Improving the safety and quality of emergency nursing care in 10 Southern NSW LHD Emergency Departments
Tracks
Concurrent Stream 1
| Thursday, October 17, 2024 |
| 11:30 AM - 11:50 AM |
| Ionic Room |
Overview
Louise Casey
Speaker
Ms Louise Casey
Rural Trauma And Emergency Cnc
southern NSW LHD
Improving the safety and quality of emergency nursing care in 10 Southern NSW LHD Emergency Departments
11:30 AM - 11:50 AMAbstract
Background
Clinical handover and assessment are essential for patient safety in the emergency department (ED), leading to potential deterioration if not completed comprehensively. In Southern NSW local health district (LHD), 60% of incidents in 2020-2021 related to clinical management, non-adherence to policy, delays in transfer to higher level care, failure to recognise clinical deterioration or escalate, and failures in communication. We partnered with the University of Sydney to implement HIRAID® (History including Infection risk, red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) into 11 E.Ds. HIRAID® is the only validated assessment tool for emergency nursing.
Methods
A multi-method study was conducted with pre and post-implementation of HIRAID®, including staff and patient surveys and medical record review for presentations to ED in Southern NSW LHD from 2021-2022. We conducted pre and post mixed-method staff surveys for nurses employed in EDs to evaluate confidence in assessment, clinical communication and satisfaction with handover and documentation.
Patients ED experience was evaluated using Schmidt’s Survey & AHPE question set.
Review of medical records for patients with deterioration events within 72hrs of admission via ED, to evaluate any contributing factors to the events.
Results
There were 200 nursing and 938 patient surveys completed. Post-implementation, there was improvement in handover including provision of relevant clinical information 9% (p=0.04), relevant background information 16% (p=0.01) and clarity of handover 14% (p=0.04) compared to pre-implementation.
Patients in post-implementation surveys reported greater satisfaction regarding pain relief requirements 13.6% (p=<0.0001), felt their needs were met and communicated about their care
The deterioration review demonstrated significant improvement in rates of deterioration related to care delivered by the ED nurses (17%).
Conclusion
The study demonstrated implementation of HIRAID® led to improvement in ED nurse related deterioration events, initial nursing assessment, communication, and clinical handover.
Clinical handover and assessment are essential for patient safety in the emergency department (ED), leading to potential deterioration if not completed comprehensively. In Southern NSW local health district (LHD), 60% of incidents in 2020-2021 related to clinical management, non-adherence to policy, delays in transfer to higher level care, failure to recognise clinical deterioration or escalate, and failures in communication. We partnered with the University of Sydney to implement HIRAID® (History including Infection risk, red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) into 11 E.Ds. HIRAID® is the only validated assessment tool for emergency nursing.
Methods
A multi-method study was conducted with pre and post-implementation of HIRAID®, including staff and patient surveys and medical record review for presentations to ED in Southern NSW LHD from 2021-2022. We conducted pre and post mixed-method staff surveys for nurses employed in EDs to evaluate confidence in assessment, clinical communication and satisfaction with handover and documentation.
Patients ED experience was evaluated using Schmidt’s Survey & AHPE question set.
Review of medical records for patients with deterioration events within 72hrs of admission via ED, to evaluate any contributing factors to the events.
Results
There were 200 nursing and 938 patient surveys completed. Post-implementation, there was improvement in handover including provision of relevant clinical information 9% (p=0.04), relevant background information 16% (p=0.01) and clarity of handover 14% (p=0.04) compared to pre-implementation.
Patients in post-implementation surveys reported greater satisfaction regarding pain relief requirements 13.6% (p=<0.0001), felt their needs were met and communicated about their care
The deterioration review demonstrated significant improvement in rates of deterioration related to care delivered by the ED nurses (17%).
Conclusion
The study demonstrated implementation of HIRAID® led to improvement in ED nurse related deterioration events, initial nursing assessment, communication, and clinical handover.
Biography
Louise Casey, Trauma & Emergency Clinical Nurse Consultant for Southern NSW LHD. Based in Bega on the Far South Coast of NSW. My LHD takes in 10 Emergency Departments ranging from ATC's to level 4. The geographical distance is up to 400km between ED's. Our LHD sought a solution to patient assessment improvements in our ED's, specifically pain assessment and improving nurse initiated analgesia. We successfully partnered with University of Sydney to implement HIRAID
