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Massachusetts ENA Nurse Practice Blog


11.21.16 

Maria writes: I do not know if your ED is experiencing the same issues as we do with regards to the opiate crisis.  We are having issues with patients using and/or having illicit substances (in their possession) while the ED.

 Would appreciate your responses to the following questions:   See Rich's answers in RED below.   If you would like to provide feedback just email me at dianegurney@twc.com and let me know what is going on....................   Or, if there is another topic you want feedback on, just email me and I will post it.

Are you having issues with your patients "using" while in the ED? 

At times but it has been limited.

 

Hiding drugs on them while in the ED? 

Yes, but again we have limited policies that cover us for searching patients. 

 

Do you have a protocol in place for undressing and/or searching patients (and their belongings) for patients seeking detox? 

We do for psy but it's very limited for Public Safety that does a quick pat down.

 

How about those patients presenting with substance use/abuse related complaint (including overdose)?  No same procedure

 

Do you place restrictions (phones, visitors) for this patient population?  No

 

Thanks for taking the time to respond.

Maria

4.6.16  Nurses and the Law.  ANA Massachusetts Report on Nursing: MA nurses can obtain and possess naloxone to administer any individual appearing to experience an opiate-related overdoes. If asked to train an unlicensed person how to administer naloxone is NOT considered delegation, however you are responsible for the accuracy of the information taught. For more information, access MA DPH at http://www.mass.gov/eohhs/docs/dph/substance-abuse/core-competencies-for-naloxone-pilot-participants.pdf 

2.4.16   Here At NSMC we also are seeing fewer backboards and patients are taken off boards shortly after arrival. We have a protocol for removal by RN so we don't have to wait for the MD except if neurological symptoms, midline neck pain, distracting injury or confused/ impaired cognition.  Patients are still arriving w collars when appropriate.

 Another push we have had in our ED is to identify patients who may have C Diff and place on precautions before admission to inpatient units.  We've done this based on pt's reported hx of<1 month hx of C Diff and current reported diarrhea of 3 or more stools in 24 hrs, or hx of recent <3 mos antibiotic use, or recent < 1 month hospitalization or nursing home/rehab, or chemo therapy or immunosuppression.  Any pts who says NO to first 2 ?'s is screened out, any pt w yes C Diff is placed on precautions in the ED and any pt who answers yes to diarrhea and yes to any of the other questions gets placed on C Diff precautions in ED.  Is anyone else doing anything like this? We used the CDC guidelines for designing this screening

1.11.16  I came across a great website.  Of course, the info has not officially been vetted by MENA.  However, the info is referenced and provides great explanations of principles we need to understand to provide quality care......and it is helpful for studying for the CEN.  http://airwayjedi.com/2015/12/09/whats-the-difference-between-oxygen-saturation-and-pao2/#more-820  for the difference between O2 sat and Pa02.

1.4.16  Do  you have "kits" in your ED?   Which ones?   RSI, Dental, ICU Transport?  How often are they checked and restocked?  Is pharmacy involved?  

On another note...a recent study regarding prevention of SIDS revealed that only 51% of senior nursing students responded that infants should be placed in a prone position to sleep.  The "Back to Sleep" campaign in 1994 has been credited with reducing SIDS and SUID (sudden unexpected infant death) 53% in the past 20 years.  When you have a patient aged 32 weeks to 12 months, you have the opportunity for patient education in teaching the parents and caregivers regarding this issue.  nichd.nih.gov/sts/pages/default.aspx  

12.7.15   Right sided EKGs.  When and how to use.  See ENA's Translated Into Practice (TIP)  https://www.ena.org/practice-research/Practice/Documents/RightSideECG.pdf

11/5/15  BE INFORMED!  Governor Baker's new Opioid bill, H.3817, An Act Relative to Substance Abuse Treatment, Education and Prevention.  What are the consequences for emergency departments if this is passed?  You can read more about the bill at https://malegislature.gov/Bills/189/House/H3817 

