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Education, Teaching, and Quality Improvement |

The Implementation of Critical Care Trained Nurses Outside the ICU

Bernadette Amitrano, RN; Tara Laumenede, MNSc; Seung-Hyun Lee, RN; Donna Doherty, RN; Diane Deak, RN; Rubin Cohen, MD
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Hofstra North Shore LIJ, New Hyde Park, NY


Chest. 2013;144(4_MeetingAbstracts):527A. doi:10.1378/chest.1703215
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Abstract

SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: A group of critical care nurses (clinical impact nurse (CIN)) was initially founded as members of the hospital’s rapid response (RR) team but whose responsibilities soon expanded to other clinical areas. We report on CIN roles and initial impact in a 500 bed academic teaching adult hospital.

METHODS: An observational study including survey of 110 nurses and 4 physician assistants on inpatient wards, prospective data collection on sepsis mortality and diaries of daily activities kept by CINs.

RESULTS: In addition to attending all RR, the CIN performed the following: 1) Daily collaboration with physicians and non-ICU team members in coordinating and implementing plans of care for high risk ward patients .2) Mentoring of ward RN's to improve recognition of and response to early clinical deterioration of patients 3) Remaining with RR patients, assisting with disposition and transfer to higher level of care, enabling faster initiation of critical treatments and reducing transfer times to ICU . 4) Assisting with education of ward RNs to facilitate adherence to IHI Sepsis Bundle, prompting early identification and treatment of sepsis. 5) Daily rounding with unit managers identifying high risk patients. A survey of 110 ward nurses revealed that > 90% felt that CIN involvement led to improved patient care and management of RR with more rapid transfers to higher level of care; 70% of ward nurses called CIN directly. Risk Adjusted Sepsis Mortality Index decreased from 0.71 prior to CIN implementation to 0.65

CONCLUSIONS: There appears to be a need for critical care nursing expertise outside of the ICU. The CIN has had a positive effect on sepsis mortality and is regarded highly and relied upon by ward nurses.

CLINICAL IMPLICATIONS: Implementation of critical care trained nurses outside the ICU has been successful in improving timely patient care, providing a resource for ward nurses, and providing an opportunity for education and support for nurses on inpatient units

DISCLOSURE: The following authors have nothing to disclose: Bernadette Amitrano, Tara Laumenede, Seung-Hyun Lee, Donna Doherty, Diane Deak, Rubin Cohen

No Product/Research Disclosure Information


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