ENA Connection - October 2012 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection October 2012 Volume 36, Issue 9

Here Comes the Stun Preparing Now Means Your ED Won’t Be Blown Away When Calamity Turns the Community Upside-Down Special Disaster Readiness Section, Pages 10-23

Sidestepping Potential Pitfalls in Research PAGE 4

INSIDE

FEATURES

ENA Launches the ENPC Revision Course

PAGE 8

Sharing the Innovations and Best Practices of the 2012 Lantern Award Recipients PAGE 26 ENA Foundation’s 2012 Scholarship and Research Grant Recipients

PAGE 36

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Dates to Remember Oct. 8, 2012 Course proposal deadline for those seeking to be selected as faculty for 2013 Annual Conference in Nashville, Tenn. Oct. 24, 2012 Deadline to apply to become a contributing author of forthcoming Emergency Nurse Advanced Critical Thinking (ENACT) course (www.ena.org). March 15, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

ENA Exclusive Content PAGE 8 ENA Launches the ENPC Revision Course PAGES 10-23 Disaster Preparedness Section 10 Board Writes: Are You Ready for the Real Thing? C onsiderations for Disaster Preparedness Exercises 12 The Use of SBAR to Facilitate Patient Communication During a Disaster 14 Disaster Nursing Education: We Must Be Working, Learning as One 16 Measuring the Effectiveness of a Communitywide Disaster Drill 18 Focus on Hurricane Preparedness 20 Mass Casualty Patient Decontamination 22 Ready or Not: What Does It Take to Make Your ED Ready? 23 Building Relationships in Advance Aids Disaster Planning PAGE 26 2012 Lantern Award Recipients: Sharing Innovations and Best Practices PAGE 30 Go Global With TNCC and ENPC PAGE 35 Spotlight on the Nominations Committee PAGE 37 Leadership Conference 2013 Advance Program Is Going Digital

Monthly Features PAGE 4 ENA Research PAGE 6 Pediatric Update PAGE 11 Feedback Frame PAGE 28 ENA Call For ... PAGE 31 ENA Connected PAGE 32 Washington Watch PAGE 34 Academy of Emergency Nursing PAGE 36 ENA Foundation

LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

An Ounce of Prevention This year at ENA’s Annual Conference in San Diego, Karen Daley, president of the American Nurses Association and a longtime friend and emergency nurse colleague, delivered the Anita Dorr lecture. Her personal story is a poignant reminder of what could happen to any one of us. In the summer of 1998, while working in the ED, Daley was stuck by a needle protruding from a sharps container. A few months later, she learned that her flu-like symptoms were because of Hepatitis C and HIV. She didn’t know whether she would live or die. What she did know for sure was that her injury had been preventable. She was determined to tell her story so others would be protected, and she became an activist. As the then-president of a state nurses association, she had a voice, which she used to the fullest and lobbied for the Federal Needlestick Safety & Prevention Act of 2001. Daley’s talk reminded me of how far we’ve come, but also of how far we have to go. While the rate of sharps injuries seems to be going down, in 2010 in Massachusetts alone there were 2,947 sharps injuries among hospital workers (250 of them in the emergency department), and 53 percent of the sharps injuries reported involved sharps without any sharp injury prevention features.1 We do not know how many of those sharps injuries resulted in illness or even death. Massachusetts does not have those figures. A 1998 CDC study found that, of health care workers who had been exposed to blood in the workplace, 2-4 percent developed Hepatitis C infections, which have a high rate of chronicity and potential for chronic liver disease and liver cancer.2 Labels for sharps are misleading, since there is no definition and no standard specification for a ‘‘safety needle’’ or ‘‘safety device.’’ Some so-labeled can be even more dangerous than the old needles, particularly if the device requires a second hand to somehow cover the needle. In contrast, look at the attention to the safety of the public. Over the last few years, as many as 1.5 million baby strollers have been recalled because three children sustained fingertip amputations and two adults smashed their fingers in hinges on the stroller,

according to news reports. There was no need to pass legislation to reduce the number of dangerous strollers or increase efforts to educate consumers to better operate the strollers with retrofitted ‘‘safety hinge’’ devices. Would we tolerate a situation in which the general population was at similar risk in their daily lives, of being stuck with a needle contaminated with tainted blood? Would we be as complacent as we have been with our nursing and physician colleagues? Look at the attention to the safety of workers in industry. When a friend who had worked for years as an occupational health and safety nurse in industry began to work with a nursing association and visited hospitals, she was amazed at what she found. Nurses and other staff might be told to follow a certain detailed safety regimen, but it was sometimes followed with ‘‘when possible.’’ If it wasn’t possible to follow the guideline, the health care worker was told, ‘‘Be careful.’’ The public, and much of industry, is afforded passive (automatic) protection by such features as airbags and meat-slicing guards, and nurses deserve no less. The authors of an in-depth safety study concluded that ‘‘we provide clear evidence that passive [fully automatic] safety engineered devices (SEDs) are more effective than active [requiring the user to activate] SEDs for needlestick injuries (NSI) prevention. Passive devices require no input from the user, and this is Continued on page 40

Emergency Nurses Week™ – Oct. 7-13 Emergency Nurses Day® – Oct. 10

PAGE 38 State Connection

The ENA Board of Directors congratulates all emergency nurses.

PAGE 40 Board Highlights

Emergency Nurses: Every Patient + Every Time = Making a Difference

Official Magazine of the Emergency Nurses Association

ENA RESEARCH |

Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research

All Results Are Useful

Sidestepping Potential Pitfalls Why do we do research? a) Research is all about getting answers. b) Research is all about getting the ‘‘right’’ answers. You have set up your study to answer your question, gone through the Institutional Review Board and had your abstract (results pending) accepted to a conference. You start to analyze all your carefully collected data, waiting for the answer to your question to reveal itself. And … you don’t find what you thought you would find. Or not enough of what you thought you would find to analyze properly. Or you don’t find anything that made a difference. Or not enough of a difference to justify the cost. Researchers go to a lot of effort to set up their studies so that they are using the right method to answer the right question. Well-done research studies can take a considerable amount of time to collect data, depending on the method. However, once the data is analyzed, it’s important to look at what the data reveals, regardless of whether that’s the answer the researcher is ‘‘hoping’’ for. For example, we recently did a study of what we thought was the implementation of nursedelivered Screening, Brief Intervention and Referral to Treatment, using a mentoring system to facilitate practice changes in emergency departments. We wanted to find out if the use of regional remote mentors increased the use of SBIRT in emergency departments. We had more than 100 sites agree to participate in the study, but only 55 sites filled out the initial survey.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

After a period of encouragement, and data from about half the regional mentors, we received follow-up data from only about 22 sites. This was not enough data from which to draw any real conclusions. Was this a useless study? Once we sat and thought about what had happened, we realized that far from giving us no information, this process had provided enormous insight into factors that might challenge or enhance other study protocols conducted in emergency departments. For example, involving people remotely was not as successful as we had expected. Only half of the remote mentors were

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The Research Column in Connection has been designed to give succinct, useful information about the research process and how research can be useful to the bedside emergency nurse. Please send topic suggestions to LWolf@ena.org.

able to engage their sites in the project. These challenges to implementation and data collection suggest that on-site mentoring might be a better method, and that on-site infrastructure and support for these kinds of practice-changing initiatives are prerequisites to adequate data collection on the effectiveness of the project. We found out that it’s easy to get people to go to one class or view one webinar, but the more content that we asked them to absorb, the less ability there was to maintain consistent participation over time. Lesson learned: Condense all the information into one session when possible. Another lesson learned: If there’s not a big incentive to participate, it’s not reasonable to ask people to do a lot of work, especially for a sustained period of time. These three really important pieces of information will allow us to plan the next study based on what worked, what didn’t and where the gaps in understanding now lie. Research studies can look really good on paper. They can be well planned and well developed. Before you begin to plan your study, however, it’s useful to look at any ‘‘lessons learned’’ literature to see if other researchers may have documented challenging issues with the implementation of a similar study. All results are useful. Use other researcher’s findings to make sure you approach your own research with the best possible understanding of potential pitfalls.

Editor in Chief: Amy Carpenter Aquino Assistant Editor, Online Publications: Josh Gaby Writer: Kendra Y. Mims Editorial Assistant: Dana O’Donnell BOARD OF DIRECTORS Officers: President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN President-elect: JoAnn Lazarus, MSN, RN, CEN

Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN Directors: Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CEN Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN Matthew F. Powers, MS, BSN, RN, MICP, CEN Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LP.D., RN, CEN, FAEN

October 2012

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PEDIATRIC UPDATE |

Elizabeth Stone Griffin, BS, RN, CPEN

A National Assessment of ED Pediatric Readiness When a gunman opened fire in a movie theater in Aurora, Colo., this past summer, the youngest victim was 6 years old. As emergency departments in the community sprang into action, each facility went immediately into disaster response mode. If the same thing happened in your community, would your facility have the resources, equipment and staff on hand to care for the child?

Introduction The National Pediatric Readiness Project is working to ensure that emergency departments nationwide know what is necessary to care for children, and it is building a clearinghouse of resources to help all facilities become ‘‘pediatric ready.’’ The first step in the project is an assessment. Beginning in January 2013, emergency departments nationwide will receive a special online assessment which holds much promise for improving pediatric emergency care. The National Pediatric Readiness Project is a multi-phase, ongoing quality-improvement initiative by the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Medical Services for Children and ENA. It will measure each hospital emergency department’s readiness to treat children based on whether it has essential resources identified by the 2009 Guidelines for the Care of Children in the Emergency Department Joint Policy Statement.1 Because an ED’s ability to care for children on a day-to-day basis is linked to its ability to provide care in the event of a disaster, the National Pediatric Readiness Project believes that every facility, whether urban, suburban or rural, should participate. The goal of this first phase is to survey every hospital emergency department nationwide that cares for children. Participating EDs also will receive detailed feedback and have access to quality-improvement resources, which will help them address any areas needing improvement. The ultimate goal of the Peds Ready Project is to ensure that all EDs, regardless of their size and location, are prepared for pediatric patients.

Assessment Details and Benefits The secure, Web-based assessment, which will roll out on a staggered timeline beginning in January 2013, will serve as the first crucial step of this project. The state of California served as the pilot for the Peds Ready Project in 2012, boasting an impressive 90 percent response rate. In 2013, the assessment will be sent to ED medical and nursing leaders in the remaining states and U.S. territories; it is advised that the recipients in each facility collaborate to complete it by printing it before completing it online. Only one entry per hospital will be permitted. Each participating facility will receive immediate feedback in the form of a pediatric readiness score (based on a weighted, 100-point scale). This score will include point values for the seven sections outlined in the National Guidelines (e.g., staffing, QI policies, equipment and supplies). In addition, upon

completion, each participating facility will receive a gap analysis detailing hospital-specific needs and recommendations to enhance pediatric readiness. The assessment will be confidential; no identifying hospital information will be released. However, overall results will be available online, thus allowing participating facilities to benchmark with other facilities nationwide based on pediatric patient volume.

ENA’s Role As one of the key organizations supporting the Peds Ready Project, ENA plays a vital role in its success. ENA is reaching out to its membership on the national and state levels to help support the Peds Ready Project by educating themselves, helping educate others and offering support to those who will be completing the surveys. Every emergency department, regardless of size and location, wants to deliver the best possible care to children. Let’s work together on this national effort to improve pediatric care by supporting the Peds Ready Project. The Peds Ready Project represents an unprecedented opportunity to empower hospitals nationwide, regardless of their size and location, to provide the best possible care for children seeking their help. For more information, visit www.pediatricreadiness.org for the schedule, printable versions of the assessment and supporting resources.

References 1) Joint Policy Statement: Guidelines for Care of Children in the Emergency Department. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee and Emergency Nurses Association Pediatric Committee. Pediatrics 2009;124;1233; originally published online September 21, 2009. 2) National Pediatric Readiness Project website: www.pediatricreadiness.org.

October 2012

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ENA Launches the ENPC Revision Course By Kendra Y. Mims, ENA Connection ENA is excited to announce that the highly anticipated Emergency Nursing Pediatric Course 4th edition is now available for participants. The ENPC Revision Work Team Committee and ENA staff members started the revision process two years ago. The instructor rollout of the ENPC 4th edition was launched Aug. 27, and Sept. 1 marked the first day that course directors could hold 4th edition classes. This is the course’s first revision since 2004. ENPC 4th edition provides emergency department personnel with the knowledge and tools needed to prepare for pediatric patients, following the Guidelines for Care of Children in the Emergency Department created by the Emergency Nurses Association, the American Academy of Pediatrics and the American College of Emergency Physicians. The ENPC 4th edition is taught using online learning, lectures, videos, group discussion and hands-on skill stations (i.e., management of the ill or injured pediatric patient and the pediatric clinical considerations) to encourage participants to integrate their psychomotor abilities into a patient situation in a risk-free setting.

What’s New in the 4th Edition Participants will be excited to know that three new chapters have been added to the 4th edition: environmental emergencies, disaster and adolescent. The environmental lecture will look at bites and venomation, and the disaster lecture will use case studies to identify the risks associated with the pediatric population. The adolescent chapter is an exciting highlight for emergency nurses, said Nancy Denke, MSN, ACNP, CEN, FAEN, chairperson for the ENPC Revision Work Team. ‘‘In the adolescent chapter, we talk about the challenges in treating adolescent patients and the common problems you’ll see with taking care of the adolescent child,’’ Denke said. ‘‘I think the adolescent chapter has been one of those chapters that has been lacking. We really need the information to care for those children better than we have been and make emergency personnel better at preparing to care for adolescent patients in the emergency department, whether they work in a rural, urban or pediatric center.’’ ENA’s Nursing Education Editor, Marlene Bokholdt, MS, RN, CPEN, CCRN, agrees that the new adolescent chapter is one of the most significant highlights of the revision. ‘‘I think that a lot of people think of pediatrics as little kids,’’ Bokholdt said. ‘‘It really isn’t. It is birth to adulthood, and that adolescent population has kind of gotten lost in the shuffle. It wasn’t part of the previous edition, so we’re very excited that it’s in the fourth edition and it does have some excellent information and real concrete tips and information that will help anyone take care of this population.’’ There are four lectures (pain, environmental emergencies, toxicological emergencies and stabilization and transport) that are presented in a webinar format, which the learner is expected to watch and complete before coming to the live class. Participants will be awarded CEs for these lectures after watching and completing them online, and they will also receive separate CEs for their attendance in the live course. Other notable changes include the behavioral emergencies chapter (previously psychiatric emergencies), which focuses on accessing children with behavioral health issues and also includes a section on autism; the special-needs child section is now integrated with all of the lectures, as opposed to being a separate lecture, as in the previous editions; and triage, which was previously part of the ill and injured skill station, is now an interactive lecture that will include case scenarios and group discussion of triage. The Jeopardy® game has been eliminated from this edition and replaced with clinical considerations/vignettes — a brief interactive

overview in which the students will look at rapid-sequence intubation, airway management, vascular access and more. One major change that occurred from the revision process is that the ENPC 4th edition will not offer a reverification course. Due to ANCC guidelines, ENA is not able to offer contact hours for reverification courses after Dec. 31. The ENA Board of Directors voted in July 2012 to discontinue TNCC and ENPC reverification courses after that date. Therefore, there can be no 3rd edition ENPC reverification courses or 6th edition TNCC reverification courses held after Dec. 31. ENA is exploring new ways to provide ongoing continuing education related to the courses and has directed that no more than four years will lapse between each new version of the TNCC and ENPC courses. Participants will be able to continue to challenge the two-day provider courses, as allowed by each individual course director. For more information about the exciting ENPC 4th Edition, please visit www.ena.org/coursesandeducation/ENPC-TNCC/enpc/Pages/ aboutcourse.aspx.

