Trauma Nursing Julia LaMonica RN CENJennifer Whalen RN CEN

A3 Thinking

Current State

Poor use of resources, communication and documentation.

• Additional nursing staff are often unorganized and tasks may be performed twice.

• Waste of medication and supplies.

• Physician staff is unsure of which nurse is responsible for a specific patient's care.

• Risk of lack of communication between surgery team and ED physicians.

• Medications, IV fluids, blood products are sometimes given by providers and go undocumented.

• Vitals are not recorded when patients are out of the trauma room receiving CT scans.

• Legal risk.

A3 Thinking

Target State

Target state defined by improved...

• Communication and documentation during all three phases of the trauma code.

• Management of both personnel and material resources in the ED.

• Identification of gaps in patient care/management and throughput.

• Staff satisfaction.

• Patient safety.

Phases of a Trauma

The Breakdown

Phase I - Arrival to trauma room

• Tasks to be completed:

• ABCs, IV access, primary assessment, IV fluids as needed.

• Identify patient's status (Trauma Red/Yellow).

• Identify team leaders.

• Begin documentation.

• Stabilize and prepare to move patient through phase II.

Phase II - Movement of patient to radiology

• Tasks to be competed:

• Continue monitoring patient on portable monitoring.

• Safely move patient to radiology.

• Obtain radiology scans.

• Avoid breaks in treatment (pumps/medication administration, airway protection, fluids, blood products, etc.).

• Continue documentation.

Phase III - Hand- off / Disposition

• Tasks to be completed:

• Secondary assessment.

• Complete history.

• Complete documentation regarding I&Os, med administration, property, family and NYPD notification, etc.

• Appropriate disposition of patient and transfer.

Target state defined by improved...

• Communication and documentation during all three phases of the trauma code.

• Management of both personnel and material resources in the ED.

• Identification of gaps in patient care/management and throughput.

• Staff satisfaction.

• Patient safety.

Proposal

Designating a RED Trauma Nurse

Role of The Red Trauma RN

The Red Trauma Nurse will assume the responsibility of 1:1 nursing care for the RED Trauma patient during the critical care period.

The Red Trauma nurse will take ownership of the patient and trauma code on a nursing level. They will work in conjunction with the attending and trauma team in order to coordinate all facets of care required during a RED trauma code.

The Red Trauma nurse may assume tasks on his/her own or appropriately delegate them to other staff and will maintain the comprehensive care of the patient under his/her own nursing autonomy.

Responsibilities

• Assume one to one responsibility of Red Trauma patient.

• Oversee nursing team during Red Trauma code.

• Account for all nursing tasks and appropriately delegate/assume tasks within nursing practice to ensure their completion.

• Coordinate care between multiple disciplines.

• Account for all nursing documentation - either completing or ensuring it is complete by appropriate staff.

• Follow Red Trauma patient throughout their ED care until disposition change to ICU/OR or clinically downgraded by Attending.

GoPack... So you don’t go Back

• Essentials:

• Etomidate

• Rocuronium

• Succinylcholine

• Benadryl

• SoluMedrol

• Epinephrine

• Atropine

• Calcium Chloride

• Flushes

• Syringes

• 18 guage needles

• Plastic bags

• Blank paper

GoPack!!

GoP

ack

GoPack Example

I f . . .I f . . . Then....Then....

Trauma Team CalledDesignated Trauma Nurse

from critical care area, triage, or teams responds.

Patient designated as RED trauma

Red Trauma Nurse identified to Attending, Charge Nurse,

Trauma team

Patient leaves from Trauma Room

Red Trauma Nurse grabs Go Pack and follows patient to

radiology

Patient leaves ED (dispo)Red Trauma Nurse gives

report

Patient is downgraded clinically

Red Trauma Nurse is relieved of 1:1 duties

Staffing

• Suggestions:

• Primary - staffing in critical care areas

• Secondary

• Days - Triage

• Nights - A and B teams

Staffing

• Implications:

• Will allow many nurses to rotate to critical care areas

• Will set standard to uphold with future requests for staffing

• Will improve patient care

• Brief 3 question survey to be filled out by the Red Trauma Nurse and Attending

• Chart Review

• Lists of RED traumas generated from Trauma Coordinator and forwarded for analysis of systems

Measures

Potential Problems

• Hand-off reports of patients with changes in staffing may be challenging.

• Patients not downgraded in timely manner and poor utilization of nursing staff.

• Poor communication between MD and RN.

• Learning curve.