next month, we'll cover self-inflicted trauma.)
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When ED nurses at University of California Medical Center Irvine transfer a trauma patient, a verbal report is given to the accepting unit.