Course Highlights Highlights of ENPC include: • Completing an observational or across-the-room assessment • Identifying subtle changes that indicate deterioration • Developmental approach to pediatric care • Cultural considerations in pediatric care • Pain assessment and management for children • Techniques for family-centered care Names of all involved in the revision process: Nancy Denke, MSN, RN, FNP-C, ACNP-BC, FAEN, Chair Paul C. Boackle, BSN, RN, CCRN, CEN, CFRN, CPEN, CTRN Angela M. Bowen, BSN, RN, CPEN, NREMT-P

Cam Brandt, MS, RN, CEN, CPEN, CPN Julie L. Miller, RN, CEN Dianne Molsberry, MA, RN ENA Board Liaisons Deena Brecher, MSN, RN, APRN, CEN, CPEN Tiffany Strever, BSN, RN, CEN

ENA Staff Betty Mortensen, MS, BSN, RN, FACHE Marlene Bokholdt, MS, RN, CPEN, CCRN Renee Herrmann, MA Curriculum Consultant Vicki C. Patrick, MS, RN, ACNP-BC, CEN, FAEN

October 2012

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Disaster Preparedness Board Writes

Are You Ready for the Real Thing?

Considerations for Disaster Preparedness Exercises By Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN, ENA Board of Directors Terrorist attacks in the United States, including the Oklahoma City Bombing on April 19, 1995, and the 9/11 attacks, have caused a renewed sense of urgency in disaster-preparedness training for emergency departments across the country. In response to these acts of terrorism, the Department of Homeland Security developed resources to help health care providers prepare for disasters, including giving millions of dollars in grants to health care organizations. However, these grants required that any disaster exercises resulting from the grant funds must focus on terrorism threats (U.S. Department of Homeland Security Office for Domestic Preparedness, 2003). This resulted in a large number of healthcare organizations focusing on biological or chemical threats, using the grant funding to assist in the purchase of decontamination equipment. While these real potential threats deserve our consideration, what does the actual data say about disasters that have occurred in the United States? There have been 281 disasters in the United States since 2000 (EM-DAT, 2012) and 16 terrorist-type attacks in the United States from 2002 to 2010 (Kimery, 2011). Clearly the more prominent problem is disasters that do not involve acts of terrorism. Table 1 highlights the number of fatalities and injured associated with some of the disasters that occurred since 2005. To further complicate this issue, the Institute of Medicine (2006) found that most emergency departments were inadequately prepared for a major disaster. This is despite the fact that numerous regulatory agencies mandate that hospitals provide disaster training to their employees. Goodhue, Burke, Channbers, Ferrer, and Upperman (2010) reported that emergency-preparedness plans tested by hospitals vary in quality since the implementation methods range anywhere from tabletop exercises to full-scale disaster scenarios. Numerous researchers have found that the

focus of these methods typically is on the overall management and coordination of a disaster rather than the clinician’s role in patient care and triage (Kaplan, Connor, Ferranti, Holmes, & Spencer, 2012). Even with full-scale disaster scenarios, hospital personnel often do not treat the volunteer patients with the same level of attention that would be required in a real disaster. It is not uncommon to hear comments such as, ‘‘I have real patients to take care of,’’ or, “This is a waste of time because it is not realistic.’’ Both of these statements have some merit. Yes, staff do have patients that are already in the emergency department that require attention, and yes, the scenarios are artificial when using live patients because the staff cannot insert intravenous lines, obtain blood specimens and perform other invasive procedures that would be required in a real disaster. Unfortunately, this prevents fully identifying the challenges that would arise in a real disaster when surge capacity is reached. So what can you do about this? Using unconventional approaches to disaster-preparedness training that have evolved from modalities used by the military and institutions of higher education may be the answer. Preparation is essential before implementing the actual disaster-preparedness scenario. This requires that staff are informed about the expectations that will be required from them during the exercise, as well as familiarizing them with the disaster preparedness plan. It should be stressed that staff should consider simulated patients as ‘‘real’’ patients as much as possible, even when the emergency department is busy. This may require that coaches be strategically placed throughout the department to help staff meet the needs of the actual patients in the department, as well as meet the expectations for the disaster exercise. Remember, the goal is to tax the system to identify problems that may need to be addressed in the event of a ‘‘real’’ disaster. Implementation of the disaster exercise is greatly enhanced if simulators are used Date Disaster Location Fatalities Injured in conjunction with live patients. July 20, 2012 Movie Theater Aurora, Colo. 12 58 This type of disaster-preparedness exercise requires Shooting creativity in the planning process. In addition to some of May 22, 2011 Tornado Joplin, Mo. 158 1,000 the issues already identified, planners need to remember Sept. 23, 2008 Train Collision Los Angeles 25 135 that in a real disaster, supplies and personnel may be in Chatsworth scarce, electricity and water may not be easily accessible, area and disposing of human waste may not be through Oct. 21, 2007 Wildfire Potrero, Calif. 5 55 traditional venues. Furthermore, 75-85 percent of your Aug. 29, 2005 Hurricane Gulf Coast 1,836 Unknown patient volume during a disaster will be self-referred and Table 1: Number of fatalities and injured associated with selected disasters not arrive by EMS (American College of Physicians, 2009). in the US since 2005 Just because we have always done it this way does not

October 2012

mean that we should continue with the same process. That just lends itself to obtaining the same outcomes. Without practice that involves nontraditional approaches in managing scarce resources, including personnel, your facility may be unable to maintain sustained operations for extended periods during surge capacity (Goodhue et al., 2010). Successful disaster preparedness training involves creative thinking in the planning, development, implementation and evaluation of realistic disaster scenarios that represent the full continuum of possibilities. Do not be afraid to step out of the box and your comfort zone. You will be glad you did in the event of a ‘‘real’’ disaster.

Feedback Frame

Disaster Preparedness

References American College of Emergency Physicians (2009). ACEP best practices for hospital preparedness. Retrieved August 5, 2012 from www.acep.org/ clinical---practice-management/best-practicesfor-hospital-disaster-preparedness EM-DAT (2012). Natural disasters in the United States f rom 2000-2011. Retrieved August 5, 2012 from www.emdat.be Goodhue, C.J., Burke, R.V., Channbers, S., Ferrer, R .R., & Upperman, J.S. (2010). Disaster Olympix: A unique nursing emergency preparedness exercise. Journal of Trauma Nursing, 17(1), 5-10. Institute of Medicine (2006). The future of emergency care: Key finding and recommendations. Washington, DC: Author. Kaplan, B.G., Connor, A., Ferranti, E.P., Holmes, L., & S pencer, L. (2012). Use of an emergency preparedness disaster simulation with undergraduate nursing students. Public Health Nursing, 29(1), 44-51. Kimery, A. (2011). Frequency of attacks in US d ropped steadily after 9/11: Increased globally since 2004. Homeland Security Today US. Retrieved August 5, 2012 at www.hstoday.us U.S. Department of Homeland Security Office for D omestic Preparedness (2003). Homeland security exercise and evaluation program, volume I: Overview and doctrine. Washington, D.C.: Author

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course. It has been revised and updated, evidencebased, and continues to incorporate various teaching and learning styles. • • • •

Upon successful completion of ENPC, RN participants are verified for four years, receive a verification card and earn up to 16 contact hours. This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day.

Call for Nominations Emergency Nurses Association/Blue Jay Consulting Award for Outstanding Emergency Department Nurse Leader of the Year To view additional information and submit a nomination for this award visit www.ena.org and click on the About tab, then Awards.

Deadline for Nominations is Monday, Nov. 12, 2012

A portion of the course will be presented in an online format through ENA’s Center for e-Learning. Pediatric Clinical Considerations is now case-based using group discussion. The adolescent patient is addressed with a separate chapter and lecture. Triage is now Prioritization with a focus on the process, rather than the place.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Official Magazine of the Emergency Nurses Association

To verify why ENPC is right for you and to view course schedules, please visit www.ena.org/coursesandeducation

Disaster Preparedness The Use of the SBAR to Facilitate Patient Communication During a Disaster By Sharon Saunderson Coffey, MSN, RN, CEN, CHEP, Emergency Management and Preparedness Committee Situation, Background, Assessment and Recommendation (see image below). The SBAR is a familiar communication and hand-off reporting tool to many nurses and allied health professionals. Reports show that simple, familiar tools will be more readily used during disasters and with fewer errors. The SBAR is used in most hospitals in south Florida, so it was a natural choice for the exchange of timely, accurate patient information in a way that is familiar to all members of the health care team.

Patient Hand-Off Reporting Form SBAR

Region VII Health/Medical Patient Transfer Summary

Patient Name

SBAR

Gender r M r F

Transferring Hospital

Age

Transferring Hospital’s Pt’s MR#

Transfer Reason: Transfer Date:

Time:

Code Status: r Full r Do Not Attempt Resuscitation (r Documents attached) Isolation: r Airborne r Droplet r Contact Organism

r Do Not Intubate (r Documents attached)

Allergies (medication, latex, environmental, other): Allergy bracelet on? r Yes r No

Background

Current Diagnosis(es)

Brief Summary Hospital Stay

Current Vital Signs: Time:________ Temp: ________ Pulse Rate:_______ Resp Rate:_______ Blood Pressure:_______ Pulse Ox:_______

Assessment

Cardiac Rhythm

FiO2

Vent Settings Current IV’s

Bipap / CPAP settings 3

Location Date of insertion Fluid Infusing Current Medications r MAR Attached

Pain Score at Transfer (Use 0-10 Pain Scale) Current Drains

Time + Route of Last Pain Med Given 1

Med given 3

Location Date of Insertion Pertainent Behav. Health Assessment / Issues Valuables r Yes r No Glasses r Yes r No

Recommendations

patient demographics and financial information, and the last 48 hours of progress notes. These records were placed in a sealable plastic bag, labeled with the patient’s name and sent with the patient. Following an after-action-review of the evacuation event, the nurses receiving the evacuated patients stated that they had more questions than answers regarding the patient’s plan of care and clinical situation. A solution to this challenge was the revision and use of the SBAR or Patient Transfer Summary reporting form. SBAR stands for

Situation

Communication failures are often at the top of the list of challenges following a hospital disaster drill of real event. Effective communication, along with teamwork, is essential for the delivery of high-quality care, patient safety and seamless transfer of patients during the chaos of a disaster. In September 2008, Hurricane Ike was predicted to hit the southern portion of the Florida Keys as a Category 4 hurricane, with maximum sustained winds of 145 mph (230 km/h). This prediction activated the evacuation plan of the Lower Keys of Florida, including Lower Keys Medical Center, the only hospital in the lower southern chain of the Florida Keys, roughly 162 miles from Miami. The logistics of transportation methods, patient preparation and family notification, receiving hospitals and fiscal outcomes was the beginning of a 24/7 assessment and evaluation process on how to best care for the patients that needed continued inpatient medical care at a hospital out of harm’s way. One key lesson learned from this evacuation was that a method was needed to communicate patient information without having to spend days printing out the complete medical records of a large number of patients. As patients move among specialized services within a hospital, and as shifts of medical personnel come and go, there are numerous episodes in which responsibility for the patient passes from one health professional to another and where patient information is exchanged. During a disaster, this normal exchange of communication is disrupted. As patients are evacuated to another hospital or facility, communication of patient information becomes a challenge. The use of electronic medical records poses unique situations in both clinical information sharing and fiscal data validation. During the evacuation and receipt of patients from the Florida Keys, the decision was made to initially print and send with the patient the medical administration record, a face sheet with

Clothing r Yes r No Hearing Aids r Yes r No

Dentures r Yes r No Personal DME r Yes r No

List on back /Narrative

Report given to: Phone #: Time: Attending Physician notified of transfer r Yes r No Who _______________________ Phone ____________ Time _______ Family notified of transfer? r Yes r No r N/A Who was notified? Complete Medical Record Transferred r Yes r No Special considerations/recommendations: Transferring Nurse/Physician Signature: Receiving Nurse/Physician Signature: P-12148 - 119970 - 8/2009

Print:

Date:

Time:

Print:

Date:

Time:

(See reverse side for additional information)

October 2012

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Disaster Preparedness Disaster Nursing Education

We Must Be Working, Learning as One After returning home from my last disaster response in September 2011, I decided to review articles and take a look at some of the educational objectives of disaster education. We are all well aware of the American Association of Colleges of Nursing’s new requirements to include disaster education in the nursing curriculum. However, many schools are not sure how they should accomplish this and/ or how they can meet requirements in an already bulging nursing curriculum. The International Nursing Coalition for Mass Casualty Education created educational competencies in regard to nurses responding to mass casualty incidents. The coalition included accrediting bodies and nurses from different sectors (i.e., public – governmental and military; private, academic) and different specialties. However, the coalition was discontinued due to the lack of funding, and each university and group went about interpreting and setting its own standards for its curriculum. We need to continue the goal of getting us all on the same sheet of music. There are no exact disaster nursing competencies for nurses. In other words, the main problem is that all of us think we have the answer, and no one is taking a stand. Because of the varied types of nursing educational programs throughout the United States, and the different state and federal mandates for nursing, there is not a clear picture. The goal is to get everyone ready for a disaster response as a single entity working toward one goal — the ability to work as a team in a disaster. We have an overwhelming amount of interest in the area. However, what we don’t have is a consensus of what the educational requirements are. During this review, it was found that faculties lack knowledge on disaster response planning, in which case many students are not getting the disaster education and those who are receive only four to five hours (Schmidt et al., 2011). In reviewing schools in the tri-state area, we have found that most students are getting about two to four hours of disaster education. It is usually in a lecture format, with little to no

Jocelyn Augustino/FEMA

By Laura Terriquez-Kasey, MSN, RN, CEN, and Tak Man Yan, BSN, RN

Flight nurses and medics assist members of a disaster medical assistance team as part of the response effort following Hurricane Ike in 2008.

interaction. At Binghamton University, we have a nursing program that is averaging 12 hours of disaster education, including lecture material, online course work through the Federal Emergency Management Agency, covering Incident Command System and National Incident Management System. Many schools are trying to change the curriculum but are unsure how. There is a need for selected core competencies for every student nurse and nurse in practice. So many regulations have been placed on today’s educators and nurses that many nurses feel they are overtasked with a burdensome workload. In the case of disaster preparedness, we need to get it right. We are headed toward catastrophic problems, as our globe is starting to realize. We have nurses who need the background and basic disaster education to be a part of the disaster response. Plans for disaster nursing education must not be placed on a shelf and forgotten after they leave school or take their examinations. Many educators have suggested that each

school could mandate a disaster education course and then allow the student or nurse to learn in the field. In an article by Tillman (2010), she discusses the need for nurses to be a major responder and be part of a team response. The American Nurses Association validated the preparation in its policy ‘‘Standards of Care under Extreme Condition: Guidance for Professionals during Disasters, Pandemics and Other Extreme Emergencies’’ (ANA, 2008). Tillman (2010) also includes major competencies of triage, a personal emergency plan, psychological considerations and ethical considerations. In another article of interest, Schmidt (2007) describes a wonderful program and experiment taking place with the work of the American Red Cross and 12 universities across the United States. The students are being asked to take a course entitled ‘‘Sheltering and Disaster Health for Nursing Students.’’ This program is only four hours long, and although it may be helpful to the Red Cross’ needs to assist in supporting sheltered patients, we may not really be

October 2012

Disaster Preparedness preparing future RNs, LPNs and students for the injury and triage concerns related to a large-scale disaster. After reviewing the document by Association of Community Health Nursing Educators (2009) in the “Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing,” the recommendations seem perfectly appropriate. It contains much of the required material, including the legal and ethical concern while providing disaster nursing care. It needs to expands its view and include the Disaster Preparedness Cycle and Paradigm as described and taught in the AMA course on Basic Disaster Life Support and the Advanced Disaster Life Support. After taking the BDLS and ADLS, it is apparent to me that the disaster paradigm taught in the program should be adopted as part of the nursing curriculum. The other items we should include are the need for careful, deliberate triage during a mass casualty situation and the categories of care. There needs to be an increased level of competency required for the basics of chemical, biological, radiological, nuclear and explosion. We need to include discussions and tabletop drills with discussion of surge capacity issues and the use of partnerships with local communities. We need to mandate the use of FEMA’s Emergency Management Institute courses. Each public health department needs to be included in the essential partnerships. Nurses, as well as all members of the healthcare teams, need to be more knowledgeable about their responsibilities. Recent experiences after Katrina in 2005 and in upstate New York after the flooding in 2006 and 2011 have left each of us with a desire to include essential education to the new nurses coming into the arena of health care. It should be obvious that we are still unprepared for disaster work after seeing the lack of preparedness in some of our excellent schools. Many schools have good intentions but lack the expertise in their faculty to provide the education required. Faculty need to be knowledgeable in order to assist students in improving their knowledgebase. These steps, along with the AACN’s new recommendations for the nursing curriculum, are essential to providing the nurses with critical thinking abilities during an actual event. It is an important idea that we continue disaster education. A question that still remains is: How do we educate the other nurses who have already been in the workforce and are unaware of the changing factors or requirements in disaster preparedness?

