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