Trauma Nursing - Connecting the Dots.pptx
- 1. Trauma Nursing –Connecting the Dots Prof.T.Samuel Ravi Kumar Former Trauma Center Coordinator CMC Vellore
- 3. 3 08-10-2023
- 4. Preamble Trauma Nurse plays a pivotal role in assuring qualitative trauma care services at the Trauma Center The continuum of clinical care provided to trauma patients extends from the time of injury through to long-term recovery and final outcomes. Towards comprehensive Trauma Care, Trauma Team to be equally trained Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma patients and their families to influence outcomes across this entire continuum Ensure optimal, equitable, and accessible care for all persons sustaining trauma Focus on Zero preventable death Contain costs while enhancing efficiency 08-10-2023 4
- 5. OBJECTIVES To achieve 1. Reduction in the Trauma Mortality 2. Empowered Certified Trauma Nurses in all the Emergency departments in India 3. Trauma Nurse Coordinator at District level ,all hospitals 08-10-2023 5
- 6. Trauma Nursing Management Concept Clinical Administration Master Grid Role Clarification Career pathway 6 FOCUS 08-10-2023
- 7. Trauma Nursing as A DISCIPLINE Overview of Trauma in India Trauma Nursing Global models Trauma Care Challenges in India – Gap Analysis Trauma Nursing – Multidimensional approach Trauma Training Trauma Care Service- • Nurse led Trauma Care • Trauma Nurse Coordinator/Consultant • Trauma Educator ◎ Trauma Quality Assurance & Research 08-10-2023 7
- 8. Overview of Trauma in India The rate of accidental deaths (per lakh of population) has slightly increased in 2019 as compared to 2018. National Crime record Bureau India 2019 Over 29,000 Road Accidents Recorded In Maharashtra In 2021; Fatalities Up By 4 Per Cent Outlook India. Dec 13, 2022 Mumbai's road mishap deaths rise 11% in 1 year, Maharashtra's maximum in 5 years Times of India June 21, 2022 08-10-2023 8
- 9. Focus Trauma Nursing Trauma 1. Prevention – Trauma Nurse Educator 2. Research 3. Training - Simulation , Certification 4. Trauma Care – Trauma Nurse 5. Trauma Quality Assurance 6. Mass Casualty / Disaster Management 08-10-2023 9
- 10. Overview of Trauma Nursing in India ◎ ( Gap Perspective) Emergency Nurse with multiple role, task. Limited empowerment Rotation within the hospital as per need which limits specialized training in the field of Trauma & Critical care Nursing Training the skill set for privileging to practice Limited training and specialization opportunities across the country Limited specialization at higher level of learning i.e. Master’s in Emergency , Trauma & Disaster Nursing 08-10-2023 10
- 11. Overview of Trauma in India – Filling the Gap Nurse led Trauma care program (Capacity for timely trauma service) Trauma Care rendered at Sub Centres – Immediate Emergency care & refer Primary Health Centres Immediate Emergency care & refer Community Health Centres Triage & Emergency care District Hospitals Triage , Resuscitation & Emergency Care Medical Colleges and Research Institutions Comprehensive Trauma Care & Trauma Nurse Practitioner Trauma Nursing Framework – India TNF-I 08-10-2023 11
- 12. Trauma Nursing Global models Trauma Nursing as an specialty approach Trauma Nurse Practitioner "feasible, safe, effective in their roles and provide quality health services.“ Trauma Nurse Quality Managers Trauma Nursing rounds in clinical setting Trauma-care process through a trauma nurse-initiated discharge planning program patient-family follow up. Trauma Nursing Framework – India TNF-I 08-10-2023 12
- 13. Towards ZERO preventable deaths Non Preventable death - when injuries are not survivable and not currently curable or reversible Possible preventable death - when injuries are severe, but currently curable or reversible under optimal circumstances Preventable death – Rate is the proportion of deaths judged to be preventable if optimal trauma care has been delivered 08-10-2023 13
- 15. Trauma Nursing Role Trauma Nurse Trauma Nurse Educator (Clinical) Trauma Nurse Manager Trauma Quality Manager Trauma Nurse Researcher Trauma Nurse Coordinator (MCM) Academic Faculty Role in International Agencies such as W H O, towards trauma quality care 15 08-10-2023
- 16. Boundary A boundary is a clear place where you begin and the other person ends. Professional boundaries are complex because they involve personal values, culture and ethics. 08-10-2023 16