References Dallas, C.E., Coule, P., James, J.J., Lillibridge, S., Pepe, P.E., Schwartz, R.B., et al (Eds) (2007). Basic Disaster Life Support. United States of America: American Medical Association. Schmidt, C.K., Davis, J.M., Sanders, J.L., Chapman, L.A., Cisco, M.C., Hady, A.R., (2011). EXPLORING nursing students’ level of preparedness for disaster response. Nursing Education Perspectives, 32(6), 380-383. Schmidt, C.K. (2007). Strategies to Prepare Nursing Students to Respond to Disasters. Dean’s Note, 28(3). Retrieved on 7 August 2012 from www.ajj.com/services/publishing/ deansnotes/jan07.pdf Association of Community Health Nursing Educators. (2009). Essentials of Baccalaureate Nursing Education for Entry-Level Community/

Public Health Nursing. Retrieved 5 August 2012 from achne.org/files/ EssentialsOfBaccalaureate_Fall_2009.pdf Tillman, P. (2010). Disaster preparedness for nurses: A teaching guide. (2011). Journal of Continuing Education in Nursing, 42(9), 404-408. Bibliography American Nurses Association. (2008). Adapting Standards of Care Under Extreme Conditions: Guidance for Professionals During Disaster, Pandemics and Other Extreme Emergencies. Retrieved 5 August 2012 from nursingworld. org/MainMenuCategories/WorkplaceSafety/ DPR/TheLawEthicsofDisasterResponse/ AdaptingStandardsofCare.pdf

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Disaster Preparedness Measuring the Effectiveness of a Communitywide Disaster Drill Consistently seeing and evaluating the different pieces is part of an effective disaster drill. We all hope we don’t need the disaster response. However, more often than not, we are seeing the terrible effects of not preparing appropriately for a disaster. Teamwork and effectively preparing the different parts of the teams is critical to a good unified response. What matters is that your teams work together and that they can work in a flexible mode. Many of us have had the rudimentary essential lectures in class and in the field, but until we experience the actual event or participate in a realistic drill, we are no match for the real response necessary when the disaster strikes us. The ‘‘lessons learned’’ portion and debriefing or ‘‘hot wash’’ are the key components to the proper evaluation process of a disaster drill. In many cases, the leadership potential and the ability to compromise and critically think are noted to display, at times, a striking acuteness to the effect of the education and training received. Drill preparation is also critical for an effective response. Each team must display good leadership skills and the ability to work well with others. Everybody needs to get out of their bubble and work as a team with the ability to provide continuum of care — triage and re-triage and effectively treat and respond to clients’ ongoing needs. Another essential piece of all of this is the preparation of the groups before the drill. Planning and placing obstacles in the way of the providers is critical in order to test the effectiveness of each group. Before you start the planning portion of the drill, all of the essential needs for the drill should be identified. Designing an effective drill must include the leaders and community representatives. Allowing each group to effectively educate its own group is all part of the process in preparing for the real disaster. When the disaster drill is designed, it must be clear what the objectives of the drill are for everyone. We also must take the time to provide the methods and tools we will use in clearly measuring the response.

Dennis Sabo/Shutterstock.com

By Laura Terriquez-Kasey, MSN, RN, CEN, Emergency Management and Preparedness Committee

Emergency responders test their preparedness in a community mock disaster drill.

The Methods of Measurement must be clear to each responder and reflect back to the essentials taught to all responders. Set some clear learning objectives for the drill. 1. Try to use the Disaster Paradigm (AMA 2007) to assist all responders in learning the basic concepts. Consider sending faculty and emergency staff to assist all in the expansion of knowledge across the health continuum. 2. Triage procedures, classification of clients into categories to allow us to respond rapidly and effectively. 3. Consider educating all in Mental Health First Aid procedures before a disaster. 4. Prepare all responders with knowledge of the equipment that will be used. 5. What are the basic emergent skills required by all staff at their level of education? 6. Carefully clarify roles and responsibilities for all responders. 7. Test each portion of the responders’ learning process. 8. Review of the policy and procedures: Are they clearly identified for the team? 9. The actual planning of a drill must reflect back to the community.

10 Perform a hazard assessment. 11. C onsider all awareness-level training to be reviewed for basic issues related to CBRNE. Example: Review the idea of (RAIN) Recognize Avoidance, Isolation, and Notification. ‘‘Remember each worker responding to an event can also become a casualty if not taught to prevent the possibility of being exposed’’ (Ryan, and Glarum 2008). If you live next to a chemical factory, then perhaps that should be a thought when you consider planning the drill. If your disaster drill committee feels the need to practice responding to a hazardous material situation, then it should consider the possible hazards in the community. If there is a large airport and or train station, then perhaps considering an airplane crash or a train accident is appropriate. 12. Review command and control and ICS roles for everyone. This is important to make sure each community prepares itself for the possible natural disasters and terrorism in its own community. Most communities should start with a single event related to a disaster drill. Then all can focus on the major problems at hand.

October 2012

Disaster Preparedness

Creating a disaster drill planning team that Glarum, J.R. (2008). BioSecurity and Tools for Hospitals Health Care Systems. (2012, includes a member from all parties is critical to BioTerrorism Containing and Preventing Aug. 5). Retrieved 2012 from www.AHRQ. the success of the drill. Make sure you involve Biological Threats. In Bio Security and gov: www/ahrq.gov/research/hospdrills. citizens and clients as volunteers. Look around BioTerrorism Containing and Preventing htm, Johns Hopkins University Evidence for volunteers from the community, as they may Biological Threats (p. 122). Burlington MA.: Based Practice Center Baltimore, Maryland have an interest, and it does raise awareness in Eleseiver. (2008). the community by having multiple groups Tools for Evaluating Core Elements of Hosptials Series Public Health Emergency Preparedness participating. Disaster Drills. Retrieved Aug. 5, 2012, from Research Resources and Tools “Hospital Consider setting up a clear exercise guideline. AHRQpublication 08-0019: www.ahrq. Assessment and Recovery Guide,” AHRQ, Use a scenario summary or timeline to assist all gov/prep/drillelements/ HHS, Prepared by Abt Associates Inc., the players. Brief each group alone so that all the Cambridge MA. May 2010. L E A D E R S H I P C O N F E R E N C E 2 0 1 3 Bibliography groups know what is required of them. Series Public Health Emergency Preparedness Consider setting up specific evaluation Coping with a Disaster or Traumatic Event. Research Resources and Tools “Hospital packets for each evaluation team. Make sure you (2012, Aug 5). Retrieved Aug. 5, 2012, from Evacuation Decision Guide,” Prepared for F O R T L A U D E R D A L E , F L F E B R U A R Y 2 7 – M A R C H have clear, delineated evaluation questions and CDCMental Health/Trauma and Diaster Event.: AHRQ, HHS, Prepared by AbT. Associates Inc. guidelines. Review the materials. http://emergency.cdc.gov/mentalhealth/ Cambridge, MA. This makes the drill more realistic. Example: . LEADERSHIP CONFERENCE 2013 LEADERSHIP CONFERENCE 2013 Try to have EMS use actual treatment tags for the triage and role playing. We need volunteers Fto O R Tplay L A U D E Rthe D A L E ,roles F L F E Bof R U Athe RY 27 – MARCH 3 E N A L E A D E R S H I P C O N F E R E N C E 2 0 1 3 F E R E N Cinjured. E 2 0 1 3Try to use seniors and children as well as students and community workers in this role. F O R T L A U D E R DA L E , F L F E B R U A R Y 2 7 – M A R C H 3 It will be important to brief each in their role and FORT LAUDERDALE, FL FEBR UARY 27 – MARCH 3 the changes that they must perform if possible. Use small index cards as coaching cards for the FL F E B R Uplayers. A R Y 2 7Using – M Asimulation RCH 3 mannequins is critical E N A L E A cannot D E R S H I P Cperform O N F E R E N Ca E 2013 to the learning process if you large drill. If possible, have F O R T L Aa U Dmoulaged E R DA L E , F L F E B R Uteam ARY 27 – MARCH 3 work with the players ahead of the actual drill. This may allow each player to look more realistic and also allow the player time to learn their role. In some cases it’s necessary to have team evaluators at different sites throughout the drill. You may need a team of evaluators at triage, a team evaluating the EMS portion of a drill, at3each nursing care area and P C O N F Eanother R E N C Eteam 201 finally a team that evaluates and coaches the ENA LEADERSHIP CONFERENCE 2013 Offering Educational and Networking command staff team. Each evaluation team FEBRUARY 27 – MARCH 3 Opportunities for Current and Future should have a specific marking on them and be F O R T L A U D E R DA L E , F L F E B R U A R Y 2 7 – M A R C H 3 Emergency Nurse Leaders. clearly given yes and no questions/answers. Consider leaving areas open for judgment and feedback. Consider allowing each evaluation team 30 minutes to prepare their return information for the hot wash of the drill. After the drill, each team should be asked to submit an after-action report to the disaster planning committee to discuss the drill and review the learning process and be allowed to make recommendations to the disaster committee for the next drill. F E R E N C E

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References Dallad, C.E., Coule, P., James, J.J., Lillibridge,S., Pepe, P.E., Schartz, R.B., et al. (2007). Basic Disaster Life Support. United States of America: American Medical Association.

FEBRUARY 27 – MARCH 3

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Official Magazine of the Emergency Nurses Association

C HA3R C H 3 FFEE B RRUUAAR YR Y2 7 2–7M A–R M

Disaster Preparedness Focus on Hurricane Preparedness By Angeli Medina, MPA, BSN, RN, CEN, Emergency Management and Preparedness Committee Weather-related natural disasters, such as hurricanes, are omnipresent, and their effect on human lives and property damage is inevitable. Advances in technology and meteorology enable public health officials, health care planners and other organizations to develop advanced warning systems, activate coastal shelter plan operations and hurricane preparedness in order to decrease mortality and morbidity.

Hurricane Categories A hurricane watch is issued for a coastal area when there is a threat of hurricane conditions within 36 hours, and a hurricane warning is issued when conditions are expected in 24 hours or less. The Regional Specialized Meteorological Centers (U.S. National Hurricane Center, U.S. Central Pacific Hurricane Center, Japan Meteorological Agency, India Meteorological Department, Meteo France and Australia & New Zealand Meteorological Service), Canada Hurricane Center, Philippine Atmospheric Geophysical and Astronomical Services Administration are responsible for tracking, naming tropical cyclones and issuing warnings and advisories to protect life and property. Hurricanes are categorized according to wind strength using the Saffir-Simpson Hurricane Wind Scale: Type of Tropical Cyclone

Category

Potential Damage

Wind Speed (mph)

Hurricane

Minimal

74- 95

Hurricane

Moderate

96- 110

Hurricane

Extensive

111- 130

Hurricane

Extensive

131- 155

Hurricane

Catastrophic

156+

Hurricane Impact The American Society of Civil Engineers made a study of the property damage caused by hurricanes from 1900 to 2005 and placed the Great Miami Hurricane of 1926 on the top with $140-157 billion in damages (adjusted for inflation in 2005), and Hurricane Katrina as the second most destructive storm in U.S. history at a cost of $81 billion in damages. Although Category 4 or 5 hurricanes can cause serious damage, Category 1 or 2 hurricanes can be as costly and devastating. A Category 3 hurricane, Hurricane Katrina cost the lives of 1,836 people.

Coastal Storm Plan Sheltering System The hurricane sheltering plan provides an orderly method of evacuating people living in low-lying areas and moving them into hurricane shelters. Solar systems are set up with associated hurricane shelters. As the center of the solar system, the evacuation center serves as the entry point into the solar system and its respective hurricane shelters. The evacuation center is the place where all staff report and obtain task assignments and just-in-time training. The evacuation center serves as the location for the following activities during an event: • Central screening for identifying and addressing evacuees with health

The remains of the Biloxi Bay Bridge in Mississippi in the aftermath of Hurricane Katrina, which made landfall as a Category 3 storm.

and medical, pet and family reunification issues • Supply requests • Troubleshooting • Dispatching training staff and evacuees to a hurricane shelter • Managing census of the mini-shelter system • Arranging for the release of evacuees at the closure of the hurricane shelters • Reports to the city’s emergency operation center. On Aug. 25, 2011, with Hurricane Irene threatening a full-force hit, the governors of New York, New Jersey and Connecticut declared a state of emergency. New York City was ready with ‘‘evacuation contingencies’’ for low-lying areas that are home to 250,000 people and made plans to shut down the transit system. The New York City Office of Emergency Management ordered nursing homes and hospitals located within the evacuation zone to evacuate residents and decrease their caseloads. The Baruch College Evacuation Center was one of the New York City evacuation centers that demonstrated a well-organized evacuation operation. The evacuation center was run by staff from the New York City Housing Authority, a teacher (Angela Becham), New York City Medical Reserve Corps volunteers (Dr. Eugenia Siegler, Leslie Lieth, PNP, and Angeli Medina, RN), mental health staff, social workers, Community Emergency Response Team volunteers and a nurse volunteer from Sweden. When the worst was over, the mayor lifted the evacuation order and the 9,000 people who stayed in the hurricane shelters and the 370,000 evacuees were able to return. The New York City coastal storm sheltering operation worked well during Hurricane Irene; there were no reported deaths or serious injuries during the hurricane watch.

What to Do Before and During the Storm A. P repare a family disaster plan that outlines what to do and how to communicate with each other. Make sure that your apartment or home

October 2012

Disaster Preparedness is properly insured. B. K now where to go. Stay with friends or relatives who live outside the evacuation zone areas; otherwise, report to an evacuation center. C. Keep ready a Go Bag that includes the following: • Copies of important documents in a waterproof container • Set of car and house keys, AM/FM radio, batteries, whistle, flashlight • Child care and special needs supplies • First-aid kit, bottled water, nonperishable food D. H ave an emergency supply kit. When instructed to stay home, keep enough supplies to survive for at least three days. • One gallon of drinking water per person/day • Nonperishable food • First-aid kit, flashlight, battery-operated AM/ FM radio, batteries, whistle • For disinfecting water ONLY, if directed to do so by the health officials, keep iodine tablets or one quart of unscented bleach with eyedropper • Phone that does not rely on electricity E. I f you do not live in an evacuation zone, assemble an emergency supply kit. F. I f you live in a high-rise apartment outside the evacuation zone, be prepared to take shelter on or below the 10th floor. If you live in a high-rise building located in the evacuation zone, heed evacuation orders.

and Atmospheric Administration. Archived from the original on February 26, 2008. • National Hurricane Center. (2005). Glossary of NHC/TPC Terms. National Oceanic and Atmospheric Administration. www.nhc.noaa. gov/aboutgloss.shtml • NYC Office of Emergency Management www.NYC.gov/oem • Department of Homeland Security www. ready.gov • National Hurricane Center/Tropical Prediction Center www.nhc.noaa.gov • National Weather Service www.weather.gov • Federal Emergency Management Agency www.fema.gov, www.floodsmart.com

•N atural Hazards Review, Journal of the American Society of Civil Engineers, “Normalized Hurricanes Damage in the United States: 1900-2005 • New York Regions Prepares for Hurricane Irene by James Barron, New York Times, August 25, 2011 • Advance Hurricane Shelter Training for Operators, Coastal Storm Plan, NYC OEM, 6/5/07 • Hurricane Irene Passes New York, MTA Scramble to Reset Commute by Colleen Long and David B. Caruso, 8/28, AP/The Huffington Post • Disaster Nursing and Emergency Preparedness by Tener Goodwin Veenema, 2nd Edition

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Other Considerations A. Secure your home • Keep lightweight objects inside the house. • Anchor unsafe items, i.e. gas grill (turn off propane tanks). • Place valuables in waterproof containers. • Shutter windows securely and brace outside doors. B. Assist persons with disability or special needs. C. Evacuate immediately when asked to do so. D. Address pet care and bring pet supplies when evacuating with your pet, i.e., leash, muzzle, food, proof of shots, cage.

