Implementation of an Advanced Nursing Directive for Suspected Appendicitis to Empower Pediatric Emergency Nurses

2.50
Hdl Handle:
http://hdl.handle.net/10755/162373
Type:
Presentation
Title:
Implementation of an Advanced Nursing Directive for Suspected Appendicitis to Empower Pediatric Emergency Nurses
Abstract:
Implementation of an Advanced Nursing Directive for
Suspected Appendicitis to Empower Pediatric Emergency Nurses
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:deForest, Erin Kate, RN, BScN, Bkin
P.I. Institution Name:Alberta Children's Hospital - ED
Title:Nurse Clinician/Registered Nurse
Contact Address:827 - 124th Avenue SW, Calgary, Alberta, T2W 1T1, Canada
Contact Telephone:403-955-7070
Co-Authors:Graham C.Thompson, MD, FRCPC, FAAP
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: Increasing wait times in the Pediatric Emergency Department (PED) can lead to delayed recognition and treatment of significant medical and surgical illness. During the fall of 2007, the Calgary Health Region called a Clinical Safety Review for the care of patients with suspected appendicitis. Using a multi-disciplinary approach, system delays were identified as a potential contributor to the adverse outcomes in patients presenting with appendicitis. To address this issue, a Pediatric Appendicitis Committee was convened, and, over a 1 and a half year period, a Pediatric Appendicitis Care Map was developed. A key component of this Care Map is the Advanced Nursing Directive (AND) for Suspected Appendicitis. In this article, the use of the developed AND to empower PED nurses in the front-line care of children with abdominal complaints is outlined. This AND was developed to a) assist PED nurses to identify children who would likely need further investigation for suspected appendicitis and b) to empower PED nurses to initiate investigations and management prior to PED physician assessment.

Design: The important components of the AND included standardized assessment measures using set criteria, a defined care plan if criteria are met and the option to seek advice when necessary. Quality Assessment data regarding the implementation of our Regional Pediatric Appendicitis Pathway was collected from March 1st and August 31st, 2009.

Setting: On December 1st, 2008, the AND for Suspected Appendicitis was implemented in a PED, with an expected 2009 census of 61 000 patient visits.

Participants/Subjects: A prospective cohort of children aged 3 to 17 years presenting to the PED with abdominal complaints was used.

Methods: After reviewing previously validated appendicitis scoring systems, a modification of the Alvarado Score was chosen, by consensus, in order to be congruent with our adult colleagues within the health region. The Alvarado Score is used in the AND as a screening tool, not an absolute diagnostic test. In order for a nurse to initiate care as directed by the AND, patients must meet specific criteria. The patient must have tenderness in the right lower quadrant (RLQ) with palpation by the examiner, or, rebound tenderness in the RLQ. In addition, the patient must also have 3 or more of the following screening criteria: 1) any complaint of RLQ pain, 2) nausea and/or vomiting, 3) decreased appetite, or, 4) elevated temperature/history of fever (equal to or greater than 38.0 degrees C). For patients meeting the screening criteria, an Emergency Nurse is able to initiate IV access, obtain bloodwork, initiate a bolus of normal saline and request a midstream urine.

Results/Outcome: Future Quality Assessment and research studies will focus on the accuracy of the AND, and in predicting which children will have imaging studies or an appendectomy as well as the impact of the AND on key PED flow measures.

Implications: In response to a Clinical Safety Review we have implemented an AND to empower our PED nurses to identify and initiate care directives for children with suspected appendicitis. The AND highlights the importance of nursing leadership in the acute care setting, and is expected to improve the pediatric patient experience and outcome.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImplementation of an Advanced Nursing Directive for Suspected Appendicitis to Empower Pediatric Emergency Nursesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162373-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Implementation of an Advanced Nursing Directive for <br/>Suspected Appendicitis to Empower Pediatric Emergency Nurses</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">deForest, Erin Kate, RN, BScN, Bkin</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Alberta Children's Hospital - ED</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Clinician/Registered Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">827 - 124th Avenue SW, Calgary, Alberta, T2W 1T1, Canada</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">403-955-7070</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">nursedeforest@yahoo.ca</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Graham C.Thompson, MD, FRCPC, FAAP</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: Increasing wait times in the Pediatric Emergency Department (PED) can lead to delayed recognition and treatment of significant medical and surgical illness. During the fall of 2007, the Calgary Health Region called a Clinical Safety Review for the care of patients with suspected appendicitis. Using a multi-disciplinary approach, system delays were identified as a potential contributor to the adverse outcomes in patients presenting with appendicitis. To address this issue, a Pediatric Appendicitis Committee was convened, and, over a 1 and a half year period, a Pediatric Appendicitis Care Map was developed. A key component of this Care Map is the Advanced Nursing Directive (AND) for Suspected Appendicitis. In this article, the use of the developed AND to empower PED nurses in the front-line care of children with abdominal complaints is outlined. This AND was developed to a) assist PED nurses to identify children who would likely need further investigation for suspected appendicitis and b) to empower PED nurses to initiate investigations and management prior to PED physician assessment. <br/><br/>Design: The important components of the AND included standardized assessment measures using set criteria, a defined care plan if criteria are met and the option to seek advice when necessary. Quality Assessment data regarding the implementation of our Regional Pediatric Appendicitis Pathway was collected from March 1st and August 31st, 2009.<br/><br/>Setting: On December 1st, 2008, the AND for Suspected Appendicitis was implemented in a PED, with an expected 2009 census of 61 000 patient visits. <br/><br/>Participants/Subjects: A prospective cohort of children aged 3 to 17 years presenting to the PED with abdominal complaints was used. <br/><br/>Methods: After reviewing previously validated appendicitis scoring systems, a modification of the Alvarado Score was chosen, by consensus, in order to be congruent with our adult colleagues within the health region. The Alvarado Score is used in the AND as a screening tool, not an absolute diagnostic test. In order for a nurse to initiate care as directed by the AND, patients must meet specific criteria. The patient must have tenderness in the right lower quadrant (RLQ) with palpation by the examiner, or, rebound tenderness in the RLQ. In addition, the patient must also have 3 or more of the following screening criteria: 1) any complaint of RLQ pain, 2) nausea and/or vomiting, 3) decreased appetite, or, 4) elevated temperature/history of fever (equal to or greater than 38.0 degrees C). For patients meeting the screening criteria, an Emergency Nurse is able to initiate IV access, obtain bloodwork, initiate a bolus of normal saline and request a midstream urine.<br/><br/>Results/Outcome: Future Quality Assessment and research studies will focus on the accuracy of the AND, and in predicting which children will have imaging studies or an appendectomy as well as the impact of the AND on key PED flow measures.<br/><br/>Implications: In response to a Clinical Safety Review we have implemented an AND to empower our PED nurses to identify and initiate care directives for children with suspected appendicitis. The AND highlights the importance of nursing leadership in the acute care setting, and is expected to improve the pediatric patient experience and outcome. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:05Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:05Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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