Cucchiara Jason, Thompson Julie, Zychowicz Michael, McHone Adam, Williamson Robert
School of Nursing, Duke University, Durham, North Carolina (Drs Cucchiara, Thompson, and Zychowicz); Northern Orthopaedics, Mount Airy, North Carolina (Drs Cucchiara and Williamson); and Mount Airy Emergency Physicians, Mount Airy, North Carolina (Dr McHone).
Adv Emerg Nurs J. 2023;45(3):240-247. doi: 10.1097/TME.0000000000000474.
The purpose of this quality improvement project is to assess and improve the quality of splint application in the emergency department (ED), as well as the splint application confidence level of the ED staff. Consistent and high-quality splint application is critical in fracture stabilization and prevention of further injury. Significantly high turnover and a lack of formal training of ED staff has led to poor splint application, and in some cases, patient injuries related to the splints themselves. These injuries include pain, edema, and skin complications (A. P. Carino, 2017). A random, Likert-based analysis was performed on 20 ED-applied splints. Once analysis was complete, training courses were implemented to improve splint application techniques. Using the same Likert-based tool, applications of 20 posttraining splints were analyzed. In addition, ED staff confidence levels were scored before and after the training courses. Overall, statistically significant improvement was achieved in splint application quality and staff confidence. Correct splint applications increased from 50% to 95% after the educational sessions. Staff confidence in splint application also increased, from 35% to 77.1%. Quality splint application affects all patients. The higher risk population is more likely to suffer the consequences of poor splint application. This project had a positive impact on the region's marginalized patient population. These patients have limited resources, including lack of transportation, financial limitations, and typically are at higher risk for complications due to comorbidities.
这个质量改进项目的目的是评估和提高急诊科夹板应用的质量，以及急诊科工作人员夹板应用的信心水平。持续且高质量的夹板应用对于骨折固定和预防进一步损伤至关重要。急诊科工作人员的高流动率以及缺乏正规培训导致夹板应用不佳，在某些情况下，还导致了与夹板本身相关的患者损伤。这些损伤包括疼痛、水肿和皮肤并发症（A.P.卡里诺，2017年）。对20个在急诊科应用的夹板进行了基于李克特量表的随机分析。分析完成后，实施了培训课程以改进夹板应用技术。使用相同的基于李克特量表的工具，对20个培训后应用的夹板进行了分析。此外，对培训课程前后急诊科工作人员的信心水平进行了评分。总体而言，夹板应用质量和工作人员信心取得了统计学上的显著改善。培训课程后，正确的夹板应用率从50%提高到了95%。工作人员对夹板应用的信心也有所提高，从35%提高到了77.1%。高质量的夹板应用影响所有患者。高风险人群更有可能遭受夹板应用不佳的后果。该项目对该地区边缘化患者群体产生了积极影响。这些患者资源有限，包括交通不便、经济受限，而且由于合并症，通常发生并发症的风险更高。
