Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Brain Injuries, Traumatic--diagnosis"
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Implementation of a Pupillometer in a Trauma Admitting UnitProblem: Traumatic Brain injuries (TBIs) are a significant cause of mortality in the United States. TBIs can cause rapid neurologic deterioration and require frequent neurologic exams with an accurate and consistent pupillary assessment. Manual pupillary exams are subjective, leading to inaccuracy and decreased pupillary assessment confidence among a trauma admitting unit staff. Purpose: Implement the pupillometer, a device that objectively measures pupil size and reactivity, to measure the pupils of patients with TBIs in a trauma admitting unit of a major academic urban trauma center. Methods: Staff was trained on the use and documentation of the pupillometer. Patients with moderate to severe TBI were assessed using the pupillometer within 1 hour of diagnosis and hourly after that until cleared by a neurosurgeon. Patients who were non-cooperative, had trauma to the eye, or had a history of pupillary dysfunction were excluded. Results: Patient capture with the pupillometer was 30%, less than the goal of 80%. Of the 30%, 68% were assessed within 1 hour. Staff surveys did not show any statistically significant increase in staff confidence with pupillary assessments. Conclusions: Despite not reaching the desired patient capture, the project proved the pupillometer was feasible in the trauma admitting unit's busy environment. This project will help inform future implementations of the pupillometer.