Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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The phenomenon of missed injury in trauma patients has been recognized for some time. Tertiary examination has been proposed as one strategy to decrease the incidence of missed injuries. The tertiary examination is a comprehensive reevaluation that includes a repeated head-to-toe examination and review of all laboratory and radiologic studies, completed within 24 hours of admission. ⋯ The 16 missed injuries represented only 2.7% of the total 589 injuries, which was not significant. The most commonly missed injuries were fractures of the extremities. We propose that tertiary examinations be adopted as a standard of care for patients admitted to level II trauma centers.
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Performance improvement (PI) in the multiple systems injured patient frequently highlights areas for improvement in overall hospital care processes. Failure mode effects analysis (FMEA) is an effective tool to assess and prioritize areas of risk in clinical practice. Failure mode effects analysis is often initiated by a "near-miss" or concern for risk as opposed to a root cause analysis that is initiated solely after a sentinel event. In contrast to a root cause analysis, the FMEA looks more broadly at processes involved in the delivery of care. The purpose of this abstract was to demonstrate the usefulness of FMEA as a PI tool by describing an event and following the event through the healthcare delivery PI processes involved. ⋯ Near-miss events may be overlooked as opportunities for improvement in cases where no harm has come to the patient. As a result of our FMEA investigation, the following recommendations were made to improve hospital care delivery in those trauma patients who require inpatient dialysis: 1. Education of RNs about the dialysis process. 2. Implementation of a formal reporting process between the RN and the dialysis technician before the procedure is initiated. 3. RN supervision of dialysis treatments. 4. Use of a preprinted inpatient dialysis form. 5. Education of dialysis technicians regarding their scope of practice. 6. Improve notification process for scheduling dialysis procedures between units and dialysis coordinator (similar to x-ray scheduling). Our performance improvement focus has broadened to include all reported "near-miss" events in order to improve our healthcare delivery process before an event with sequelae occurs. We have found that using FMEA has greatly increased our ability to facilitate change across all services and departments within the hospital.
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Multifactorial changes within healthcare systems across the United States and beyond have forced hospitals to reevaluate the ways in which resources are used. With recent restrictions on resident work hours, the nurse practitioner has emerged as a front-line player in healthcare. This change, however, has brought with it more advanced therapies, treatments, and interventions which the nurse practitioner now practices more independently. ⋯ To date, little information on the demographic data and the background of these professionals has been published, nor has there been much discussion related to the orientation process for this innovative role. The data described in this article identify commonalities and differences in the trauma nurse practitioner's professional experience. This information will be used to collectively propose formal recommendations for more structure and organization of the future trauma nurse practitioners' orientation to this unique and valuable role.
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Nurse practitioners have played a pivotal role in both advances in patient care and healthcare policy over the last 40 years. As the healthcare environment continues to change, so too does the role of the nurse practitioner. ⋯ As the role continues to evolve and grow, the growing pains will multiply. This article will discuss one nurse's experience of being the new nurse practitioner in a new role and the challenges, both positive and negative, that have grown out of that experience.