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Resources • en.wikipedia.org/wiki/Tropical_cyclone • en.wikipedia.org/wiki/List_of_United_ States_hurricanes • National Weather Service (September 2006). “Hurricanes … Unleashing Nature’s Fury: A Preparedness Guide” (PDF). National Oceanic

Official Magazine of the Emergency Nurses Association

Disaster Preparedness

4 Questions of Mass Casualty Patient Decontamination By Paul Meek, MA, BSN, BEd, RN, CEN, CLNC Hospitals across the nation continue to work hard to improve their preparedness for a mass casualty incident or a mass contaminated casualty incident related to either a man-made or natural disaster. Since Sept. 11, 2001, billions of dollars have been spent to improve the response capability for such incidents. The primary focus has been the incident scene. Thus, the patient decontamination needs have been incidentscene-centric. However, OSHA statistics show that up to 80 percent of patients and others who are contaminated will leave the scene before first responders arrive. Almost all of these people will eventually end up at a hospital contaminated. The American Hospital Association report identified that most hospitals were well prepared for a low-intensity, shortduration event, but there was inadequate planning for the true large-scale events that would require entire community involvement. They went on to define a mass casualty event to be a community-wide concern, necessitating a response that incorporates multiple resources within the community. This was based on the possibility that a mass casualty situation may actually have to be addressed for days or weeks rather than hours. Furthermore, the mass casualty incident may overwhelm the capacity of all the hospitals in the region, not just the local hospital. This would greatly impact the capabilities of the local hospital to provide service. Their conclusion was that more community-wide planning was needed to properly prepare hospitals for high-intensity and long-duration events. While this article was written in 2000, we still see the same problems. Most hospitals have improved by embracing the Hospital Incident Command System, which provides for better communication and operations during disasters and mass casualty incidents. There are four key questions that each hospital needs to incorporate into its emergency operations plan regarding patient decontamination:

How Many? How many patients can you decontaminate during a MCCI? This is a complicated question. Considerations need to include the following:

1. Your hospital surge capacity. 2. Your plan for moving or dealing with patients when you exceed both your operating capacity and your surge capacity. (Are these capabilities different if on back-up generators?) 3. Your staffing pool and available staff. 4. Your plan to bring in volunteers to assist staff. 5. The size of your staging/triage area for decontaminated patients. (You may have the capacity to decontaminate 100 patients an hour, but can you treat/release or admit 100 patients an hour? If not, where do you place these overflow patients where they can monitored by professional staff and have access to bathrooms, water and food as their numbers increase?) 6. The number of injured who are decontaminated at the scene and transported clean to your hospital. 7. Basic supply levels. 8. Estimated resupply delivery times and methods. 9. Where will patients go upon discharge? How will they get there? 10. Where will you place the discharged patients who are awaiting transport to shelters? What if they refuse to leave? 11. How will you deal with family? 12. Will treatment be given before decontamination? (Note: Any equipment used will be lost as contaminated â&#x20AC;&#x201C; oxygen tanks, beds, cots and more.) 13. Where will contaminated human remains be staged? (You will need a separate storage method and place for contaminated human remains.) 14. How will your staff communicate within the mass gathering areas of patients (postdecontamination, triage and staging area for discharged patients)?

How Long? How long can your hospital operationally maintain a mass patient decontamination line? There are several key components that will be factors in answering this question. Your decontamination operation depends on specialized PPE/equipment which is in limited

supply at your hospital. How long can you maintain your mass decontamination efforts if level-C PPE is required? This will be based on the number of filters, batteries, protective suits and boots your facility has in stock. Another factor is the amount of available and trained staff. During an MCCI, the hospital patient load is surging. This requires additional staff in all areas of operation. How many staff members are required to maintain your mass decontamination line? How often are they swapped out? If you are using level-C PPE, swap-outs will likely be on an hourly basis. In extreme temperature situations, it may need to be more frequent. These staff members need technical decontamination as they swap out. You should also maintain a partially dressed safety response team to deal with staff decontamination emergencies.

What If? What happens to your mass decontamination line when an anxious, contaminated patient pulls off a staff memberâ&#x20AC;&#x2122;s PAPR hood, or a patient decontamination team member goes down, becomes contaminated or suddenly displays signs and symptoms of chemical or radiation exposure? Many patients may feel personally violated by the decontamination process. What if the contaminated patients refuse to disrobe or give up personal items? What if a group of contaminated patients becomes violent and/or attempts to storm its way into the ED demanding treatment? Rebmann & Mohr report that fewer than 50 percent of Missouri nurses have received training in MCI or MCCI hospital response. Furthermore, fewer than 25 percent have received hands-on training in clinical disaster management. How will the remaining staff react to this situation? It is

October 2012

Disaster Preparedness very conceivable that your decontamination staff could begin to refuse to don PPE and decontaminate patients. They may fear for their lives and voice concern that the level of PPE, level of training and/or security is inadequate. Can you force your minimally trained staff to risk their lives and health to perform patient decontamination? Remember, as the number of patients decontaminated increases, so will the demand on your supplies and staff. What happens when your facility can no longer staff the mass patient decontamination line? You must have detailed in your plan the number of staff required to safely maintain your mass patient decontamination line.

What Then? Having identified needs, we must find solutions that can prevent or resolve these situations during an MCCI. You need to develop a plan to move discharged patients and family members away from your hospital, as you will not be able to both surge and shelter. Your emergency plans need to include requesting a shuttle that will transport these discharged patients, worried wounded and family members to the established local shelters. Furthermore, you need to plan if you want to move admitted patients. You can try to call the local air ambulance, but they will likely be dispatched from the multi-agency coordination system. If NDMS is activated and an ESF 8 Aerial Point of Embarkation is established, you still will need to request transport or arrange transport from your hospital to the APOE. If your mass patient decontamination line fails, you must have a plan for the contaminated patients who will continue to arrive at your hospital. One option would be a shuttle that would take these contaminated patients, worried wounded and family members to a mass decontamination site.

Conclusion Every hospital in our nation has a limit for how long or how many patients it can decontaminate in a MCCI. As such, data needs to be collected so that emergency preparedness planners can develop strategies to better assist hospitals in the MCCI incident. Hospitals need to embrace their designation as critical infrastructure/key resources and step forward in their planning by requesting assistance from local, state and federal agencies in times of disaster, terrorist attack and other emergencies. The 2009 U.S. National Health Security Strategy states: ‘‘Government at all levels has an inherent responsibility, particularly in helping

build and strengthen the systems (e.g., plans, people, and equipment) that help prevent (e.g., through biosafety, biosecurity, nonproliferation of WMDs, and other measures), protect against (e.g., through community interventions, including medical countermeasures), respond to, and recover from health incidents.” The time has come for hospital MCI and MCCI plans to develop ways to innovate, incorporate and communicate their potential needs to the local and state emergency planners and their state National Guard before the next disaster or terrorist attack. References Powers, R. (2009). Evidence-based ED Disaster Planning. Journal of Emergency Nursing, 35(3), 218-223.

(2005). OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances: Occupational Safety and Health Administration, 1-30. (2009). National Health Security Strategy of the United States of America. United States Department of Health and Human Services, 1-44. (2000). Hospital Preparedness for Mass Casualty: Final Report. The American Hospital Association, 1-58. Darr, K. (2006). Katrina: Lessons from the Aftermath. Hospital Topics: Research and Perspectives on Healthcare, 30-33. Rebmann, T. & Mohr, L. B. (2008). Missouri Nurses’ Bioterrorism Preparedness. Biosecurity and Bioterrorism, 6(3), 243-251.

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Official Magazine of the Emergency Nurses Association

Disaster Preparedness Ready or Not?

What Does It Take to Make Your ED Ready? By Knox Andress, BA, RN, AD, FAEN The television reporter’s interview in the Louisiana State University Health–Shreveport Emergency Department began with a weighty question: ‘‘So what goes into making the emergency department prepared for a disaster or mass casualty like the recent and tragic shooting in Aurora, Colo.? Are we ready?’’ The reporter was aware of the heroic response required by emergency nurses, doctors and other first responders in Aurora in July and wanted to learn more about local and regional ED and hospital planning for a similar threat. We discussed planning and preparedness for various hazards. What do you think it takes? What are the potential hazards, considerations and roles for the ED?

was posted on the Internet. Viewers can watch as the still room becomes suddenly engulfed in the storm, with chairs, curtains and debris swirling violently. ED disaster responses can result from multiple natural, man-made and/or technological threats. Multiple populations can be affected, including pediatric, adult and the elderly. Emergency nurses need to be prepared for the ‘‘all hazards’’ response. A starting place for all hazards principles and strategy is found in the ENA Emergency Management and Preparedness for All Hazards position statement.

The ENA ‘All Hazards’ Position Statement

Recent Incidents and Hazards Threatening the ED Imagine yourself as an emergency nurse in the following incidents: • Bomb: On July 19, a 50- to 60-pound pipe bomb was carefully removed from the trunk of a visitor’s car in the St. Mary’s Hospital (Rochester, Minn.) parking garage. Threats exist outside and sometimes within the hospital. When it comes to bombings, the CDC has referred to bombings as the ‘‘expected surprise.’’ • Tour Bus MCI: On Aug. 3, 38 people were transported to local EDs and trauma centers after a double-decker bus slammed into a bridge pillar support while speeding down an Illinois highway. School bus accidents occur almost weekly somewhere in the country, resulting in numerous pediatric injuries. • IT Systems Failure: On Aug. 3, the Los Angeles Times reported dozens of hospitals across the U.S. lost access to critical electronic medical records during a major, five-hour computer outage later attributed to human error. The outage raised concerns about data stability and security weaknesses potentially compromising patient care. • Hazmat: On Aug. 1, the Houston-area Danbury Hospital ED was reported shut down after word was received of several incoming ill

patients who had been exposed to an unknown white powder. A decontamination unit was established by hazmat teams at the hospital. • Hurricane: On Sept. 2, the East Jefferson Hospital (Metairie, La.) emergency department reported seeing the types of injuries associated with hurricane debris cleanup. Hurricane Isaac injuries in the ED included traumas resulting from debris removal, with increased numbers of lacerations, plus back injuries resulting from falls from ladders. • Power Failure: On July 15, Doctor’s Hospital (White Rock, Texas) was reported to have experienced an electrical power failure after a storm. A backup emergency generator then failed, leaving dependant systems without power for about two hours. • Tornado: On June 28, security-camera video from the ED waiting area of St. John’s Regional Medical Center in Joplin, Mo., which was hit by a devastating tornado May 22, 2011,

Many excellent resources for disaster and emergency management applicable to the emergency nurse can be found at www.ena. org. One in particular, ENA’s Emergency Management and Preparedness for All Hazards position statement, offers significant considerations and concepts for an emergency nurse to ‘‘be prepared.’’ Within the ENA position statement is a background description of the emergency nurse role in the phases of disaster mitigation, preparedness, response and recovery. The statement also provides 13 focus areas detailing the ENA position. Position statement component topics addressed include the following: • The primary importance of individual preparedness • Considerations for ongoing preparedness training and education • The National Incident Management System • Implications for resource allocation during disaster • Importance of the hazard vulnerability analysis • Evaluating and testing emergency response plans • Recognizing needs of special and vulnerable populations • Planning for the ability to self-sustain for 96 hours • The volunteer response including

October 2012

Disaster Preparedness deployment and engagement • Standards of Care in disaster • Mass Casualty triage • Continuing education and training A starting place for appreciating response needs for emergency nurses is the ENA Emergency Management and Preparedness for All Hazards position statement. Resources http://kaaltv.com/article/stories/S2696701. shtml?cat=10151

http://www.usatoday.com/news/nation/ story/2012-08-02/megabuscrash/56715768/1?csp=hf http://articles.latimes.com/2012/aug/03/ business/la-fi-hospital-data-outage-20120803 http://www.myfoxhouston.com/ story/19184465/2012/08/02/hazmatteams-shut-down-er-of-angleton-hospital http://www.nola.com/hurricane/index. ssf/2012/09/high_number_of_injuries_ from_i.html http://watchdogblog.dallasnews.com/

2012/07/power-failure-sends-regulators-todoctors-hospital-in-e-dallas.html/ http://www.wtsp.com/news/national/ article/261482/81/Caught-on-camera-ERcamera-during-tornado http://www.ena.org/SiteCollection Documents/Position%20Statements/ AllHazards.pdf Readers may contact the author at wandr1@lsuhsc.edu. Follow Knox Andress @ENAdman.

Building Relationships in Advance Aids Disaster Planning By Carl Schramm, RN, EMT-B Emergency Management and Preparedness Committee We all have disaster/emergency response plans for our facilities to address a wide range of emergencies, ranging from natural disasters to industrial accidents to terrorist attacks. How realistic are these plans? A good, comprehensive plan must include not only a facility’s resources but the resources available from outside facilities and agencies. When a disaster occurs, one facility’s resources can quickly be stretched to the limit. Augmenting and replenishing these resources can be extremely difficult, if not impossible, during a disaster. To strengthen our capabilities, we need to coordinate with outside facilities and agencies. The key to successful coordination is building professional relationships before a disaster occurs, when you have the time necessary to develop a good working relationship and address potential problems. Emergency managers need to sit down with the leaders of outside resources to share their emergency response plans. External resources need to be evaluated and understood to ensure that they are going to be able to assist our facilities during emergency operations. It is important to know exactly what an agency is going to send when it is called to assist during an emergency. For example, can the agency send supplies, equipment and/or personnel? Which ones and how much? Will the type of emergency have an effect on the resources an outside agency can send? Evaluate the type of equipment used by an outside facility or agency to ensure that its equipment is compatible with your own. What brand of chemical suits does it use, what level of protection do the suits offer, and how many does it stock? It does no good to call in outside assistance that cannot work with your existing responders. Know in advance the types of communication equipment other facilities and agencies have. Is it possible to communicate with each other if traditional communication methods go down? If not, can something be done to accomplish this, such as adding frequencies to existing radios? Just having contact information for the leaders of these outside facilities and agencies can be vital during an emergency.

Official Magazine of the Emergency Nurses Association

To help operations run smoothly during an emergency, we need to determine to what level each facility or agency has trained its personnel. The requirements for these training levels are vague at best, and there can be a wide range of interpretation of requirements. For example, while the objective of decontamination is to remove contamination, not every program teaches decontamination by using the same steps or in the same order. During an emergency, the police and fire departments and emergency medical services each have to address different aspects of an emergency incident and use resources and personnel differently. Depending on the nature of the emergency, these outside facilities and agencies may not always have the ability to send the same assistance to any one facility. We need to realize that these responsibilities can cause outside agencies to commit more of their resources to their primary objectives. Having an understanding of the different responsibilities and objectives of these outside agencies is beneficial during an emergency. We can better understand why outside agencies handle an emergency the way they do, and they will better understand why we do what we do. We can modify how we handle an emergency to allow us to better coordinate our operations. Having an understanding that emergency medical responders have to follow specific protocols when they are in the field, and that they do not operate under the same rules as the nurses who work in the emergency department, is important. This understanding and respect of each other’s responsibilities will prevent conflict during an emergency and help everyone to use resources as efficiently as possible. Developing and maintaining emergency/disaster response plans is a difficult and time-consuming assignment. But without taking these considerations into account, it will be hard to have a truly effective, comprehensive plan. When an emergency occurs, no one wants to wait for help, only to find out it was either not what they were expecting or not coming at all. We need to prepare as best we can for anything to happen at any time.

