Newsletter

President's Message

Carol Minnis, RN, CEN

Challenges in Emergency Nursing

I had already begun to write this article when 42 of us gathered at Miles Memorial Hospital for the Maine ENA Spring Education Day.  Part of the program in the afternoon was moving from room to room having round table discussions on “Hot Topics”.  One of the topics was improving ED throughput and the problem of boarding patients in the ED.

Not surprisingly, we all had identified the same problems and obstacles.  We also had improved most of the issues that we had control over, but all continue to struggle with the ones that depend upon the cooperation and buy in from other departments, such as actually getting our patients who need to be admitted into their inpatient beds.

One of the things that many of us have done is to move patients from the waiting room to an exam room as soon as possible.  If triage is backed up and there are empty rooms, we bring patients back and triage them there. At my ED on the night shift, when census is usually at its lowest, we pull the triage nurse and place a tech at triage.  Every patient who comes in is brought back immediately.  Patients who come in through triage get a “Quick Reg” and then full registration is done at the bedside.

If the admitting physician takes more than one hour to come in to see the patient, our ED providers write holding orders and we take the patient to the floor.

When we get a bed assignment, we call to give report and if the nurse is busy or otherwise not available, we can sometimes give report to the charge nurse.

The creation of a position for a day supervisor, or “Bed Czar”, has been very valuable for shortening the time for bed assignments by coordinating admissions and bed placement through out the hospital.

All the work has been very rewarding with increased patient satisfaction as well as the improvements in decreased time to provider and ED length of stay. Identifying obstacles is, of course, the easy part.  Changing practices and old habits is the most difficult part.

Our hospital, like many others, has recently done some restructuring and down sizing.  We have 21 beds less than we had a year ago and in the ED we are definitely feeling the impact of this.  We have suddenly begun to board some of our admitted patients for several hours.  We continue to meet regularly and work on solutions to our problems. One thing we have done is to identify areas in the hospital that may occasionally have extra beds that we can move patients from the ED into.  If these are not available, we have three rooms designated in the ED to hold admitted patients.  Developing a list of float nurses who will take care of these admitted patients has been a priority.

This process is not easy, but necessary, and we continue to strive to make constant improvements to the systems we have in place.

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Spring Meeting & Education Day

The Maine Spring Educational Day and Meeting, entitled “Challenges in Emergency Nursing” was held on April 6th at Miles Memorial Hospital, on the banks of the Damariscotta River.  46 emergency room nurses attended the spring program which was a blend of lecture, demonstration and interactive sessions.

The morning program consisted of four presentations which covered a variety of topics.  The first presentation, “Sepsis:  A Nursing Call to Action” delivered by Jane Dunstan, RN , CEN  reviewed staggering statistics relating to deaths due to sepsis, as well as examined the progression of disease states with corresponding signs and symptoms and the importance of early symptom recognition in high risk patients.  The need for nurse to nurse outreach  in other clinical settings (nursing homes, MD offices, etc) was also discussed as a way to educate other health care providers regarding the importance of  early recognition of  signs and symptoms, in an effort to both improve patient outcomes and encourage a system wide approach to early identification of a deadly disease.
“Emergency Nursing Implications in Caring for Bariatric Patients”  was the second presentation of the day by Crystal Buchanon, MS, NP-C.  This presentation examined how to create a bariatric friendly environment in the emergency room along with discussion of morbid obesity and national statistics surrounding its prevalence.  The presenter discussed bariatric surgery, comorbidities after surgery as well as possible complications which may ensue following the procedure.  Information was reviewed concerning the variety of presenting symptoms by patients who arrive at the ED along with special nursing considerations in the care of this patient population.
Following the morning break with refreshments and visits with vendors,  Stephen L. Johnson, Esq spoke on “Nursing Documentation in the Electronic Medical Records Environment”.   The importance of medical documentation was reviewed along with charting/documentation guidelines.  Further discussion centered on the documentation issues specific to electronic medical record environments.  Following the formal presentation, participants engaged in a lively question and answer session which could have continued long after the allotted time.  
The final morning presentation by Tammy Lachance, RN, BSN, CEN was entitled 
Therapeutic Hypothermia:  Current Recommendations and Applications to Practice.”  The history of induced hypothermia was reviewed along with the rationales and contraindications for inducing hypothermia.  Methods for inducing hypothermia were discussed  along with cooling methods and passive re-warming techniques.  Potential complications of therapeutic hypothermia were presented along with a case study.
Prior to the beginning of the afternoon session, participants had the opportunity to stretch their legs and enjoy a short walk to Schooner Cove, where a light lunch of  chicken caesar salad and desert was served in the formal dining room overlooking the river.

The afternoon sessions were both lively and interactive.  Participants were divided into three separate groups which rotated through three separate offerings which included:  Trauma Jeopardy, Hot Topics in the Emergency Department:  Round Table Discussions and Tough IV Sticks:  Peripheral Venous Access Using a FAST Scan.  
Jeopardy!  came equipped with a large screen version of the actual jeopardy game and buzzers!  Gameboard headings included: Every Breath I Take,  My Achy, Breaky Heart,  Gut Wrenching, Goin Out of My Head, Dem Bones and  Poison Potpourri.
Round Table discussions served to be a wonderful opportunity for folks to network and share ideas concerning 3 key topics for discussion:  1.holding patients in the ED until a bed becomes available, 2. time of case disposition by ED physician to arrival of/admission orders by a hospitalist or 3.  time from registration to triage to room:  what works?  Discussion evolved around inherent problems as well as creative solutions.  Each group assigned a recorder and key points during the various discussions were later shared at the conclusion of the day.
Tough IV Sticks:  Peripheral Venous Access Using a FAST Scan was presented by Colin Coor, MD, an emergency room physician at both PenBay and Miles.  Dr. Coor reviewed the actual FAST Scan and probes, the anatomy of the upper extremity (cephalic and basilic veins) and demonstrated imaging techniques

Despite tight quarters given the large attendance, everyone appeared to enjoy the variety and style of offerings, the opportunity for networking and good food.

Hope you will join us in September for the Annual Meeting and educational day!

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Save The Dates!

TNCC Dates for 2009 at CMMC

• Oct 6 & 7
• Dec 2 & 3

ENPC Dates for 2009 at CMMC

• July 16 & 17
• November 16 & 17

2009 ENA Annual Conference

Hope to see you in Baltimore!

MENA Annual Meeting

September 11th 2009
At The Senator Inn, Augusta
Watch for the brochure

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Welcome New Members

We now stand at 316 Members!

Please welcome these new (since January) members:

• Lori Allen
• Dawn Cates
• Scott Cook
• Shelly Daniels
• Linda Dutil
• Melissa Fairfield
• Sheila Flanigan
• Steven Hooper
• Jeff L’heureux
• Timothy Nelson
• Renn Nichols
• Pamela Pahel
• Valerie Philipot
• Carrie Ponte
• Lori Towne
• Kathryn Warner

Thank You!!

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