Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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This quality-improvement project aimed to evaluate the effectiveness of implementing multidisciplinary education and deploying utilization tools aimed at reducing the inappropriate insertion of indwelling urinary catheters (IUCs) in the emergency department. Literature supports the use of decision support tools and education as proven techniques to reduce IUC use. Few studies have implemented a multidisciplinary approach involving the use of focus groups to understand the thought processes behind deciding to place an IUC. ⋯ The potential risks associated with IUCs often go overlooked by direct-care staff members. Educating staff and creating new standards and utilization tools have often been used to decrease the initial insertion of IUCs and to improve recognition of appropriate removal of IUCs. Using direct feedback from staff to develop the interventions led to a reduction in IUC insertions in the emergency department in the short-term, but long-term changes were not seen. The project results suggest that incorporating staff into the decision making and implementation will lead to long-term acquisition of knowledge and longer-term results. Ongoing regularly scheduled education refreshers need to be assessed for their potential to affect long-term change.
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Comparative Study
The Impact of Prehospital 12-Lead Electrocardiograms on Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction.
Multiple strategies have been implemented to reduce door-to-balloon times. The purpose of this study was to compare door-to-balloon times between ST-elevation myocardial infarction (STEMI) patients who arrived at the emergency department by ambulance with a pre-hospital electrocardiogram (ECG), to those who self-transported and had an ECG on ED arrival. ⋯ Door-to-balloon times can be reduced when chest pain patients are transported to the emergency department by ambulance. The paramedics are equipped to perform an ECG, thereby making a preliminary diagnosis of STEMI. The emergency department can them prepare for potential angioplasty or percutaneous coronary intervention. An opportunity exists for emergency nurses to educate the public about the importance of calling 911 for chest pain.
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Review Case Reports
Treatment of Acute Intermittent Porphyria in the Emergency Department.
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Patients with chronic pain who frequent emergency departments present a challenge to health care providers. Mental health, substance abuse, and pain issues are difficult to distinguish in fast-paced clinical settings, and significant symptoms may remain unaddressed. This pilot study sought to determine whether electronically delivered screening tools measuring pain and mood could identify areas to target for improving emergency care. ⋯ Online surveys delivered to patients with chronic pain detected unmet needs for depression and persisting high levels of pain interference after ED encounters. Adding mood-specific screening tools to pain assessments may be necessary in clinical settings to identify depression and refer for appropriate treatment.