Achievement Awards Robert Breese, CCEMTP, FP-C

Anne Stefanoski, BSN, RN, CEN

Kathy J. Morris, DNP, APRN, FNP-C, FAANP

Michelle A. Marini, RN, MSN, CPNP, CPEN

Joyce Foresman-Capuzzi, MSN, RN, CCNS, CEN, CPN, CTRN, CCRN, CPEN, SANE-A, EMT-P

Amy W. Truog, RN, BSN, CPEN

Behind the Scenes Award

Nursing Professionalism Award

Frank L. Cole Nurse Practitioner Award

Gail P. Lenehan Advocacy Award

Nursing Research Award Nursing Research Award

Joseph M. Lenehan, MD President’s Award

Diane L. Gurney, MS, RN, CEN, FAEN Judith C. Kelleher Award

Kristen Connor, RN, PHN, BSN, CEN Rising Star Award

Sharon McGonigal, RN, CEN

ENA Lifetime Achievement Award

Leslie A. Christiansen, RN, BS, CEN Nurse Manager Award

Donna M. Roe, DNP, ARNP-BC, CEN Nursing Competence in Aging Award

Timothy J. Murphy, MSN, RN, ACNP-BC, CEN Nursing Education Award

Judith Common, RN, CEN, CPEN, CA/CP SANE, SANE-A, SANE-P

Sandra M. Waak, RN, CEN Linda Arapian, RN, MSN, CEN, CPEN, EMT-B Lisa Tenney, RN, BSN, CEN, CPHRM Anne May , RN, BSN Emilie Crown, RN Pamela S. Fox, RN, BSN, CEN, CPEN Lucy McDonald, RN, CPEN, CPN, EMT-B Team Award

Nursing Practice Award

Academy of Emergency Nursing Inductees Meredith Jaye Addison, MSN, RN, CEN, FAEN

J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-P, FAEN

Rita T. Anderson, RN, CEN, FAEN

Fred Neis, MS, RN, CEN, FACHE, FAEN

Audrey Elizabeth Cloughessy, AM, MHM, RN, FAEN

India J. Taylor Owens, MSN, RN, CEN, NE-BC, FAEN

Christine M. Gisness, MSN, RN, BC, FNP-C, CEN, FAEN

Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, FAEN

Diane L. Gurney, MS, RN, CEN, FAEN

Judith A. Scott, MHA, BSN, RN, PHN, FAEN

Andrew D. Harding , MS, RN, CEN, NEA-BC, FACHE, FAHA, FAEN

Paula Tanabe, PhD, MPH, MSN, RN, FAEN

Cindy L. Hearrell, MSN, RN, CEN, FAEN

Mary Ann Teeter , MEd, RN, FNP-C, CEN, CNRN, FAEN

Lantern Awards Advocate Good Shepherd Hospital Emergency Department (Barrington, IL) Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, MI) Boston Children’s Hospital Emergency Department (Boston, MA) Cedars-Sinai Medical Center, Ruth and Harry Roman Emergency Department (Los Angeles, CA) Chandler Regional Medical Center Emergency Department (Chandler, AZ) Children’s Medical Center of Dallas, Seay Emergency Center (Dallas, TX) Cincinnati Children’s Hospital Emergency Department – Burnet Campus (Cincinnati, OH) Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis, IN)

2012 Lantern Award Recipients

Sharing Innovations and Best Practices Authored by the 2012 ENA Lantern Award Committee: Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, chairperson; Denise M. Bajer, MSN, RN, CEN, NE-BC; Jennifer M. Davis, MSN, MPH, RN, EMT-P, CEN; Susan K. Ebaugh, MSN, APRN, CEN, ACNS-BC; Andorra L. Foley, MSN, RN, CEN; Tami L. Morin, MS, BS, RN, CPEN; Teresa O’Neill, MSN, MBA, RN; India J. Owens, MSN, RN, CEN, NE-BC; Cheryl Rourke, MSN, RN, NE-BC; Barbara A. Weintraub, MSN, MPH, RN, APRN, CEN, CPEN, ACNP-BC, FAEN; and Matt Powers, MS, BSN, RN, CEN, MICP, Board of Directors liaison The ENA Lantern Awards, first presented in 2011, were envisioned as a means of recognizing exemplary emergency departments. In addition, the awards provide an opportunity for identifying outstanding, novel practices from those EDs that achieve Lantern Award designation. Based on a systematic review of each application, which is subjected to a blinded review process by multiple reviewers and evaluated against preset evidence-based criteria, the awards recognize EDs that exemplify exceptional practice and innovative performance in the core areas of leadership, practice, education, advocacy and research. Here are some of the initiatives that made these 2012 recipients exemplary:

Advocate Good Shepherd Hospital Emergency Department (Barrington, Ill.) Advocate Good Shepherd Hospital is a not-forprofit hospital in the Chicago suburbs, serving almost 34,000 patients in the ED each year. It’s an accredited trauma and stroke center. Twentyone percent of patients presenting to the ED are admitted. Within the general ED, 5 percent of visits are pediatric patients under age 18. Staff and leaders identified opportunities for planning and collaboration to address the needs of patients at both ends of the age spectrum. Following a hazard vulnerability analysis, a disaster drill was planned to include more than 20 children to test the hospital’s response to a disaster involving unaccompanied children. Lessons learned from the multi-disciplinary, intradepartmental and intra-agency drill resulted in changes implemented to the pediatric decontamination process, as well as the child identification process. Having children participate in pediatric disaster preparedness exercises is one effective strategy for meeting the needs of the community during a disaster response. Regarding older adult patients, analysis and review of data revealed that falls among this population were the primary causative factor for trauma admission, with 51 percent of these falls occurring in the community and 25 percent of trauma admissions coming from one specific senior living facility. Staff members embarked on a training initiative to present the Matter of Balance program at the identified facility. The

program, which teaches strategies to overcome the fear of falling, helps set realistic goals for increasing activity, as well as strength and balance, with the goal of reducing the risk of falling. Six months after initiating this collaboration, there was a 62 percent decrease in fall admissions, and the affected facility reported a 77 percent decrease in total falls. Due to this success, the team has taught the Matter of Balance program at other senior living facilities and senior community centers in 10 different cities in and around their service area.

Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, Mich.) Beaumont Health System in Grosse Pointe, Mich., is a not-for-profit facility that has nearly 37,000 patient visits to its ED yearly. Sixty-nine percent of the patients admitted to the hospital come through the ED, and almost 30 percent of ED patients are admitted. The ED at Beaumont Health System – Grosse Pointe has proven that strong, committed, involved and visionary leadership can inspire staff engagement to improve practice, safety and satisfaction for patients, families and staff. The staff works collaboratively to own its department by assuming responsibility for various services, such as stroke and chest pain certifications. The ENA Emergency Nursing Scope and Standards of Practice, as well as ENA position statements and toolkits, have been cited as foundational resources for many activities and best practices implemented in the emergency department. The ED successfully advocated for legislation in collaboration with the Michigan ENA State Council to increase penalties for violence against health care workers. In addition, Beaumont described a clear commitment to training of ED and security staff on de-escalation and prevention of violent incidents. As a result, incidents have been declining, and patients and staff are safer. Beaumont also described a longstanding support of family presence that is hospital-wide, including comprehensive support for patients and families in a needs-based model. An impressive component of its family presence program is family-member follow-up for up to a year.

Boston Children’s Hospital Emergency Department (Boston) Boston Children’s Hospital is a not-for-profit, academic medical center that is a designated trauma center. It is recognized as a Magnet facility and has also received the Beacon Award. The ED sees just under 59,000 patients annually, and 58 percent of hospital admissions present through the ED. The team at Boston Children’s Hospital ED recognizes the challenges immunocompromised patients pose when they present to the emergency department with a fever. Time to antibiotics is critical to outcomes. Clinical practice guidelines set a target for antibiotic administration within 60 minutes of arrival to the ED. A one-year retrospective chart analysis demonstrated that this time was exceeded more than 50 percent of the time. A multidisciplinary team mapped the current process for antibiotic administration and identified barriers to meeting the target time. Interventions implemented included a fast-pass system, ANC pre-notification calls, communication enhancements between team members, retraining of nurses on portacath access, pharmacy prioritization of Fever and Neutropenia template orders and reinforcement of topical cream application by parents before ED arrival. As a result, the mean time to antibiotic delivery dropped from 99 minutes to 49 minutes, and the percent of patients who met the target time to antibiotics rose from 50 percent to 80 percent.

Cedars-Sinai Medical Center, Ruth and Harry Roman Emergency Department (Los Angeles) Cedars-Sinai Medical Center is a 952-bed, not-for-profit, non-academic teaching hospital and is also a designated trauma, chest pain and stroke center. The Ruth and Harry Roman ED at Cedars-Sinai serves almost 84,000 patients annually. Like many hospitals, Cedars-Sinai has experienced long waits for availability of inpatient beds. It was noted that it knew its process needed improvement, as it typically took more than six hours to admit an ED patient. The organization implemented a project to address patient flow called the Toes Out-Toes In initiative. Using the Toyota Production Process Improvement Methodology, it engaged a

October 2012

multidisciplinary team to eliminate waste in its bed turnaround process. The team used rapid improvement events to make multiple process changes, leading to tremendous improvement in throughput. Changes were made to the discharge computer entry, eliminating steps and resulting in an average one-hour reduction in turnaround times, as well as providing real-time notification of the discharge. A housekeeping discharge team was also created, decreasing room cleaning times from 75 to 45 minutes. This department’s staffing was changed to provide increases at peak times, mimicking the hotel industry. Only clean and ready rooms were then assigned for patient placement. Additionally, a culture change took place, including having the staff in the medical/ surgical/monitored units call the ED for report within 20 minutes of an ED admission notification, essentially ‘‘pulling the patient’’ to the open bed. Within one year, this organization had reduced the turnaround time to 110 minutes on average. Drilling down further into the outlier data, Cedars-Sinai Medical Center has been able to trim further waste, now averaging 88 minutes to admit an ED patient. One important change was to eliminate the no-fly zone where floor nurses would not take report 15 minutes before or after the change of shift. This initiative helped to eliminate some of the bottleneck issue of patients waiting to go to their rooms from the ED and facilitated timelier placement.

Chandler Regional Medical Center Emergency Department (Chandler, Ariz.) Chandler Regional Medical Center is a 209-bed, not-for-profit, non-academic teaching hospital in Chandler, Ariz. Sixty-three percent of hospital admissions originate in the ED, which serves nearly 63,000 patients a year. The emergency nurses are continually developing and implementing ideas to improve patient outcomes and quality of care. In response to news that antivenom was being discontinued due to a lack of state funding, one of the nurses became very concerned, as they see a pediatric and older adult population that often needs the drug. She took the initiative to find out about a newly available investigational antivenom. Steps were taken to design a research study and get approval from the Institutional Review Board. The physicians and nurses in the ED eagerly participated in the

defaults and prompts for high alert medications, and the addition of a pharmacist in the emergency department 24/7.

Cincinnati Children’s Hospital Emergency Department – Burnet Campus (Cincinnati)

research, and the project became a huge collaborative effort not just between the ED staff and pharmacy, but also with other area hospitals and the Poison Control Center. Many envenomed patients arrive in a life-threatening condition requiring transfer to an ICU; yet with the antivenom protocol developed through the research conducted, patients are now discharged within four hours of arrival to the ED with fewer complications.

Children’s Medical Center of Dallas, Seay Emergency Center (Dallas) The Seay Emergency Center at Children’s Medical Center of Dallas is a not-for-profit, academic medical center in the Southwest serving more than 118,000 children per year. This designated trauma center and Magnetstatus medical center admits 11 percent of its inpatients through the ED. Patient safety is a top priority at this facility. With more than 88,000 doses of medication administered in the emergency center in January 2012 alone, medication safety has been a major focus, with several initiatives implemented to prevent medication errors, increase reporting and support a just culture. One initiative involves ED staff on the hospital’s High Alert Medication Committee, which shares data as well as identifies trends and opportunities for improvement. An initiative to reduce the incidence of incorrect weights being entered into the electronic health care record resulted from the work of this committee. After review of the issues, improvements were identified, including the use of an alert activated when a patient falls outside the normal range for his or her age, and a request for a second entry. In addition, steps were initiated to introduce electronic scales that transfer data directly into the EHR, reducing human error. Other efforts to eliminate and reduce the number of medication errors also have contributed to a significant decrease in errors at this facility over the last two years. Some examples are the implementation of a barcode system, effective use of the EHR to provide

Official Magazine of the Emergency Nurses Association

Cincinnati Children’s Hospital is a not-for-profit, academic medical center that is a designated trauma center. The Burnet Campus ED serves about 89,000 children a year, with 14 percent of those patients being admitted. Cincinnati Children’s employs the innovative practice of using postcards to close the communication gap and improve patient satisfaction. An interdisciplinary team that meets weekly to review patient satisfaction data recognized that identifying a patient’s chief complaint was only a small part of the puzzle. They began by collecting patients’ and families’ expectations of the visit on postcards. These postcards are then used as a way to communicate the families’ unstated expectations. For example, their child’s primary physician may have sent them to the ED with the expectation that the ED would start an IV and give their child fluids. The cards also serve as a tool that alerts the staff to the families’ concerns. As emergency nurses, we know that some of our patients come through our door for reassurance. Perhaps their cousin was diagnosed with cancer after exhibiting similar symptoms. The staff is alerted early on, through the postcards, that reassurance is a primary need of the patient and family. This tool has taken some of the guess work out of meeting patients’ expectations at Cincinnati Children’s, resulting in enhanced patient satisfaction scores and a feeling by staff that it is better able to meet patients’ needs. Safety is also a top priority in any highfunctioning ED. The interdisciplinary team at Cincinnati Children’s recognized that when stress levels are high, miscommunication is more common. This led to the implementation of a shared-mental-model process during stabilization of critically ill or injured patients. The shared mental model begins with a history and primary assessment using a team model led by a nurse and physician. The physician then asks for everyone’s attention while a shared mental model is performed. The physician shares aloud the initial assessment and plans. The team quickly reaches agreement on next steps together. A sharing of the mental model typically occurs within five to seven minutes of Continued on page 40

ENA Call for…

2013 ENA Board of Director and Nominations Committee Candidates Note: Amendments to the current ENA bylaws that may change candidate eligibility requirements were decided at the 2012 General Assembly, Sept. 12-13. For updated information, please check www.ena.org. Watch for ENA’s call for candidates seeking election in 2013 to serve on the board of directors and on the Nominations Committee. Application information for candidates will be available this month at www.ena.org. Open board positions include president-elect, secretary/treasurer and two three-year-term director positions. The officer positions are one-year terms with the president-elect continuing on to the presidency the following year, then an additional year as immediate past president. Depending upon the outcome of the officer elections, additional director seats may be available for terms equal to the unexpired terms of the vacating directors. The candidates receiving the next highest number of votes would fill these positions. Qualifications for all board of director positions include current ENA membership and membership for five consecutive years prior to submitting a candidate application; a current unencumbered RN license; attendance within the last three years at one ENA General Assembly as a delegate, alternate delegate or member of the board of directors; and having served in an elected or committee position on the local, state or national level within the past five years. Candidates for the position of president-elect and secretary/treasurer currently must be serving as a voting member of the national ENA board of directors. More qualification details are listed within the current ENA bylaws at www.ena.org.

