Trauma RN EJ Program: Advancing nursing practice and reducing IV team activations in the emergency department
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Brandee Khoshnevis, MSN, BSBA, RN, CEN, TCRN
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Purpose: PIV access in the ED can be challenging. Failed attempts often prompt RNs to place an order for Vascular Access Team (VAT). This delays patient care by prolonging the time from MD to order to obtaining labs & administering necessary medications and/or IV fluids. Multiple attempts also leads to patient discomfort & dissatisfaction with care; wait times for VAT can be extensive. Evidence-based practice demonstrates a link between patient safety & Nurses functioning to the full extent of their training & licensing.
Design: This was a retrospective, quantitative study.
Setting: The study was conducted in a teaching facility with over 1000 beds. The Emergency Department is an academic, urban Level 1 Trauma Center with the 6th highest trauma volume in the nation.
Participants/Subjects: The goal was to have all trauma nurses in the Adult ED trained & validated to place EJs on an ongoing basis and exhibit a decrease in the number of VAT activations in relation to the addition of this skill. Using evidence based practice to guide this skill, implementation of this skill exhibits an elevation of nursing skills and practice in experienced nurses.
Methods: The first data point collected was the number of VAT activations in the Adult ED for the month of December 2015. There were a total of 22 orders for VAT during that month. Trauma nurses were offered EJ validation classes beginning mid-December. By the first quarter of 2016, approximately 96% of this group had received education and were granted the ability to initiate EJs. Value of this skill is exhibited by measuring five follow-up data points. In the month of January 2017 the ED had 4 VAT activations, in February there were 4, , in March there were 2, April there were 3 & May had 3 VAT activations.
Results/Outcomes: The first data point collected was the number of VAT activations in the Adult ED for the month of December 2015. There were a total of 22 orders for VAT during that month. Trauma Nurses were offered EJ Validation classes beginning mid-December, 2015. By the first quarter of 2016, approximately 96% of this group had received education & were granted the ability to initiate EJs. Value of this skill is exhibited by measuring five follow-up data points. In the month of January 2017 the ED had 4 VAT activations, in February there were 4, in March there were 2, April there were 3 & May had 3 VAT activations.
Implications: Per the data presented, EJ placement by ED nurses is a valuable and time saving skill which benefits patients and nurses. Per ENA recommendations, alternative IV access should be pursued when traditional peripheral access fails. As of mid 2018, there was a 44% decrease in VAT activations as compared to 2015. Next steps will be too continue training new trauma nurses with the goal of consistently having at least one EJ validated nurse in staffing at all times. Future plans include consideration of validating additional nurses in the department based on skills rather than trauma designation.
Emergency Nursing 2019. Held at the Austin Convention Center, Austin, Texas, USA
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | Quantitative Research |
Keywords | Difficult Intravenous Access; Advancing Nursing Practice; Emergency Department |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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