Critical care nursing quarterly
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On a 30-bed trauma surgical unit in an academic medical center, a best practice group was established. For a first project, we worked on improving the patient's pain experience. The decision was driven by the units Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) pain scores. ⋯ The nurse manager, educator, pain relief attendant, anesthesia attendant, and 2 trauma surgeons met to discuss how to improve the surgical patient's pain experience. This trauma surgical unit now exceeds the top performers in HCAHPS scores. We have moved from the 1st percentile to the 90th percentile in 5 months.
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This article reports the results of a study designed to explore the experiences and needs of family members for prognostic communication at end of life in an intensive care unit (ICU). Subjects in this qualitative study included 20 family members of patients at high risk for death in 1 adult medical/surgical ICU. All subjects were interviewed once utilizing a semistructured interview format, with approximately half interviewed multiple times during the ICU stay. ⋯ Suggestions for clinical practice to support families in their information-related work are presented. Overall, the importance of providers approaching communication from a holistic perspective, extending beyond simply passing on information, is emphasized. Viewing communication as a therapeutic modality, and communicating with compassion, sensitivity, and a genuine sense of caring, can help provide both the information and the emotional support and comfort families desperately need.
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Team training and practice is an essential part of emergency department workflow. TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is a teamwork and communication systems model that has the potential to improve patient safety while also addressing aspects of staff satisfaction and morale. This article describes the experience of one emergency department's implementation of TeamSTEPPS, with a focus on methods of training faculty and staff, progression of implementation over a period of time, and evaluation of the process with recommendations for future growth. Background, history, and specific tools used within the department are described, with an emphasis on "briefs," "huddles," and "debriefs" or team "wrap-ups."
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The trauma-surgical intensive care unit at Harborview Medical Center has developed a multidisciplinary case review process to allow discussion of complications and issues in an open forum among multiple services. Conducted monthly, this meeting provides a forum for clear communication between members of the patient care team with the goal of developing best practices, system changes, and policies that will minimize risk for the patients and provide education for the staff.
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Trauma is the leading cause of death in the United States for those younger than 35 years and injuries sustained from trauma are a significant source of moderate to severe disability. The inability to establish, secure, or maintain a definitive airway is a major cause of preventable death and secondary injury due to inadequate oxygenation and ventilation. Prehospital airway management is an essential skill of any prehospital care provider. ⋯ This article presents some of the challenges faced by flight nurses in the air medical environment and how Airlift Northwest has developed a structured, standardized approach to airway management both in training and it the prehospital setting. We will discuss the process improvements that lead to the implementation of video laryngoscopy as our first-line intubation tool. The ultimate goal of any air medical or prehospital emergency medical services program is to manage 100% of airways without complications, which will decrease morbidity and mortality, ultimately improving patient outcomes.