Application Process Interested members are required to complete and submit an application with a professionally taken digital portrait photograph (details will be included on the application form) to elections@ena.org. The deadline for submission will be posted on the ENA Web site as soon as it is available. Watch for the application form available this month at www.ena.org. A candidate screening process is conducted on all board of director and Nominations Committee candidates. The screening process includes a limited background check verifying personal identity, professional licensure, current employer, highest academia and a criminal history check. Accepted candidates for the board of directors are encouraged to attend the Candidates Election Forum Saturday, March 2, at Leadership Conference 2013 in Fort Lauderdale, Fla.

Making a Commitment Serving on the ENA board of directors and Nominations Committee in any capacity requires a significant time commitment. Board service involves in-person meetings, reading correspondence, completing projects and talking to members on a variety of issues. Prior to running for national office, candidates are encouraged to discuss the role and responsibilities with their employers and negotiate the time they will be away from work. The support of the candidate’s employer and family is essential in meeting the responsibilities of a board member.

Board of Director Responsibilities The ENA bylaws determine the official duties of the board of directors. The major responsibilities of the board include all duties entrusted to officers and directors of a corporation, including determining association policy, providing oversight of the financial affairs of the association and reviewing and evaluating the strategic plan. The ENA board of directors conducts its official business meetings with all information and agenda items distributed electronically. Board members are required to work with this technology.

Board Meetings Board members are required to attend scheduled board of directors meetings. Expectations for these meetings include the following: • Attendance at the August Nursing Organizations Alliance annual Nursing Alliance Leadership Academy conference (for incoming officers and directors). • Submission of agenda items based upon member needs or current trends in emergency health care. • Required attendance at the year-end 2013 board of directors meeting and board member orientation. • Thorough review of the board agenda materials prior to the meeting. • Utilization of contacts, resources, state presidents and other members to obtain a broader perspective on agenda topics. • Recommendation of potential strategies, charges and projects for consideration in the strategic planning process. • Familiarity with current technology (smart devices) and access to the Internet.

Committee Duties Each board member is assigned liaison responsibilities for two to four national committees or work teams. The role of the board liaison is to represent the board’s position on the committee’s charges, to participate in committee assignments, to assist the committee’s staff liaison in reporting committee activities to the board and to mentor committee members as future chairpersons and/or board members. The president also may ask board members to represent ENA at meetings of affiliate or allied organizations. Typically, assignments are based upon a board member’s area of expertise.

State Responsibilities Each board member, excluding the president, serves as board liaison for five to six states. Board members are encouraged to have frequent contact with state presidents to exchange information about activities and the needs of members at the local and state levels.

October 2012

Nominations Committee Responsibilities Nominations Committee Member Election Members will be elected to serve for a two-year term on the Nominations Committee by geographic regions 2, 4, 6 and the past board member position. The state breakout by region is available at www.ena.org/ about/elections/Documents/NomComRegionalMap.pdf. The Nominations Committee is charged to do the following: • To review, ratify and present a qualified slate of election candidates for each position in the election of officers, directors and the Nominations Committee. • Review candidate applications for ENA national elections, according to established policies and procedures. • Encourage and mentor candidates throughout the election cycle.

• Conduct and facilitate the Candidates Election Forum for the Leadership Conference 2013. • Promote membership interest, education and voting participation. • Provide a status report at ENA board of director meetings. • Review and provide input on all policies and procedures related to the elections process. As we look to the future, ENA remains dedicated to strong leadership among its members. The nominations process is one step to ensuring that our national volunteer leaders are highly qualified and prepared for this responsibility. The Nominations Committee encourages members to vote in the 2013 election. If you have questions or need assistance, please contact Executive Services at 800-900-9659, ext. 4095, or e-mail elections@ena.org.

ENA Call for…

Proposed Bylaws Amendments and Resolutions Submission Deadline: March 11, 2013 The ENA General Assembly meets yearly before the start of the ENA Annual Conference to determine official association policy and positions by reviewing, debating and voting on proposed bylaws amendments and resolutions. Bylaws amendments may be proposed by the board of directors, state councils, association chapters or five active members of the association. Resolutions may be submitted by any active ENA member. Others who may submit resolutions include the ENA board of directors, state councils, chapters, the Journal of Emergency Nursing editorial board and ENA committees. The Resolutions Committee is available to help ENA members with developing proposed bylaws amendments and resolutions. This assistance provides members with the resources to effectively write proposed bylaws amendments and resolutions in the proper format before the deadline. If you are interested in bringing a proposed bylaws amendment or resolution to the 2013 General Assembly, it is recommended that you begin drafting your proposal and working with the Resolutions Committee at least three months before the submission deadline. Please contact ENA Component Relations at componentrelations@ena.org to obtain assistance from the Resolutions Committee. All proposed bylaws amendments and resolutions must be submitted in the proper template form and must follow the format as outlined in the Resolutions and Bylaw Guidelines. The guidelines may be found at www.ena.org in the General Assembly area (members only). Final submissions must be e-mailed to ENA headquarters at componentrelations@ena.org by 5 p.m. CT, March 11, 2013. Formal consideration of proposed bylaws amendments and resolutions will occur at the 2013 General Assembly, Sept. 18-19, in Nashville, Tenn. This is your opportunity to bring important professional emergency nursing issues to the 2013 General Assembly.

Official Magazine of the Emergency Nurses Association

Barry Hudson, BSN, RN, CPEN, immediate past president of the Texas ENA State Council, addresses the 2012 ENA General Assembly in San Diego.

Go Global With TNCC and ENPC By Ray Bennett, BSN, RN, CEN, CFRN, CTRN, NREMT-P Thinking back almost 25 years since finishing my nursing program, I never imagined doing anything that would impact health care in another country. In 1999 there was an open call in ENA Connection for members who had achieved faculty status in TNCC or ENPC to submit a letter for consideration to be a part of a team of instructors that would take a course to another country. The open call did not list where or when the next course dissemination would occur. I remember sitting at my computer on a Friday morning in November 2001, reading an e-mail from ENA regarding bringing TNCC to Portugal in February 2002. Before I hit the reply key, I discussed with my wife traveling to Europe in the era of post-9/11 and other significant terrorist events. As much as this was a concern, I felt the ability to teach TNCC in Portugal would be a unique opportunity. Since that trip, I have been fortunate to return to Portugal to teach ENPC in 2006, and I was the team leader for a 2010 trip to teach TNCC in Korea. Over the last 10 years, TNCC has spread to 14 countries and ENPC has spread to six countries. This October, ENA will bring TNCC to Kenya. Trips to disseminate TNCC and ENPC are filled with challenges and a lot of work. The process starts with a request from the host country to have either TNCC and/or ENPC brought to them. The ENA national office has a screening process for countries requesting the courses, which validates nursing practice standards and that the host country has the infrastructure to maintain teaching either TNCC and/or ENPC after the initial course dissemination. The basic schedule of a course dissemination is to hold a provider course for 16 students. At the end of the first course, the team of faculty will select eight students who will then take the first instructor course. These eight will then be mentored and signed off as instructors, teaching in the second provider course. The team of faculty will then select four of the new instructors to be mentored in teaching the second instructor course. At the end of the trip, the team of faculty will have taught two provider courses for 32 students and two instructor courses, making eight instructors, with four of them signed off as faculty. This will allow the course to continue to develop in the host country. Since my first trip to Portugal in

A TNP station overseen by new TNCC instructors Maj. Eun-goung Ann and Lt. Col. Myoung-Ran Yoo in Daejeon, Korea, in August 2010.

Alzira Silva leads the scenario and Patricia Gaspar serves as the patient during a 6th edition TNCC instructor update in Oporto, Portugal, in April 2008.

2002, the Portuguese TNCC instructors have since taught more than 100 TNCC courses. Canada, the UK and Australia have very active

TNCC and ENPC programs. Teaching internationally offers exciting, memorable moments as well as challenges. On

October 2012

ENA Connected

How Sound Is Your Social Media Policy? By Thomas Barbee, ENA Digital Marketing Manager You likely have been in this situation: You notice when checking your social media channel of choice that one of your friends or colleagues has posted something questionable. How do you react? It’s a tough situation, to be sure, especially given the instantaneous nature of social media. This is the reason that social media policy has become so vital for many organizations, hospitals and companies. The pace at which social media networks are growing is unprecedented, and there are increasing ways for not just text but multimedia to be shared. Consequently, one of the best strategies is to create a policy that is specific in its expectations and corresponding penalties that are applicable to all situations. It’s not so much that policies need to be reinvented for this technology, but expounded upon to capture the very nature of what that technology allows its user to do. Beyond an organization standpoint, a personal level of self-policing measures can go a long way. The first and most important is to never share anything with a social media outlet that you wouldn’t want shared with everyone in your organization. While this may seem to be common sense, there are a surprising number of cases where those very actions

all three of my trips there have been obstacles, such as translation issues, to overcome. In preparing for our trip to Korea, we discovered that they did not have rescue airways, such as the Combi-tube or King Tubes, so we had to pack these items. On all trips we found that while understanding spoken English was common for our international colleagues, using English conversationally was not. We spend approximately nine of the 15 days on the ground teaching. These are long days, often lasting 10 hours, in addition to evening preparation meetings. However, each trip allows for some down time to explore the host country and socialize with our new international colleagues. As I reflect on each of my three trips, I feel lucky to have had the opportunity to provide trauma and pediatric nursing education, which in turn will improve the quality of health care being provided in emergency departments around the globe. E-mail and social networking sites allow me to maintain contact with my international colleagues, who are now great friends with commons goals. This fall, ENA will post another open call for TNCC and ENPC faculty for future international dissemination trips. Even though ENA does not have any definitive countries requesting a trip at this time, the organization would like to maintain a current database of members who are interested in improving the quality of health care around the world. I encourage ENA members to apply. The memories will last a lifetime.

have occurred with disastrous results. Another proactive way to maintain privacy, and one that has become increasingly popular, is simply keeping a private profile that’s completely separate from your public, or professional, profile. That allows a certain degree of freedom, though there is still risk in anything that gets published online. Because of all of these factors, it is impossible to say one policy works better than another. However, the best thing that anyone can do is to always be mindful of what is posted; and if you have clear consequences in place for those who violate terms, ensure that quick and decisive actions take place. As this is a constantly evolving issue, I would be interested in hearing what you are doing personally or within your organization in terms of social media policy. There is no right or wrong approach, and it is always fascinating to hear what else is out there. Send your feedback to webmaster@ena.org or post on the ENA Facebook page (www.facebook.com/enaorg).

Ray Bennett presents the SHOCK lecture in Daejeon, Korea, with Taehoon Park assisting with translation.

If this article described something that would interest you, watch for an e-mail – “Call for TNCC/ENPC Faculty” – coming from ENA in late 2012, asking for TNCC/ENPC faculty who are interested in participating in an international dissemination.

Official Magazine of the Emergency Nurses Association

WASHINGTON WATCH |

Kathleen Ream, MBA, BA, Director, ENA Government Affairs

From the States

Be Alert for State Legislation Impacting ED Nursing Practice In March 2006, the Emergency Nurses Association, along with the American College of Emergency Physicians, urged the Senate to exclude Section 202 of H.R. 4437, the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005, from any bill that was passed on this issue. In a letter dated March 28, 2006, the two organizations stated that the language in this section could inadvertently place emergency nurses and physicians and their hospitals in untenable positions while attempting to comply with existing federal laws, primarily EMTALA. If it had been included in the final bill, which it wasn’t, Section 202 of H.R. 4437 would have expanded current immigration law by criminalizing anyone who attempted to provide “assistance” or “harbored” an illegal immigrant. ENA and ACEP noted in their letter that providing needed and legally required health care to an illegal alien could meet this definition and, thereby, criminalize the care provided by emergency nurses and doctors. Six years have passed and emergency personnel are still faced with immigration legislation that may put them in untenable positions. In 2012, America’s attention was focused on the Supreme Court’s review of Arizona’s SB 1070 immigration law. What many Americans didn’t know was that other immigration bills had also worked their way through the Arizona legislature in 2012. Of particular importance to emergency department health care providers was a bill requiring EDs or hospitals to report illegal immigrants. SB 1445 stated, ‘‘If a person who seeks or is receiving emergency or nonemergency care at a hospital cannot provide valid health insurance information, the hospital admissions officer or representative must reasonably confirm during the course of the person’s admission or treatment that the person is a citizen of the United States, a legal resident of the United States or lawfully present in the United States.’’ According to the bill, if the hospital/ED cannot confirm legality, it must immediately contact immigration or law enforcement. The hospital also would be required to annually submit a report on the number of patients seen who did not show proper valid information and the number of calls made to immigration or law enforcement. This bill was

assigned for review to three committees in the legislature: Health Care and Liability Reform, Government Reform and Rules. It died in committee (www.azleg.gov, 2012). The U.S. Department of Homeland Security estimates that there are 11.5 million illegal immigrants in the United States.1 In 2009, Modern Healthcare noted that at least one third of all immigrants lack health care.2 Among Mexican immigrants, this number is even higher, with an equal or greater-than-50-percent uninsured rate. Arizona is one of seven states with the highest illegal immigrant population. The others are California, Texas, New York, Florida, Illinois and New Jersey. Undocumented immigrants tend to use the emergency department more often than all other uninsured patients.3 The ED is a safety net for all the underinsured and uninsured, required by the Emergency Medical Transport and Labor Act to provide evaluation and emergency care to all who enter the facility (www.ena.org/government/ emtala/Pages/Default.aspx). As professional nurses, we are advocates for safe, competent, available emergency care for our patients. Certainly, we have multiple reporting requirements in our practice. A myriad of state and federal regulations requires us to report child and adult abuse, sexual assault, animal bites, knife and gun wounds and burns, for example. All of these are meant to protect patients and society. It should not be a part of our practice to be responsible for immigration enforcement. As emergency nurses, we need to take responsibility for our profession and our practice. It is imperative that nurses do not remain legislatively illiterate. We are leaders and advocates for those who need us most. Become aware of the bills in your state and have a strong voice on issues. The Emergency Nurses Association and the ENA Government Affairs Committee are here to help you. As Margaret Mead said, ‘‘Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.’’ References 1. United States Department of Homeland Security. (2012). Statistics. Retrieved July 6, 2012, from www.dhs.gov/ index.shtm. 2. Carlson, J. (2009). Immigrants are missing quotient in reform talks. Modern Healthcare, 39(25), 18. 3. American College of Emergency Physicians. (2012). Illegal immigrant care in the emergency department. Retrieved July 6, 2012, from www.acep.org/content. aspx?id25206. Article by Rita Anderson, RN, CEN, FAEN, ENA Government Affairs

Massachusetts ED Costs Increase Dramatically A new report finds that unnecessary ED costs in Massachusetts have gone up by about 35 percent, or nearly $150 million between FY 2006 and 2010. The

October 2012

Division of Health Care Finance and Policy report found there were nearly 2.5 million ED visits in FY 2010, and about half those visits were preventable or avoidable. State lawmakers say that they expect the costs to go down. The Senate’s Health Care Financing Committee Chairman, Richard Moore, says the state’s new health care law will promote access to primary care doctors and reduce ED visits. Despite increasing costs, the report found that the number of ED visits is decreasing. It also recommends that there should be a greater availability of health care services to reduce unnecessary costs.

ENA wishes to express its sincere gratitude to these 2012 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant services and educational programs to improve your practice of emergency nursing.

