2.50
Hdl Handle:
http://hdl.handle.net/10755/198304
Title:
Straight Talk on Pediatric Spinal Immobilization
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Straight Talk on Pediatric Spinal Immobilization

Purpose: The purpose of this evidence based practice project was to determine how best to care for a pediatric trauma patient requiring spinal immobilization in the emergency department. Currently there are no randomized controlled trials that evaluate the necessity of spinal immobilization due to the ethical nature such studies pose.

Design: The project was conducted as part of an Evidence Based Practice (EBP) Scholar Fellowship program, a course designed to teach EBP skills to the nurse so that she/he will be able to conduct extensive evaluations of existing evidence to improve patient care. Twelve nurses were chosen to participate in the fellowship program; each nurse chose a current practice subject and formulated a PICO style question to base the search for latest evidence. The goal of the fellowship was to discover what is best practice and carry that evidence to the bedside to improve patient care and outcomes.

Setting: The project was conducted in a multi campus mid-west urban children’s hospital. Focus was on emergency care at a current level 3 trauma designation, while actively working towards level 1 designation within the next year. The teaching facility has a combined total of 305 inpatient beds with 47 emergency department beds.

Participants/Subjects: Since no formal research study was conducted, no participants were required. IRB approval was not required for searching for and critically appraising the evidence found.

Methods: A PICO style question was formulated as it applied to the area of study. The PICO question’s scope included population, intervention, comparison and outcome. The question formulated for this project’s purpose was “In the emergency department, what is best practice in the management of spinal immobilization in the pediatric patient population?” Searches were then conducted using Pub Med, Cochrane Library, Ovid, CINAHL and Google Scholar data bases. Search terms included spinal immobilization, pediatric, backboard, cervical immobilization, trauma, emergency department and management of. A seven level rating system from Melynck and Fineout-Overholt (2005) was used to grade the evidence found. Once all evidence was reviewed, determinations of best practice were recommended.

Results/Outcomes: The evidence evaluated supported spinal immobilization as necessary for the pediatric trauma patient who presents with traumatic mechanism of injury and complaint of pain to neck and/or back. However, the evidence did show there are negative consequences for the pediatric patient when they are subjected to extended and/or unnecessary immobilization times in the emergency department.

Implications: In this project it was concluded that all pediatric trauma patients who present to an emergency department with traumatic mechanism of injury (as outlined by individual facility guidelines) along with report of pain to neck and/or back be placed in full spinal immobilization until possible injury to spinal area can be quickly ruled out. Recommendations for rapid evaluation of pediatric patient upon arrival along with padding areas in the lumbar spine area and under shoulders helps to add comfort, maintain airway alignment and prevent pressure sores and alterations in initial assessments were also included.


Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleStraight Talk on Pediatric Spinal Immobilizationen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198304-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Straight Talk on Pediatric Spinal Immobilization<br/><br/>Purpose: The purpose of this evidence based practice project was to determine how best to care for a pediatric trauma patient requiring spinal immobilization in the emergency department. Currently there are no randomized controlled trials that evaluate the necessity of spinal immobilization due to the ethical nature such studies pose. <br/><br/>Design: The project was conducted as part of an Evidence Based Practice (EBP) Scholar Fellowship program, a course designed to teach EBP skills to the nurse so that she/he will be able to conduct extensive evaluations of existing evidence to improve patient care. Twelve nurses were chosen to participate in the fellowship program; each nurse chose a current practice subject and formulated a PICO style question to base the search for latest evidence. The goal of the fellowship was to discover what is best practice and carry that evidence to the bedside to improve patient care and outcomes.<br/><br/>Setting: The project was conducted in a multi campus mid-west urban children’s hospital. Focus was on emergency care at a current level 3 trauma designation, while actively working towards level 1 designation within the next year. The teaching facility has a combined total of 305 inpatient beds with 47 emergency department beds.<br/><br/>Participants/Subjects: Since no formal research study was conducted, no participants were required. IRB approval was not required for searching for and critically appraising the evidence found.<br/><br/>Methods: A PICO style question was formulated as it applied to the area of study. The PICO question’s scope included population, intervention, comparison and outcome. The question formulated for this project’s purpose was “In the emergency department, what is best practice in the management of spinal immobilization in the pediatric patient population?” Searches were then conducted using Pub Med, Cochrane Library, Ovid, CINAHL and Google Scholar data bases. Search terms included spinal immobilization, pediatric, backboard, cervical immobilization, trauma, emergency department and management of. A seven level rating system from Melynck and Fineout-Overholt (2005) was used to grade the evidence found. Once all evidence was reviewed, determinations of best practice were recommended.<br/><br/>Results/Outcomes: The evidence evaluated supported spinal immobilization as necessary for the pediatric trauma patient who presents with traumatic mechanism of injury and complaint of pain to neck and/or back. However, the evidence did show there are negative consequences for the pediatric patient when they are subjected to extended and/or unnecessary immobilization times in the emergency department. <br/><br/>Implications: In this project it was concluded that all pediatric trauma patients who present to an emergency department with traumatic mechanism of injury (as outlined by individual facility guidelines) along with report of pain to neck and/or back be placed in full spinal immobilization until possible injury to spinal area can be quickly ruled out. Recommendations for rapid evaluation of pediatric patient upon arrival along with padding areas in the lumbar spine area and under shoulders helps to add comfort, maintain airway alignment and prevent pressure sores and alterations in initial assessments were also included. <br/><br/><br/>en_GB
dc.date.available2011-12-21T12:45:34Z-
dc.date.issued2011-12-21T12:45:34Z-
dc.date.accessioned2011-12-21T12:45:34Z-
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