• Implementation of a Pupillometer in a Trauma Admitting Unit

      McKernan, Andrew S.; Wilson, Tracey L. (2021-05)
      Problem: 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.
    • Implementation of Wound Photography for Pressure Injury Documentation in Trauma

      Pyzik, Amber S.; Wilson, Tracey L. (2021-05)
      Problem: Pressure injuries that are present on admission but not documented within 24 hours of admission are deemed a hospital acquired pressure injury (HAPI) per Centers for Medicare & Medicaid Services (CMS) guidelines. Anecdotal data has reported at least three known cases of patients admitted via the admitting trauma unit of an academic medical center with a pressure injury (PI) that was not documented in the electronic health record (EHR) within 24 hours of admission. This documentation deficit can have a significant impact since the financial burden of any PI deemed a HAPI is the responsibility of the organization. Purpose: The purpose of this evidenced-based quality improvement (QI) project was to implement and evaluate the effectiveness of wound photography via a smartphone application on PI documentation in the EHR for patients treated in the admitting trauma unit. Methods: Wound photography was implemented as method to document a PI in a timely manner. Educational resources were provided to the staff nurses prior to implementation. Throughout implementation, barriers to workflow changes were addressed to facilitate compliance with wound photography PI documentation. PI documentation compliance at 24-hours post admission from outside hospital (OSH) was compared using a chi-square test of independence. Results: The findings presented numerous challenges educating the nursing staff due to the limited time that can be spent on unit, therefore a virtual learning platform was used as a primary method to educate the staff. Of the seven patients admitted with a PI, all PIs were documented with wound photography. According to the WOCN, there were no incidents of missed PI documentation within 24 hours of admission from the trauma admitting unit for the duration of this QI project. Conclusions: The conclusions suggest that wound photography is a valuable and simple tool that could increase efficiency of PI documentation in a fast-paced level I admitting trauma unit.