Nurse Driven Treatment Algorithms for Common Injuries Experienced at a Midwestern Zoo’s First Aid Station

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Becker, RandyLynn
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Quality Improvement , Clinical Treatment Algorithms
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Purpose: The purpose of this project was to create a system’s change to integrate evidence- based, standardized treatment algorithm for the four common pediatric injuries and medical needs that are seen at a Midwestern Zoo’s First Aid Station (FAS). This change will help the FAS nurses to efficiently assess, intervene, treat, and educate pediatric patients who are injured or in need of medical assistance. Background: The Midwestern Zoo hosts 2.1 million visitors annually. The FAS treats approximately 900 pediatric patients each year with heat stroke/heat exhaustion, allergic reactions, head injuries, and wounds being the four most common medical needs. These conditions often result in minimal morbidity but without proper intervention may lead to significant sequelae and even death. The American Zoo Association (AZA) holds high standards on how safety is conducted at the zoo and recommends that written information be available to the zoo staff to treat emergent and non-emergent health concerns. The American Academy of Pediatrics (AAP) suggests the use of protocols and/or guidelines as an efficient approach to effectively treat the pediatric population and decrease variations in the care given to patients. These clinical guidelines reduce harm, foster cost-effective practice, and generate positive patient outcomes. Currently the FAS lacks a seamless, evidence-based approach to respond to childhood injury or medical needs. Setting: Midwestern Zoo’s FAS. Sample: Six registered nurses employed at the FAS. The target population was pediatric patients (1 week-19 years of age) who presented to the FAS with heat stroke/heat exhaustion, allergic reactions, head injuries, and wounds. Methods: The Plan, Do, Study, Act (PDSA) cycle provided the foundation for implementing the four treatment algorithms. Integration of the treatment algorithms into practice was determined by reviewing the nurses’ documentation of pre-determined key components of each specific algorithm. Results: The results of the FAS nurse’s documentation showed 97% accurate documentation to the assessment of a wound, only 84% adherence for documentation related to patient education on the signs and symptoms of wound infection. Head Injury: 100% documented on level of conscious, 84% documented the Glasgow Coma Score (GCS), only 80% documented on assessing the eyes- Pupils, Equal, Round, React to Light (PERRL). Allergic Reaction: 81% documented on education of signs and symptoms to watch for when they go home, and only 63% or less included specific treatment of the allergic reaction. Conclusion: Treatment algorithms appear to be a reasonable approach for promoting consistent, seamless care when treating pediatric common, acute injuries at a FAS. The treatment algorithms empowers nurses to respond in an evidence-based manner which supports positive outcomes for the pediatric population seen at the FAS. Keywords: evidence-based nurse driven treatment algorithms, First Aid, mass gatherings, Heat Illness, Head Injuries, Wound Care, Anaphylaxis, evidence-based practice
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