- 17. Trauma Quality Assurance Core Measures ◎ Core Measures focus efforts which utilize data to improve the healthcare delivery process ○ Process measures ◉ System operations/Not clinical in nature ◉ Qualitative filters (e.g. Satisfaction survey) ◉ Institutional filters (e.g. Time to CT) ○ Outcome measures ◉ Clinical/Patient focused ◉ Quantitative/benchmarks (e.g. VTE rates) 08-10-2023 17
- 18. Process Measures - Required Surgeon response to ED – highest level trauma plus all other required responses Trauma team activation criteria Response of specialists to time-sensitive procedures Over and under triage Admissions to non-surgical service Transfers out Times trauma center is on diversion ED physicians covering other hospital units – response times to ED 08-10-2023 18
- 19. Process Measures – Required Response times of CT/MRI when on-call Transfers to higher level of care within the institution Organ donation rate Registry abstraction – 80% within 2 months Multidisciplinary Trauma Committee Decisions 08-10-2023 19
- 20. System Process Core Measures Protocol compliance ED dwell time for trauma activation In-house emergent/urgent intubations Delay in OR availability OR staff response & PACU staff if on-call Radiology misread rate 08-10-2023 20
- 21. Clinical Practice Guidelines Evidenced based practice guidelines reduce variance in care Road map for clinical decisions Effect outcomes Trauma Centers must Track compliance Monitor effect on outcomes Trauma quality indicators: internationally approved core factors for trauma management quality evaluation Coccolini, F., Kluger, Y., Moore, E.E. et al. Trauma quality indicators: internationally approved core factors for trauma management quality evaluation. World J Emerg Surg 16, 6 (2021). https://doi.org/10.1186/s13017-021-00350-7 08-10-2023 21
- 22. The Trauma Registry The Trauma Registry is the foundation for the trauma program Provides data to support: Research Finance Special projects All aspects of the trauma program 08-10-2023 22
- 23. Trauma Nursing Role Trauma Nurse Trauma Nurse Educator (Clinical) Trauma Nurse Manager Trauma Quality Manager Trauma Nurse Researcher Trauma Nurse Coordinator (MCM) Academic Faculty Role in International Agencies such as W H O, towards trauma quality care 23 08-10-2023
- 24. Trauma Nursing -India 1. Trauma Nursing Journal – Knowledge update 2. Trauma Nursing Association 3. Specialized training in Trauma & Mass Casualty Management 08-10-2023 24
- 25. Timeline 25 DEC NOV OCT SEP AUG JUL JUN MAY APR MAR FEB JAN With the Input of the Experts the time line is to be finalized for further proceedings
Editor's Notes
- #18: Define what a core measure is and difference between process and outcome measures. Benchmarks /targets in care management. Core measures are established and monitored through well defined audit filters Qualitative filters easier to measure than quantitative but both are important Some audit filters are always reviewed as a ‘standard of care’ Examples Time to antibiotic administration for a patient with an open fracture. Time to definitive airway in obtunded patient Some filters may be specific for that medical center Examples New treatment modalities (e.g. plasma in the pre-hospital setting) Monitoring chemical dependency consultations for patients not admitted to a trauma service Trauma core measures can and should interface with hospital core measures
- #19: These would be considered non-discretionary audit filters and measures to meet the ACS criterion since they are required by an agency charged with program review
- #20: Continued non-discretionary examples. These are required measures to support criterion for ACS verified trauma centers. Note – not all of these are clinical in nature
- #21: Examples of system resource non clinical mandatory measures
- #22: Discuss Clinical Practice Guidelines (CPGs) are medical consensus of care based on sound science and current best practice. Reduces variability in care Always multidisciplinary These are physician driven as road map into clinical decision making Level III and Level IV hospitals may find CPGs especially helpful to assure care given follows current standards of care. May recommend they interface their CPG’s with the uplink center
- #23: The Trauma Registry is the foundation for the trauma program Failure to recognize this, and support this concept, represents a failure to support the basic needs of a trauma program The data from the trauma registry supports all aspects of the trauma program