11/5/15  A member from Charlton sends us info that patients are no longer being sent to Charlton on backboards.  Take a look at the Mass College of Emergency Physicians Guidelines at  http://www.acep.org/workarea/DownloadAsset.aspx?id=45190

10-20-15  Pull till full. When an ED room is open, Christiana Care Health System uses direct bedding, bypassing triage and placing patients in open beds.  Read more about strategies to improve flow at

http://www.hfma.org/Leadership/Archives/2012/Spring_2012/Unclogging_Patient_Flow_in_the_ED_and_Beyond/

10-19-15  I received feedback from Lowel General Hosp that they are receiving fewer patients on backboards.  Are you seeing this in your practice as well?

09-22-15   Someone has asked about the new protocol for application of cervical collars recently seen on TV.  Are we doing it in MA?  Does anyone have any info?

08.28.15   Are your patients being backboarded by EMS?   Read about the evidence:   https://www.ena.org/practice-research/Practice/Documents/LongBackboardUse.pdf.   Also look at https://www.acep.org/Physician-Resources/Policies/Policy-Statements/EMS-Management-of-Patients-with-Potential-Spinal-Injury/.

Email me your responses at dianegurney@twc.com

08.19.15   Did you read on Facebook about "the Pause"?   Check it out at http://wmra.org/post/emergency-medical-workers-pause-after-traumatic-death.  Is anyone in MA doing it? email me at dianegurney@twc.com

08.12.15   I hear that many of you are doing direct bedding.  How have you gone about it?  What have your challenges been?   What has worked?   email me at dianegurney@twc.com

07. 07.15  One of the topics brought up recently was related to the ENA position statements (PSs). In 2014 the process of developing a PS included a new step. The position statement drafts are now being posted on the ENA website for member comment. Each comment is then reviewed and considered by the committee. As chair of the committee I can tell you that we have made edits, additions, deletions and have gone back to the "drawing board" by completing another literature review in order to respond to these comments. For example, when we wrote the PS on Palliative and End of Life Care in the Emergency Setting (2013) we were updating an existing position statement and conducted a literature search, but none of us had heard of and/or had any experience with POLST and A.N.D. Are you aware of these? Do you implement these in your facility? What are they? POLST is Physician Orders for Life- Sustaining Treatment. A. N. D. is Allow Natural Death. Both of these approaches are based on thoughtful, perceptive, respectful and open communication and assist the patient and family to better manage end-of-life decision-making. 1 The practice of posting these position statements for member comment allows for rich discussion and more global, yet in-depth information and strategies to be shared. Member input is valuable and we appreciate everyone who takes the time to give feedback.

So, the question is: what does an ENA position statement mean to me? ENA PSs are a statement of belief and can help to direct care, serve as a philosophy, or recommend a course of action important to your practice, your ability to deliver safe care and/or the achievement of optimal patient outcomes. They are evidence-based........and now, they include member comments/feedback. As well, in addition to a current (within 5 years usually) reference list, many of them include a "resources" area with links to important information related to the topic. You can print off a position statement and use the information with your colleagues in your discussions related to Advanced Practice, Certification, Use of Credentials, and Mobile Electronic Device Use in the Emergency Setting. Or, you can advocate for changing practice in your department related to resuscitative decisions, what constitutes a safe discharge from the ED, violence in the ED or weighing patients in kilograms.2 You may identify a topic or issue that needs to be brought to the forefront of our practice. We recently had a request from a student nurse to address Human Trafficking. The PS on this topic was extremely popular and the member comments quite passionate. These topics and the information included in the PSs keep us connected and can assist to authenticate and support our practice.

What topic is an issue in your practice? Mass ENA's Fall Education Conference titled "Crisis in Behavioral Health: How Massachusetts ED Nurses are Meeting the Challenge" presented multiple strategies being implemented across the state. Valuable tools and resources were shared. Join the MA ENA Nurse Practice blog to bring your issues to the forefront and engage your colleagues in finding solutions.

Diane Gurney Chair Nurse Practice Committee

 

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Diane Gurney, MS, RN, CEN, FAEN dianegurney@twc.com