the new frontier of clinical initiative nurses

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2009 CENA International Conference for Emergency Nursing

The NO L-A-T-E-X principle—–Safe and effective care of thelatex-allergic patient in the emergency department

Sarah Bullen

Sandringham Hospital, 193 Bluff Road, Sandringham, VIC3191, Australia

E-mail address: s.bullen@alfred.org.au.

Have you ever had a patient who reports being aller-gic to latex or rubber? What is this allergy and what causesit? What patient groups are at risk? How can we take careof these patients safely and effectively in the emergencydepartment?

Since the emergence of HIV and the increasing trans-mission of Hepatitis B, the use of latex rubber glovesand products both within and outside of health care hasincreased markedly. Along with this trend, the incidenceof latex rubber allergy and sensitivity in both health careworkers and the general population has also grown.

The purpose of this session is to discuss latex rubberallergy in the context of the emergency department patientincluding a review of the incidence of the problem in thegeneral population, the patient groups at risk, how thisallergy is diagnosed and how to assess a person’s risk ofsevere allergic reaction. In addition, methods for identify-ing the latex rubber content of medical products will bediscussed and the emergency nursing implications of pro-viding a ‘latex-safe’ environment to this patient group willbe presented.

Safe and effective care of this group of patients in theemergency department is both reasonable and possible withcareful attention to the NO L-A-T-E-X principle. Participantswill leave this session with a basic understanding of latexrubber allergy in the context of the emergency departmentto enable them to apply the knowledge and skills gained totheir own workplaces.

Keywords: Latex; Latex hypersensitivity; Emergency nursing

doi:10.1016/j.aenj.2009.08.052

Checking on the children: Reviewing the changing modelof practice for Discharge Planning in Emergency Depart-ments

Bridie Cooper

Redcliffe Hospital Emergency Department, Anzac Ave, Red-cliffe, QLD, Australia

E-mail address: bridie cooper@health.qld.gov.au.

Emergency Departments globally are feeling the strain ofmeeting the demands of ever increasing volumes of patients,providing high standards of care and ultimately improv-ing the flow of patients through the department. The DidNot Wait (DNW) category at Redcliffe Emergency Depart-ment was identified as a significant Diagnosis Related Group(DRG). A project was started to address this issue through

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he Home Based Acute Care Service (HBACS). This discus-ion will explore the findings by assessing the benefits andmplications of this practice. It identifies the changing modelf practice of Discharge Planning to meet the needs of themergency Patient by enhancing the quality of care and edu-ation provided and thereby enhancing the flow of patientshrough busy Emergency Departments.

A review of the transcripts of the follow up telephonealls over a three-month period highlights the benefits foratients having Discharge Planning commenced from triage.t also highlighted the benefits for patient satisfaction ofervice and those patients recalled for medical assessment.t will briefly cover the types of presentations and categoriesiven at triage for the focus group and their reasons for notaiting. Also discussed is a comparison of this group with itsdult counterparts from the same three-month period andetermines correlations between DNW’s and the number ofatient presentations from the same day.

It is demonstrated that with appropriate Discharge Plan-ing models in place, the level of patient satisfactionncreases, fewer patients re-present and patient safety isrotected. It describes which elements of Discharge Plan-ing are critical for Emergency Patients, either that ofatient education beginning at triage or the important fol-ow up telephone call if the patient has chosen not toontinue through the Emergency process. Ultimately it willake you glad that someone is ‘Checking on the Children’.

eywords: Discharge Planning; Emergency Departments

oi:10.1016/j.aenj.2009.08.053

he new frontier of Clinical Initiative Nurses

llison Jordan ∗, Matt Luther, Michael Holroyd

Emergency Department, Calvary Health Care ACT, Australia

As Emergency Departments across the nation strain underonstant pressure to meet triage benchmarks, ambulanceff stretcher times and patient and governmental expec-ations, innovative approaches to Emergency Departmentodels of care is being demanded.1,2 These new methodolo-

ies have seen the traditional role of emergency departmentursing evolve with the introduction of advanced practiceoles such as the Clinical Initiative Nurse and the Nurseractitioner.

As patient waiting times for category four and five pre-entations increase, the potential for compromised qualityatient care and dissatisfaction is ever present. Calvaryealth Care ACT has worked to prevent this trend by imple-enting Clinical Initiative Nurse to improve access, enhanceatient safety and increase timeliness.

While the Clinical Initiative Nurse role is not a new con-ept, Calvary Health Care ACT has seen the potential in thisole and is currently progressing the role beyond its normalunction. The new approach will allow for greater indepen-ence, leadership and advanced practice procedures. Theole is tenaciously supported by the organisation demon-

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Keywords: Recruitment; Retention; Nursing workforce

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ve waiting times, improving patient journey and thereforeatisfaction and through these goals, staff satisfaction.

