Disclosures. Objectives

Transcription

1 Disclosures The presenters have no conflicting interests to disclose. Henedia V. Sirilan, RN, BSN Susan Fowler, PhD, RN, CNRN, FAHA The Immune Side of Allergy Nursing Describe basic and advanced components of allergy nursing. Discuss the development of resources to support competency based allergy nursing. Outline a process for achieving and maintaining competency in allergy nursing. Delineate outcomes of competency based allergy nursing. Objectives Competent Evidence-Based Practice Competent Potential ability and/or capacity to function in a given situation Need to be competent in order to achieve competency (Schroeter, 2008) Competence is comparing current work functioning with an established performance standard Competence is both performance (performing a certain task) and psychological (integrating cognitive, affective, and psychomotor skills) Evidence-Based Evidence Based Practice of nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences (Burns & Grove, 2009) Ask the burning clinical question (PICO);Collect the best evidence; Critically appraise the evidence; Integrate the evidence, clinical expertise, and patient factors/preferences to implement a decision; Evaluate the outcome Allergy Nursing Who are allergy nurses: Nurses who focus on the diseases of the immune system, with an emphasis on the causes of allergic reactions (allergens, antibodies), the diagnosis of allergies (percutaneous and intradermal testing); treatment of allergy (prevention and coping, medications and immunotherapy); RNS who passed the allergy competency assessment skills. What allergy nurses do? Collect patient health data Analyze data to determine nursing diagnoses Identify expected outcomes individualized to patient Develop plan of care with prescribed interventions to attain expected outcomes Implement interventions Evaluate progress toward attainment of outcomes(sohn, 2008) Educate patients about risk/benefits of treatment and latest trends in allergy testing and treatments Prepare and mix allergen extracts Enter documentation of allergy testing and treatments in EMR 1

2 Allergy Nursing The Trigger to Change Practice Basic Use of nursing process to guide allergy nursing practice Application of theory, evidence, and pathophysiology to practice Advanced Use of nursing process but more comprehensive assessment, critical review of data, individualized & proactive plan of care, continual evaluation Greater understanding of theory, evidence, & pathophysiology and its application to practice Higher level of critical thinking Personal experience of having to learn hands on with no policies and procedures in place Concerns for patient safety Areas of need: Nurse competency Protocols Allergen extract preparation Anaphylaxis management plan Consent forms Educational materials Development of Resources Team Approach Inside the institution Tapped the knowledge and expertise of MD allergy specialists Capitalized on knowledge and expertise of seasoned nurses in allergy clinic Outside the institution Professional organizations Literature search Network with nurses from other allergy clinics/practices Continuing Education Conferences Nursing Care Coordinator leader of the team All RN staff, MDs PAs Process: Draft Draft reviewed by MDs and RNs Changes Finalized protocol Achieving & Maintaining Competency Initial competency for present staff December 2011 New hire competency No annual competency required Components (KAP): Knowledge Attitude Practice Components of Competency Knowledge Case scenarios Verbal actions including rationale reflective of critical thinking Attitude Case scenarios Perceptions of patients responses including coping Practice Psychomotor skills of administering right drug, right allergens, right dose, right route, right time, right patient 2

3 Components of Competency Color Codes for Allergen Strength Practice - Focus on psychomotor skills: Observes aseptic technique and extracts preparation Reviews prescriptions for accuracy Labels preparations Checks expiration dates Observes hand hygiene and PPE Checks solutions Draws up allergen with proper technique Administers allergen and discards/disposes of materials Documents allergens and patient responses Maintains work environment Silver top 10,000 PNU/BAU/AU Red top 1,000 PNU/BAU/AU Blue top 100 PNU/BAU/AU Green top 10 PNU/BAU/AU Allergens Immunotherapy Nursing Protocol Immunotherapy Nursing Protocol Build Up Phase Protocol A predetermined pathway of treatment for a specific type of patient or situation Components Build up phase Maintenance phase Every one to two weeks Start w/ 10 PNU/AU/BAU per ml Check peak flow prior to administration if asthmatic Next, 100 PNU/AU/BAU ml to 1000 PNU/AU/BAU per ml Then, 10,000 PNU/AU/BAU per ml Adjustments if patient did not show up Doses can be increased at 1-2 week intervals Doses can be maintained between 3-5 week intervals Reduce doses between 6-11 weeks If 12 weeks or more from last dose, start as if never treated Dosing can be presented and recorded as the volume drawn from the vial, or as the actual number of units being administered Immunotherapy Nursing Protocol- Maintenance Phase Once reach highest dose (0.5-1ml of 10,000 PNU/AU/BAU per ml). Injections every 4 weeks. Adjustments if patient did not show up for appointment Dosage Titration Sheet Week Dosage Conc. ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml /ml weeks: Repeat last dose 7 weeks: Decrease 25% 8 weeks: Decrease 50% 10 weeks: Decrease 75% 12+ weeks: Restart Week Dosage Conc. ml /ml /ml /ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml ,000/ml 0.4 3

4 What Does a Competent Allergy Nurse Look Like? The Art of Nursing Caring Patient/family focused Continuity of care Holistic approach The Science of Nursing Uses best evidence and approach in practice Stays abreast of trends and changes in practice Outcomes Patient driven Decreased wait times Increased trust & confidence in the staff Increased knowledge of allergies and changes in decisionmaking processes Enhanced quality of life Nurse driven Time saving use of color coded tops for patient safety Increased satisfaction ease of work, more time with patients Helping Patient Cope Patient Education - Before Allergy Testing Why allergy clinic? Trained staff; specialists Safe, controlled environment What to do? Before, during, and after allergy testing and diagnosis What to expect? Patient s role Frequency of appointments; time requirements; purpose and procedures; follow-up Retesting/2 nd testing Patient Education - During Allergy Allergy Shots What to do if I have a systemic reaction? Patient Education - After Allergy elimination diet Specific allergies: Aspirin allergy Asthma action plans Link between asthma and allergy (Lui, 2010; cause & effect uncertain) Sinusitis treatment Link between allergies and sinusitis: swelling sinus lining trap bacteria (Kirtsreesalul & Ruttanaphol, 2008) 4

5 Patient Education Applying Competency to Practice Eczema action plan Case Study Bleach baths Wet pajamas Nurse competency Executed Safety Patient education 5

6 Future Directions for Nursing Research Longitudinal study: quality of life Use of guided imagery in early course of testing and treatment Use of other complementary and alternative medicine (CAM) interventions during testing and interventions Effect of allergy journal club on nurse competency and utilization of best practices Why Do Nurses Choose to Practice Allergy Nursing? Hear and see a change in patients quality of life Develop a strong, long-lasting, heart warming relationship with clients Nurse satisfaction continues to drive desire to maintain and enhance competency References Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). St. Louis, MO: Saunders. Kirtsreesalul, V., & Ruttanaphol, S. (2008). The relationship between allergy and rhinosinusitis. Rhinology,46, Lui, A. H., et al. (2010).National prevalence and risk factors for food allergy and relationship to asthma: Results from the National Health and Nutrition Examination Survey The Journal of Allergy and Clinical Immunology, 126, Miller, C, Hoggan, J, Pringle, S & West, G. (1988). Credit where credit s due. The report of the accreditation of work-based learning. (SCOTVEC). Scottish Vocational Educational Council. Schroeter, K. (2008). Competence literature review. Competency & Credentialing Institute