Massachusetts Law Includes Ban on Mandatory Overtime

Strategic Sponsors

On Aug. 6, Massachusetts Gov. Deval Patrick (D) signed into law the state’s much-anticipated health care cost containment bill – SB 2400 – that includes a ban on mandatory overtime for RNs. Under the new law’s provision banning mandatory overtime, a hospital cannot, except in the case of a declared emergency, require a nurse to work beyond his or her scheduled shift, and no nurse can be required to work more than 12 hours in a 24-hour period. Hospitals that assign a mandatory overtime shift are required to report those incidents to the Massachusetts Department of Public Health, along with the justification for its use. Any nurse can refuse overtime without fear of retribution or discipline of any kind from his or her employer. A number of scientific studies published in the last decade have documented the dangers and costs of mandatory overtime. The studies included findings that nurses working mandatory overtime are three times more likely to make costly medical errors, and that such overtime was associated with an increased risk of catheter-related urinary tract infections and bedsores, both preventable medical complications. In addition, a report issued by the Institute of Medicine in 2002 linked mandatory overtime and the under-staffing of nurses to thousands of patient deaths each year, and called for prohibition of the practice.

Strategic Supporters

Conference Sponsor

Conference Supporter

*As of print time

Official Magazine of the Emergency Nurses Association

Tips for a Successful Application to the Academy of Emergency Nursing By Maureen Curtis Cooper, BSN, RN, CPEN, CEN, FAEN AEN Board Member at Large, Academy of Emergency Nursing We are all back at work after being professionally refreshed, revitalized and invigorated at the 2012 ENA Annual Conference in San Diego. The 1st Annual Awards Gala was a wonderful way to conclude our time in sunny California. Terry Foster, MSN, RN, CEN, CCRN, FAEN was an excellent master of ceremonies as we welcomed our eighth class of fellows into the Academy of Emergency Nursing. Now is the time for our 2013 class of fellows to start preparing their application for admission into the AEN. Will you be in the ninth class of inductees? Information and applications are now available at www.ena.org under “Calls and Opportunities.” The deadline to submit online applications is 5 p.m. (CT) on Friday, Nov. 30, 2012.

Are You Ready to Apply? One criterion for admission into the AEN requires substantial and enduring contributions to the emergency nursing profession. Contributions and impact can be in broad categories of practice, education, research, leadership and/or public policy. This requires being active not only on the local level but also on the regional, national and/or international level as well. Have you been an active member of ENA for the last three consecutive years without any gaps in membership? (International applicants must be ENA members for one year and members in their country’s emergency nurses association for the last three consecutive years.) Has your substantial and enduring contribution made a significant impact on emergency nursing? Is your curriculum vitae current and, most important, does it reflect your significant contributions to our profession? Another criterion requires potential for future contributions. Admission into the AEN truly honors your impact on the profession. Moving forward as a fellow, you will be called upon to freely share your expertise with ENA and its members. Have you cultivated two sponsors? One sponsor must be a current fellow of the AEN. If you do not know a current fellow, there are ways to meet and work with one. Fellows are active on national ENA committees and in all areas of practice. Consider applying for the

EMINENCE mentoring program, where you are paired with a fellow to work on your project of choice. Network with fellows at national conferences. It is often so surprising to discover that your clinical problem is a national clinical problem, and there are fellows who can collaborate with you or guide you to new heights. In these times of economic hardship, it would be remiss not to mention financial readiness. The AEN budget is maintained by fellow annual dues and ENA. To be a fellow in good standing requires maintaining membership in ENA and paying annual AEN dues (currently $100). You might want to consider lifetime memberships in both. The Academy of Emergency Nursing’s ninth inductee class will be required to attend the induction in Nashville, Tenn., during the 2013 ENA Annual Conference. Inductees’ presence also is requested at AEN annual business meetings held in conjunction with the ENA Annual Conference. If after some consideration you have discovered that your body of work as an emergency nurse has been substantial and enduring with a significant impact, you have a plan for potential future contributions and you have two sponsors who know your work, this may be the year for your application. The following are some tips to help you realize your professional goal as you complete the application process:

Deadlines Be aware of the deadlines. Communicate these deadlines to your sponsors. Allow yourself enough time to write, rewrite and edit a thoughtful statement. Fall is a busy time of year for everyone. Do not expect your sponsors to drop everything to meet a short deadline. Your poor planning does not create an emergency for your sponsors.

Content and Word Limits Be aware of the word limits for each section:

•C riterion 1, Active Involvement – 400-word limit •C riterion 2, Enduring and Substantial Contributions – 750-word limit •C riterion 3, Potential for Sustained Contributions – 300-word limit Do not exceed word limits. Your application and two letters of support are the only materials used to determine eligibility. Even if your contributions are known but not included in the statements, they cannot be considered. Proofread your application. Have an uninterested party proofread it as well. In this day of abbreviated e-mail messages, it is easy to omit a verb or noun or include an incomplete sentence. Be sure spelling and grammar are correct and use correct punctuation.

Criterion 3, Potential for Sustained Contributions Pay special attention to this section. Rather than restate items from the enduring and substantial contributions statement, outline clear and attainable goals that demonstrate how you will impact the future of emergency nursing. Future contributions can be made in the areas of practice, education, research, leadership or public policy.

Sponsors Sponsors should be individuals who know you and your professional contributions. Share your criterion statements with your sponsors so their statements enhance and highlight the impact of your contributions. Letters of support should speak to these items and not simply restate your three criterion statements. Make the most of your statements so your AEN reviewer can truly understand why you are an excellent candidate.

Before You Hit Send • Did you follow the application instructions? • Did you e-mail your CV separately? • Have you budgeted money to attend the 2013 ENA Annual Conference in Nashville? By keeping these tips in mind, you will avoid common pitfalls that can derail a worthy application to the Academy of Emergency Nursing. As a current fellow and member of the Academy Board, I look forward to welcoming you among the ninth class of inductees.

October 2012

ENA Nominations Committee:

The Work Doesn’t End After the Votes Are Tallied By Amy Carpenter Aquino, ENA Connection

The ENA Nominations Committee is the only committee elected by the ENA membership. While the committee members are very visible during election time, especially at the Candidates’ Election Forum at Leadership Conference, the members continue working on the election process throughout the year. In fact, as soon as one election is completed in mid-June, the committee begins working on the next election, said Louise Hummel, MSN, RN, CEN, CNS, 2012-2013 Nominations Committee chairperson. “I don’t know if the membership understands what goes on behind the scenes,” said Hummel, as she prepared to attend the 2012 General Assembly, where the committee was presenting bylaws amendment proposals to the delegates gathered in San Diego. “We’re reviewing candidate applications; we work with the candidates to help them prepare for the forum; and each candidate has a committee member assigned to him or her, and that person acts as the intermediary throughout the election process.” Monthly – or even more frequent – conference calls are just part of the committee’s ongoing commitments. Prior to writing and submitting proposed bylaws amendment(s) to the General Assembly for consideration, committee members must review current election rules and conduct necessary research. The committee looks at election candidate applications for completeness, which includes verifying that each candidate’s membership is current and that the candidate has the qualifications to run for ENA office, said Hummel. The Nominations Committee also has the responsibility for writing the questions the candidates will answer at the Candidates’ Election Forum, which is held annually at Leadership Conference. “We write questions that are specific to the president-elect, questions that are specific to the secretary/treasurer and questions that are specific to the director candidates,” said Hummel. In deciding which topics to cover in their questions for the various candidates, Hummel said the Nominations Committee considers current issues in emergency nursing, hot topics

Louise Hummel, MSN, RN, CEN, CNS Chairperson Region 1

Scott E. Stover, MSN, MBA, ACNS-BC, CEN Region 2

Cathy C. Fox, RN, CEN, CPEN Region 4

Ellen E. Ruja, MSN, RN, CEN, FAEN Region 6

Terry M. Foster, MSN, RN, CEN, CCRN, FAEN Region 3

Lucinda W. Rossoll, MSN, RN, CEN, CPEN, CCRN Region 5

Tiffiny Strever, BSN, RN, CEN Past ENA Board Member

in the association, as well as national trends in the practice. The committee also solicits questions from the audience via a questionnaire distributed during the Candidates’ Election Forum for consideration in using at the next year’s forum. “We ask the audience what they would like to hear addressed by the candidates, and then we compile them, look them over and say, ‘Maybe this would make a good question for next year,’” said Hummel. “We may tweak it a little bit, but we enjoy taking suggestions from

Official Magazine of the Emergency Nurses Association

the membership, because they are voting for their future leaders. We want to be able to find out what issues they want addressed.” The Nominations Committee – which increased its visibility with a new badge holder ribbon at the 2012 Annual Conference in San Diego last month – has been working tirelessly to improve the voting turnout for the ENA national election. Hummel was thrilled when the election results jumped an entire percentage point this year. She credits several reasons, including moving to an all-electronic ballot and broadcast e-mails sent to remind members to vote as well as e-mails highlighting the election candidates. “We are always open to suggestions from the membership,” said Hummel, adding that members can contact the committee at elections@ena.org. Hummel also thanked the dedicated Nominations Committee members whose terms of service recently ended: Gail Carroll, BSN, RN, CEN, and Carlene Kincaid, BSN, RN, CEN. The Nominations Committee’s responsibilities include but are not limited to the following: 1. C onduct a fair and equitable national election, including the review of all candidate applications and ratifying the slate of candidates according to established ENA bylaws, policies and procedures. 2. R eview and update election rules and procedures as needed. 3. C ollaborate with staff to investigate ideas and invest in methods that may promote greater voter interest, visibility of candidates, exchange of information and participation in the election process. 4. Review and update the national candidate application for content, ease of use and effectiveness and assist potential candidates throughout the election cycle. 5. Plan, promote and facilitate the 2013 Candidates’ Election Forum at the annual Leadership Conference. 6. Provide progress reports to the ENA Board of Directors throughout the year.

2012 Scholarship and Research Grant Recipients The ENA Foundation would like to extend a special thank you to the individuals, state councils, local chapters, industry and friends of emergency nursing who have supported the profession through their generous donations. Because of your contributions and passion to promote the advancement of the profession, our applicants are afforded the opportunity to receive educational scholarships and research grants in the discipline of emergency nursing. The ENA Foundation is excited to announce the following 2012 scholarship and research grant recipients and share how our donors are making a difference:

Academic Scholarship Recipients Non-RN Scholarships • California State Council – Bryan Stow Scholarship – $5,000 Nathan Dreesmann, EMT – Washington • New York State ENA September 11 Scholarships – $2,500 each Khristeen Sproul, EMT – New York Jon Manzano, NREMT-B – California • ENA Foundation Non-RN State Challenge Scholarships – $2,500 each Deya Montalvo, EMT-B, Paramedic – California Dana Johnson, EMT-B – Colorado Matthew Onofrio, NREMT-P – Iowa Jillian Conley, EMT-B – New Jersey

Undergraduate Scholarships

• Kentucky State Council – Kentucky ENA Founders Scholarship – $5,000 Dawn McKeown, BSN, RN, CEN, CPEN – Louisiana • Maryland State Council – Maryland ENA State Council Scholarship – $5,000 Megan Doede, BSN, RN, CEN – Maryland • Minnesota State Council – “Pathways IV” Scholarship – $5,000 Mary Jagim, BSN, RN, CEN, FAEN – North Dakota • Mississippi State Council – Sonja O. Adkins Mississippi State Scholarship – $5,000 Jennifer Denno, BSN, RN, CEN – California • New Jersey State Council – Emergency Care Scholarship – $5,000 John R. Stott II, BSN, RN, CEN, CPEN – New Jersey • New Jersey State Council – New Jersey State Challenge Scholarship – $5,000 Julie Ann Dale, MSN, RN, CEN – Missouri • Northern Chapter (NJ) – Mary Kamienski Scholarship – $5,000 Dawn M. Sullivan Wright, BSN, RN, CEN – Indiana • West Central Chapter (NJ) – Jeanette Ash Scholarship – $5,000 Jill McLaughlin, BSN, RN, CEN – New York • South Carolina State Council – Antoinette Ruff-Johnson Memorial Scholarship – $5,000 Kathy Van Dusen, BSN, RN, CEN – California

• Charles Kunz Memorial Undergraduate Scholarship – $3,000 Rita Anderson, RN, CEN – Arizona

• Tennessee State Council – Tennessee State Challenge Scholarship – $5,000 Kylie Kersten, BSN, RN – Arizona

• Betty J. Smith, RN (Lt. Army Nurses Corps, WWII) Memorial Scholarship – $3,000 Mark J. Smith, RN, CEN – North Carolina

• Texas State Challenge – Vicki Patrick Legacy Scholarship – $5,000 Tiffany Young, BSN, RN – North Carolina

• Board of Certification for Emergency Nursing (BCEN) Scholarship – $3,000 Adam Bruhn, RN, CEN – Nebraska

Graduate Scholarships • Stryker Masters in Healthcare Scholarship – $5,000 Kristen Connor, BSN, RN, CEN, PHRN – California

• ENA Foundation Graduate State Challenge Scholarship – $5,000 Jennifer Lechota, BSN, RN – Michigan • Board of Certification for Emergency Nursing (BCEN) Scholarship – $4,000 Reagan Norman, BSN, RN, CEN – Indiana • Physio-Control, Inc. Scholarships – $3,000 each Nancy Alexander, BSN, RN, CEN – Ohio Andrew W. McLuckie, BSN, RN, CEN, CPEN, CCRN – Pennsylvania

• Board of Certification for Emergency Nursing (BCEN) Masters in Healthcare Scholarship – $5,000 Cheyenne Brown, BS, RN, CEN – Utah

• Gisness Advance Practice Scholarship – $3,000 Terry Stigdon, BSN, RN, CPEN – Indiana

• AnnMarie Papa Stretcherside Miracle Scholarship – $5,000 Kimberly Johnson, BSN, RN – Michigan

• Karen O’Neil Memorial Scholarship - $3,000 Theresa Sexton, RN, CEN – Massachusetts

• Board of Certification for Emergency Nursing (BCEN) Scholarships – $5,000 each Diane Blackman, BSN, RN, CEN – Pennsylvania Joyce Fuss, BSN, RN, CEN, CPEN – Indiana Jonathan Green, BSN, RN, CEN, CCRN – New York Lynn Sayre Visser, BSN, RN, CEN, CPEN – California

• ENA Foundation State Challenge Scholarships – $3,000 each Amanda Brothwell, BSN, RN, CEN, CPEN – Nevada Lori L. Carlen, BSN, RN, CEN – Nebraska Theresa Del Biondo, RN – Pennsylvania Jenna Hannity, BSN, RN, CEN – Washington Ruth Keniston, RN – California Rachael M. Young, BSN, RN, CEN – Illinois Katie Zielinski, BSN, RN – California

• Colorado State Council – Colorado Rocky Mountain Scholarship – $5,000

Cindi Warburton, BSN, RN, CEN – Oregon

October 2012

Doctoral Scholarships • Pamela Stinson Kidd Memorial Doctoral Scholarship – $10,000 L aura E. Gallagher, MSN, RN, CNS, CEN – South Carolina • Board of Certification for Emergency Nursing (BCEN) Doctoral Scholarships – $5,000 each L inda Roney, MSN, RN-BC, CPEN – Connecticut J ennifer Williams, PhDc, RN, ACNS-BC, CEN – Missouri • Hill-Rom Doctoral Scholarships – $4,000 each K ayla Thompson, BSN, RN, CEN – North Dakota Patti Van Auker, MSN, RN, CEN – New York

Andrea Rich, BSN, RN, CEN, CFRN – Arizona Shannon Mazza Roberson, BSN, RN, CPEN – North Carolina Deborah Robichaux, RN, CEN, CCRN – Georgia Laura St. Clair, MA, BSN, RN – Wyoming Jeanne Venella, DNP, MS, RN, CEN, CPEN – New Jersey Michael Zonak, RN – New Jersey

Research Grant Recipients • ENA Foundation / Sigma Theta Tau International Research Grant – $6,000 Jessica Draughon, MSN, RN – Maryland

Continuing Education Scholarship Recipients • Vidacare Annual Conference Scholarships – $500 each J anice Alley, RN, CEN – Virginia J. Richard Beshore, BSN, RN – California B randon “Kit” Bredimus, BSN, RN, CEN, CPEN – Texas Teresa Brunt, RN – Utah Kaleigh Byrne, BSN, RN – Virginia Jenny Edmonds, EN, RN – United Kingdom John Fraleigh, BSN, RN, CFRN – Arizona Peter Giordano, BSN, RN – Illinois Crista Jimenez, BSN, RN, CEN – Florida Sherri Mimbs, RN – Florida

• ENA Foundation / Sigma Theta Tau International Research Grant – $3,000 Mary Johansen, PhD, NE-BC, RN – New Jersey • Industry Supported Research Grant – Supported by Stryker – $5,000 Recipient not selected as of press time. As a donor, you can make a difference in the future of emergency nursing. Your donation will help to provide funding for research that can improve the quality of patient care, build future leaders, support education that can change the practice of medicine in the future and much more. If you would like to join others in making a difference in emergency nursing, the ENA Foundation has opportunities. Please visit www.enafoundation.org to find out how you can contribute to advancing emergency nursing.