This overall success of this new role will be demonstratedy a direct comparison between pre and post implementa-ion data relating to relevant DRG seen times, re-educationn ‘did not wait for treatment’ presentations and improvedatient satisfaction. This presentation will also show the keyenefits, challenges and lessons learnt from the introductionf the Clinical Initiative Nurse role.

eferences

1. Australasian College of Emergency Medicine. Access blockand overcrowding in Emergency Departments [Elec-tronic Version]; 2004. Retrieved July 6th, 2008, fromhttp://www.acem.org.au/media/Access Block1.pdf.

2. Cameron P, Campbell D. Response to access block in Australia:Royal Melbourne Hospital. The Medical Journal of Australia2003;178(3):109—10.

oi:10.1016/j.aenj.2009.08.054

RAL PRESENTATIONS 4B — Workforce & Quality

oyal Melbourne Hospital Emergency Departmentedevelopment—–The journey continues

lizabeth Virtue

Royal Melbourne Hospital, Grattan Street, Parkville 3050,ictoria, Australia

-mail address: elizabeth.virtue@mh.org.au.

In September 2008 the Royal Melbourne Hospital Emer-ency Department completed the first stage of a $56 millionedevelopment. After several delays, with inadequate timeor familiarization and training the staff moved into a tem-orary home. Simultaneously we introduced the PyxisTM

edication storage system and the first stage of a decen-ralized model of care designed to keep clinicians at theedside.

What ensued was a very dark time for the staff as theytruggled to deliver safe care in an unfamiliar environ-ent with sub-optimal workflows, an inadequate work force

o function in a decentralized department, constructioneficiencies and mounting pressure to meet performanceargets.

Now nearing completion at the end of 2009 the RMHD offers state of the art facilities; 105 clinical spaces—–ncluding 58 cubicles, 12 short stay and 30 assessment andlanning beds with a first floor administrative and staff wing.he reconfiguration of the treatment areas has incorporatedontemporary designs, future technologies and LEAN prin-iples. Enhancing the patient experience has been at theentre of all design considerations with particular emphasisn the provision of privacy, comfort and distraction.

This paper will feature a pictorial overview of the designoncepts, discuss the challenges of the journey so far and

eyword: Emergency department; Design

oi:10.1016/j.aenj.2009.08.055

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CONFERENCE ABSTRACTS

epartment-based recruitment and retention plans: Oneepartment’s journey to success

hane Lenson ∗, Rowena Dyer

Emergency Department, Calvary Health Care ACT, ACT, Aus-ralia

-mail address: shane.lenson@calvary-act.com.au (S.enson).

Workforce challenges are not a new issue for the healthare sector. The ability to recruit and retain skilled nurs-ng staff is an immense and ongoing challenge. Amidst thesehallenges, the Emergency Department at Calvary Healthare ACT embarked on a locally based recruitment andetention plan developed by the Emergency Departmenteam members’ inline with their own identified needs.

The identified plan involved a number of key elements tonsure a comprehensive and skilled workforce to meet theepartments operational requirements. These key elementsnclude the branding and marketing of our team’s ethos,n aggressive recruitment program for both permanent andasual team members, a clearly defined skills developmentrogram including a nursing career pathway, an academicartnership allowing for emergency nursing specific post-raduate studies to be coordinated by the department’sducational team and burn out prevention strategies.

The initial results indicate that this program has provenuccessful. The recruitment campaign has led to the depart-ent filling all vacant positions and the skills developmentrogram has seen the commencement of formal emergencyursing education improving departmental skill mix andnsuring the provision of best practice health care. Thiscademic partnership has led to fourteen team membersommencing post-graduate studies in emergency nursing.he burn out prevention program has led to an increased usef annual leave and a significant reduction in the incidencef unplanned personnel leave. Supporting these observa-ions is an external formal staff satisfaction survey in whichhe department has made major gains, including the forma-ion of new survey bench marks in a number of the areasurveyed.

Throughout this process the department has been able toease the use of agency nursing staff which has led to a sig-ificant reduction in workforce costs, has led to a reductionf incident reports and an increase in staff compliance withhe hospital’s patient satisfaction program

These positive results have been largely attributed tohe local development and ownership of the recruitmentnd retention program. As a offshoot to the results seen inhe Emergency Department, Calvary Health Care ACT is nowncouraging all hospital areas to take a greater role in theirtrategic recruitment and retention activities in contrast tohe traditional reliance on human resource departments and

oi:10.1016/j.aenj.2009.08.056