heather wicks, rn, bsn. part i: program overview leaders in trauma program trauma activation...

Heather Wicks, RN, BSN

Livingston HealthCare Trauma Program

Part I: Program Overview• Leaders in trauma program• Trauma activation• Components of trauma

program

Part II: Improvement Activities• Data collection and analysis• Results• Outreach

Outline of Presentation

Leaders in trauma program

Dr. Christopher Lee• Trauma Medical Director• General Surgeon• ATLS Certified

Heather Wicks, RN, BSN• Trauma Coordinator• Emergency Department Nurse• Instructor of TNCC, ENPC, ACLS, PALS• ATCN Certified

Dr. Allan Supak• Emergency Department Director• EMS Director• Emergency Department Physician• ATLS Certified

Kiera Pattison, RN, BSN• Emergency Department Manager• Training Center Faculty • Instructor TNCC, ENPC, ACLS, PALS• ATCN Certified

Mary Ellen Szafranski, RN, BSN• Emergency Preparedness Coordinator• CHEC and ADLS Certified

Trauma Activations

Two tier decision scheme

Standby Alert

Minor Anatomical Criteria

Major Anatomical Criteria

Mechanism Physiological

Special Consideration Special Consideration

Yellowstone National ParkGateway Hose Company

LFRParadise ValleyClyde ParkCooke CityWilsall

Private Vehicle

Initial Activation, EMS

Standby Alert

ED Physician/Nurse Surgeons

Radiology House Supervisor/ICU nurse

Laboratory Surgical Services

Cardiopulmonary (if in house)

Nurse Anesthetist

Trauma Coordinator

Pharmacy

Activation Personnel

ED physician• In house 24hrs a day• ATLS Certified• Peer Review Meetings

ED nurses• One ED nurse 24hrs a day• 2nd ED nurse Fri-Mon 11-23• TNCC and ENPC• Monthly meetings• Trainings

ICU nurses/House Supervisors• 2nd nurse• TNCC• Trainings

Trauma Activations ED

Radiology Technician • 0700-2100 in house• On call 24hrs a day

Laboratory Technician• 0600-2300 in house• Night 6 days every two weeks• On call 24hrs a day

Respiratory Therapist• 0700-1900 in house• Standby if in house• Alerts on call 24hrs a day

Ancillary Services

OR nurses• Two on call 24hrs a day• One PACU nurse on call 24hrs a day• TNCC

Nurse Anesthetists• One on call 24hrs a day• ATLS

General Surgeon• On call 67% 2013• ATLS• Meetings

Orthopedic Surgeon• On call 96% 2013• Meetings

Surgical Services

Improvement Activities

Part II

• Targeted modification of trauma care practices

• EMS

• ED

• Ancillary Services

• Process Overview

• Determine criteria for ideal care (care points)

• Quarterly analysis

• Implement solutions

Systematic Analysis of Care

Gather charts• ICD-9 codes- 1600 charts per year• Review each chart• State trauma charts- 70 charts per year

Performance Improvement • Case to case• Record care point statistics on charts

Method: Analysis

General Chart Information

Total charts reviewed

Total charts with performance improvements

Total charts submitted to the state

Mechanism

Activation/Accuracy

Quarterly Meetings

Evaluation

• Monitor future statistics for improvement

Method: Meetings & Evaluation

Example, Initial and Repeat Temps

Example, Initial and Repeat Temps

Example, Initial and Repeat Temps

Triage 2013

EMS Results

EMS Care Points

Chart available

Correct O2 applied

GCS charted and circled

Activation called in field

Intervention times recorded

Warming measures

IV catheter size

Scene time

Emergency Department Results

Emergency Department Care Points

Trauma chart used

Trauma team response

Tetanus

Initial temperature

Full set of vital signs

Correct O2 applied

Cardiac monitor

IV catheter size

GCS

Primary/secondary survey

Warming measures

Off backboard < 20min

Repeat temperatures

Time in ED <3hrs

< 2 liters infused

Radiology Laboratory

Chest x-ray Time until lab draw

Pelvis x-ray CBC

CT time in Scanner Chemistry

CT time until read Blood Banking

Ancillary Services

Currently Adopting Process

• Care points:

Further Improvements

Emergency Medical Services• Meetings• TXA• Disaster Preparedness training• IV Protocol

Emergency Department• Pediatric Cart• Lead/ PPE• TXA• Auto-transfuser• Pericardiocentesis Kit• Cricothyroidotomy Kit• EZ-IO

Cardiopulmonary• O2 application

• McGrath• ETCO2 Monitoring• Obtain ABG

Imaging Services• Bucky with portable machine • Mobile Ultrasound• CT (4 to 32 slice)

Further Improvements

Laboratory• O-negative blood• Trauma binder• Massive transfusion guidelines

Surgical Services• In-services OR auto-transfuser• TNCC• New orthopedic surgeon• General surgeon fill-in coverage

Further Improvements

2012 Community Outreach

2013 Community Outreach

2014 Community Outreach

Thanks for listening!