Leadership Conference 2013 Conference Program Is Going Digital With the ever-changing landscape of our members who are becoming more technologically savvy, ENA has listened by putting the Conference Program for Leadership Conference 2013 online at www.ena.org/lc. Traditionally, we have mailed out the Conference Program with the October issue of ENA Connection, but by putting the program online, you are guaranteed to have the Conference Program at your fingertips 24/7. This also allows us to make the latest updates to the program anytime, day or night. Besides putting the Conference Program online, we are also refreshing and updating the look and feel of the program for a better overall read. We are boiling over with excitement about the new Conference Program and we want to share some of those new features, such as: • Bulleted copy – For more detailed and precise course information with more focus on the objective of the course. • Easier read – More course listings on a page which will help you determine which courses to take. This allows us to have fewer pages in a more condensed format. • Schedule-at-a-Glance – Think ‘‘TV Guide’’ format: better visual with side-by-side information on when and where education

sessions and special events occur. • Social media – A much larger social media presence for not only ENA but to follow keynote speakers, etc. • Much more! We could not be prouder of the accomplishments we made this past year at our Leadership and Annual conferences, but there is much more work to be done to make 2013 even better. We hope you enjoy this digital Conference Program.

Official Magazine of the Emergency Nurses Association

ENA STATE CONNECTION Arizona ENA State Council Submitted by Tomi St. Mars, MSN, RN, CEN, FAEN One of the many challenges that emergency nurses face on a daily basis surrounds the management of pain for patients coming to the emergency department. The patient with chronic pain is especially challenging for emergency physicians and nurses alike. The ED is not the best environment to fully assess, diagnose or provide definitive pain management. Recently, AZ ENA representatives attended a collaborative, one-day forum to discuss the scope of the problem, barriers in proper management, standards of care and the resources in place to monitor ED prescription drug use. The goal is to develop statewide guidelines for care of the chronic pain patient and increase prescriber participation with the prescription drug monitoring program. Currently, only 15.6 percent of all prescribers are registered to use the system. The July 18 forum was organized by the Arizona Department of Health Services and provided representation from more than 60 health care providers, which included ACEP, the Board of Pharmacy, AZENA, AHCCCS (Arizona Medicaid), Indian Health Services, behavioral health organizations, nursing and executive management from hospital systems throughout Arizona, as well as DEA enforcement personnel. This collaborative activity began with two emergency physicians recognizing a problem, developing a program and providing insight to the implementation program currently in use at one hospital system. Through education, a spark has ignited. One such presentation to the AZENA membership in January 2012 grew to include the forum in July and a proposed resolution presented at the ENA General Assembly in September.

Florida ENA State Council Submitted by Pattie Stadler, MS, BSN, RN, CEN, CCRN, and Terri McGowan-Repasky, MSN, RN, CNS, CEN Leading by Example Every new year brings an opportunity to develop and grow strong leaders within our organization. In the spring, the Florida Emergency Nurses Association Executive Committee presented our Chapter Leaders Orientation program. Chapter leaders from around the state were invited. Florida is a three-tier state with 16 chapters. Two leaders from every chapter were invited to attend the all-day workshop. Topics included the following: • Overview of ENA and FENA, including responsibilities of GA delegates • Chapter Management/Responsibilities and Strategic Planning •R esponsibilities of Treasurer (chapter and state) •R esponsibilities of Secretary (chapter and state) • Government Affairs and Resources • Overview of ENA and FENA websites This day offered more than just education; it provided an opportunity to network and put faces and names together. State leaders had the opportunity to meet and exchange ideas with the executive team in a comfortable setting.

Florida: Manasota Chapter Submitted by Jennifer Sweeney, MSN, BA, RN, CEN On May 10, the Manasota Chapter of the Florida ENA State Council co-provided the 2012 Nurses’ Week Research Conference with Sarasota Memorial Healthcare System in Sarasota, Fla. The theme of the conference was ‘‘The Power to Change Using Research.’’ This event brought together nurses from all over the west coast of Florida to celebrate the value of evidence-driven professional nursing practice. The event included presentations from several nationally recognized speakers, as well as 14 poster presentations from local nurses who have made a meaningful impact on professional nursing practice through the implementation of evidence-based initiatives.

Poster presentations highlighted evidence-based projects, including the use of high-fidelity simulation to enhance ACLS team training, Neonatal Abstinence Syndrome, Preventing Falls, Emergency Obstetric ACLS skills, nursing knowledge of geriatric-specific issues in acute care, and more. The Manasota Chapter was thrilled to have the opportunity to collaborate with Sarasota Memorial Health Care system in this highly successful professional nursing event. In total, more than 50 nurses from all over the southwest Florida area joined us in celebrating and supporting the value of evidence-based nursing practice. We look forward to an even larger event in 2013.

Manasota (Florida) Chapter members Maribeth Desiongco, MA, RN-BC (left) and Jennifer Sweeney, MSN, RN, CEN, present the poster “A Hybrid Program Utilizing Heart Code ACLS & BLS with Simulation to Validate Competency.”

North Carolina ENA State Council Submitted by Mary Lou Forster Resch, BSN, RN, CEN North Carolina had a great time in San Diego. We are honored and proud to have had a voice in the decision-making process of our professional organization. Thanks to everyone who stopped by our fundraising booth and supported our endeavors. Our membership blitz ran Sept. 1-30. We will award a free ENA membership to the nurse who recruited the most new members. We invite you all to Wrightsville Beach on Nov. 9 for our 8th Annual Fall Conference. The planned presession is an ENPC Instructor Course, which we hope to present at a very affordable fee. We have borrowed the ‘‘pay it forward’’ concept from Leadership Conference and incorporated it into our State of the State presentation. For more information, visit www.nc-ena.com.

Texas ENA State Council Submitted by Christine Russe, MSN, RN, CEN, CPEN The TENA Nursing Practice Committee was charged in 2012 with submitting two position statements: 1 - Position Statement: Social Networking (statement addresses social networking and potential privacy issues in the emergency care setting). 2 - Position Statement: Wireless Telecommunication Devices (statement addresses any device that makes or receives phones calls, leaves messages, sends text messages, capable of browsing the internet, or downloads and allows for the reading of and responding to e-mail). These ratified position statements were presented to and unanimously approved by the TENA State Council on July 14. These two Texas ENA position statements are a first for the Texas ENA. They are the results of more than two years of diligent work by the Texas ENA Nursing Practice Committee. The TENA Nursing Practice Committee plans to provide additional position statements in the future. Thank you to everyone who contributed to these TENA statements. These new TENA position statements will soon be posted at www.txena.org. A Nurse’s Guide to the Use of Social Media pamphlet by National Council of State Board of Nursing was also disseminated to attending members. If you are

October 2012

interested, additional copies may be obtained free from NCSBN website. Submitted by Rhonda Manor-Coombes, BSN, RN On July 14, the Texas ENA 3rd Quarter State Council Meeting was held in Lubbock, Texas, with two members attending the meeting via WebEx. As press secretary/media chair, I was charged with making participation possible for those members unable to attend a state council meeting. WebEx is a Web conferencing tool that combines desktop sharing via Web browsing and phone conferencing. The only need is a computer and reliable Internet access. I was able to share my documents with the attendees after they logged in. I could intermittently send chat messages to the attendees to make sure that they were still participating. The attendees were also able to send me questions or comments that I would then share with the council and delegates. Monitoring participation is crucial, especially if the member is to receive credit for attending a state quarterly meeting. The only issue was sound quality. While the attendees were able to hear using a USB microphone I had attached to my computer, they had a hard time hearing those members who spoke softly. One of ENA’s Strategic Plan priorities is to expand and fortify ENA’s membership. I truly believe that with remote access, this can be accomplished. All in all, I would say that this was a success. The idea of members remotely accessing the meeting is a huge step and a benefit for our members.

The ignition interlock system is used to limit drunk driving since it has been documented that DUI offenders will continue to drive under the influence. The ignition interlock device requires the driver to take an alcohol breath test every time he or she gets behind the wheel, and it will also do random tests or ‘‘rolling retest’’ while driving to ensure the driver isn’t drinking while driving. These devices are more effective than license suspension because DUI offenders will continue to drive under a suspended license. Studies have shown that states using the ignition interlock system can decrease DUIs by 66 percent. Linda Whitt, BSN, RN, CEN, an emergency nurse of more than 40 years, has seen the consequences of driving under the influence and the tragedies from alcohol-related crashes; knowing her mother was an offender of drinking and driving, she had an ignition interlock device placed in her mother’s vehicle. Whitt believes this device works and said, ‘‘I am happy to say that she never hurt anyone

because I had the ignition interlock device installed on her car to keep her from being able to start the car while intoxicated.’’ Whitt said she would not have been able to live with herself if something happened while her mother was driving under the influence, knowing she had a problem and didn’t do anything about it. Virginia’s goal is to decrease the number of alcohol-related crashes and fatalities. Although these have decreased over the years, the ignition interlock can prevent more lives from being lost in senseless crashes from DUIs. Statistics from the Virginia Department of Motor Vehicles and the Virginia Highway Safety Office for 2011 reports that Virginia had more than 8,400 alcohol-related motor vehicle crashes resulting in 245 fatalities and 5,465 injuries. Although we won’t totally eliminate driving under the influence, having a voice to decrease DUI-related crashes by showing our support of these bills acknowledges ENA’s mission in injury prevention and saving lives.

Virginia ENA State Council Submitted by Janice McKay, RN, CEN, CFRN Emergency department nurses see the consequences of alcohol-related crashes, the loss of life or crippling injuries and are in favor of methods to decrease and prevent alcoholrelated crashes. Members of the Virginia State Council were asked to support the House Bill 279 and Senate Bill 378 and contact their state legislators to have these bills passed to prevent drunk driving in Virginia. Effective July 1, first-time driving-under-theinfluence offenders in Virginia may be mandated by the court to have an ignition interlock device installed in their vehicle for resumption of driving privileges. Previously, the law was a fine no less than $250, jail time and suspension of their driving license for a year, with stricter penalties determined by the blood alcohol content of the offender. The ignition interlock system was used as an option for second-time offenders but is now required by the court. Currently, 15 states have laws mandating the use of interlock systems for first-time convictions, and now Virginia joins these states.

New ENA monthly offering for FREE Continuing Education with contact hours for our members. • Available October 1 – Improving the ED Flow 1.0 contact hour Barbara Weintraub, RN, MPH, MSN, APN, CEN, CPEN, FAEN

Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Official Magazine of the Emergency Nurses Association

July 2012

Board Meeting Actions and Highlights

The ENA Board of Directors met July 18 via teleconference. All board members were present and took the following actions: • Approved the June 21 board of directors meeting minutes as written. • Approved the Leadership Conference 2013 budget as presented. •A pproved a request to support the American College of Emergency Physicians’ clinical policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. •R eferred board governance policy 3.14, Board of Directors Stipends, back to the Governance Committee. • Approved a restructure of ENA committees as amended. •A pproved the following actions related to Trauma Nursing Core Course and Emergency Nursing Pediatric Course Reverification as presented. °T NCC and ENPC reverification will no longer be offered after Dec. 31, 2012.

Letter From the President

References

to recognize that products that are not passively designed and require training put nurses at risk. In this study, “passive devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding Shield.”3 A syringe with a retractable needle is one example of a passive device. When the plunger of the syringe is pushed down to deliver medication, it triggers the needle to

automatically retract from the patient before it is pulled out. So, in the end, there is no contaminated needle to harm anyone. The needle is immediately and safely enclosed in the syringe. This type of syringe has been available for years, and yet, is still not standard in hospitals. The prevention of sharp injuries and resulting illnesses should begin long before nurses hold a device in their hands. Manufacturers have a need and a responsibility to make devices that are truly safe. Emergency nurses are at special risk. They deserve the same robust protection that the public and industry enjoy.

1. Massachusetts Department of Public Health Occupational Health Surveillance Program. (2010). Sharps Injuries among Hospital Workers in Massachusetts, 2010: Findings from the Massachusetts Sharps Injury Surveillance System. 2. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. (n.d.). Retrieved from www.cdc.gov/niosh 3. N eedlestick Injury Rates According to Different Types of SafetyEngineered Devices: Results of a French Multicenter Study William Tosini, MD; Celine Ciotti, RN; Floriane Goyer, RN; Isabelle Lolom, MSc; Franc¸ois L’Heriteau, MD; Dominique Abiteboul, MD; Gerard Pellissier, PhD; Elisabeth Bouvet, MD.

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the beginning of care; however it can be requested at any time, by anyone on the treatment team. Performing a shared mental model keeps the team grounded, allowing for focus on the primary needs of the patient and allows staff to hone in on the plan, providing the opportunity to contribute suggestions.

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis) Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center is part of a not-for-profit, Magnet-designated academic medical center and has an annual census of 108,000 emergency patients. Forty-nine percent

° Continuing education updates will be offered in place of the reverification courses. ° New editions of the courses will be available every four years. • Ratified Judith Halpern, MS, RN, APRN, as a replacement member for the Emergency Nursing Resources Committee as presented. • Ratified Carey Goryl, MSW, CAE, chief executive officer (International Association of Forensic Nurses) and Kim Day, RN, FNE A/P, CFN, SANE-A, SANE-P (IAFN) as the replacement Forensic Special Interest Group co-facilitators as presented. • The board agreed to continue appointing ENA representatives to the American College of Emergency Physicians’ committees. Highlights of the next scheduled board of directors meeting will be published in a future issue of ENA Connection.

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particularly important when healthcare personnel are working long hours or night shifts, as well as in emergency situations, all of which are associated with a higher rate of NSIs. Furthermore, passive devices eliminate the need for intricate training. The drawback of higher cost might be offset by lesser training requirements and by cost savings associated with a reduction in NSIs (eg, serological tests, counseling, post-exposure prophylaxis, time off work, and treatment).’’ 3 These costs don’t even include the cost of one nurse who becomes infected with HIV or hepatitis C, or the human toll. If we take safety seriously, we need

2012 Lantern Recipients

of hospital admissions come through the ED. Success in improving patient flow is demonstrated by the fact that the emergency department has no boarded patients. Through a strong shared governance model, collaborative decision-making and staff nurse autonomy were utilized in developing evidence-based strategies to solve barriers to throughput and patient satisfaction. As part of a throughput improvement project, a multidisciplinary team was established to develop an escalation plan that included senior leadership. All nursing directors were educated on the National ED Overcrowding Score. Through review of their processes, they realized the need for a new nursing position, director of

operations. New processes were developed following a root cause analysis which revealed bottlenecks and discharge barriers. Their analysis also showed the need for an upgraded bed tracking system to expedite and improve bed turnaround time, length of stay and ED length of stay. As a result of these initiatives, the ED decision-to-admit to arrival-in-an-inpatient-bed time has been reduced by two hours. In addition, ED door-to-provider time has decreased from 17 minutes to four minutes, and the LWBS rate dropped from 2 to 1.3 percent.

ENA Lantern Award Program For more information about the ENA Lantern Award Program, please visit www.ena.org/ IQSIP/LANTERNAWARD/.

October 2012

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