A mnemonic device to optimize post ROSC care for neuroprotection
Noah McManus, ADN, RN; Brittany Atkinson, BSN, RN; Jennifer Krebsbach, BSN, RN; Patrick McKinney, BSN, RN, CEN; Andrew Mittelman, BS, RN, CEN; Jordan W. Tiller, BSN, RN, CEN, TCRN
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Session H presented Friday, September 28, 2:30-3:30 pm
Purpose: Emergency department and EMS resuscitation teams sometimes achieve return of spontaneous circulations in cardiac arrest patients. These patients are then very vulnerable to neurological injury for various reasons. The nurses in our department developed a mnemonic device using the word OPTIMIZE aimed at avoiding brain damage after cardiac arrest and ROSC. The device was designed to organize treatment teams, goals and the interventions needed to achieve these goals to provide neuroprotection to ROSC patients. Some of the neuroprotective strategies included are tight SpO2 and EtCO2 control, targeted temperature management, maintenance of target MAP to support adequate CPP, tight glucose control and addressing metabolic derangements.
Design: This project started out as a process improvement initiative in our department. Our shared governance councils worked on design and implementation. Our education council developed the device and presented the concept to our staff with an opportunity to practice using it in a simulation environment at our annual skills day. The professional development council thought it would be a good topic to for a poster presentation or paper, and resolved to submit an abstract. Setting: This project was implemented in an urban emergency department. This facility is a level 1 trauma, chest pain, comprehensive stroke and burn center.
Participants/Subjects: The mnemonic device was used for patients who had cardiac arrest and ROSC in the pre-hospital or emergency department setting. Those using the device are multidisciplinary teams comprised of emergency department nurses, MDs, PAs, techs, pharmacists, respiratory therapists, and ancillary staff.
Methods: Each letter of the word OPTIMIZE was printed in 128pt font on a landscape oriented piece of paper. Next to each letter (in smaller type) are related treatment goals, interventions, current state and desired state physiological parameters. For example, 'O' for oxygenation, 'P' for pressure and so on. On each sheet there is also a spot to note which team member will be working on the interventions needed to reach the goals. The eight sheets were laminated and connected to form a vertical banner 1ft wide x 6ft tall, which was posted on the walls in our resuscitation bays. After ROSC is achieved; and ABCs are confirmed, the code team leader calls a 90 second time-out and the team goes down the banner to address identified needs. A dry erase marker is used to write down the information on the banner so that all in the room can reference it. The team then breaks to execute the planned interventions. All of the interventions and treatment goals are evidence based and widely accepted as best practice. If the device was used a patient sticker is retained for tracking purposes.
Results/Outcomes: So far, 83% patients departed the ED alive and arrived in the ICU with MAP goals met. 50% of patients met induced hypothermia goals. No patients were hyperglycemic on admission. Implications: As more data is collected we expect trends to show increased frequency of survival and treatment goals being met for this critically ill patient population. Expanding the device's arena of use is being considered.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
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