Optimizing the clinical role of the ACP in Trauma Gena Brawley, ACNP Carolinas Healthcare Systems NPSS Asheville, NC

Transcription

1 Optimizing the clinical role of the ACP in Trauma Gena Brawley, ACNP Carolinas Healthcare Systems 2017 NPSS Asheville, NC

2 Objectives Discuss the role of the Critical Care Nurse Practitioner in Trauma Identify settings for practice Discuss daily responsibilities of the ACP

3 All about me BS Psychology Associates Degree in Nursing Bachelors in Nursing Masters in Nursing Cardiac ICU RN Acute Care Nurse Practitioner (now AGACNP) 7 years of Trauma/ Critical Care NP experience

4 My team

5 All about us 15 ACPs - 8 PAs, 7 NPs 3 ACPs dedicated to Trauma Floor, 2 ACPs dedicated to General Surgery, 4 ACPs on Critical Care Nights Shifts: Trauma floor, Float, Surgical Critical Care, Trauma ICU, General Surgery, Clinic Additional needs- High acuity, Resident coverage Schedule- 10 or 13 hour shifts, 3 or 4 days per week

6 Where I work Carolinas Healthcare Systems- Charlotte, NC Level 1 Trauma Center for Adults, Level 1 Trauma Center for Pediatrics 874 beds, 115,000 ED visits per year, 27% admitted with 1/4 admitted to ICU Trauma in Trauma activations, 6 th highest volume in US, 89% blunt trauma, 9% penetrating

7 Level I Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury from prevention through rehabilitation. Elements of Level I Trauma Centers Include: 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care. Referral resource for communities in nearby regions. Provides leadership in prevention, public education to surrounding communities. Provides continuing education of the trauma team members. Incorporates a comprehensive quality assessment program. Operates an organized teaching and research effort to help direct new innovations in trauma care. Program for substance abuse screening and patient intervention. Meets minimum requirement for annual volume of severely injured patients.

8 Clinical Setting Rounding/ documentation Procedures Work under supervising and back up physicians Maintain collaborative practice agreement

9 Scope of practice Promotion and maintenance of health Prevention of illness and disability Diagnosing, treating, and managing acute and chronic illness Guidance and counseling for both individuals and families Prescribing, administering, and dispensing therapeutic measures Planning for situations beyond expertise, consulting and referring Evaluating health outcomes

10 Emergency Department Consults Trauma/ General surgery Codes Trauma codes, Code sepsis Procedures Resuscitation, Lines, Chest tubes, lacerations Triage Determining admission needs, level of care

11 Trauma Codes Ages Peds up to 18 years old Adult years old Geriatric- 55+ years old

12 Trauma code levels Trauma Code 1 -Shock, airway compromise, declining mental status, penetrating trauma Trauma Code 2 - Pulmonary injury, vascular injury, burn, marginal mental status, femur/pelvic fracture, pregnancy Trauma Alert - Suspected multiple fractures, significant mechanism, Blunt traumatic arrest

13 Trauma arrival scene

14 Primary Survey Secondary Survey Adjuncts to exam Procedures

15 Trauma Exam documentation

16 ACP Role in ED trauma management Primary survey ED procedures- Chest tubes, Lines, Chest tubes, Intubations Ordering diagnostic tests Diagnostic interpretation Consultation with specialists

17 OR First assist Consent/ updates

18 Inpatient Floor Rounding Communication with consultants Communication with multidisciplinary team Procedures

19 Inpatient ICU Rounding Procedures Resuscitation Critical care time

20 Daily Rounding Multiprofessional team RN/ RT participation in rounding Recap in afternoon with PT/OT, CCM, RT, Palliative

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22 ICU Procedures Central/ arterial lines Intubations Bronchoscopy Chest tubes Trach/ PEGs

23 Diagnostic testing Appropriate diagnostic imaging Interpretation of diagnostics Appropriate interventions Follow up

24 Education Family/ patient Learners on service Nursing NP student Resident

25 How to effectively utilize the ACP Engagement Education opportunities Autonomy Teamwork Physician/ ancillary support Opportunities for organizational involvement

26 Engagement Identify scope of practice, work towards optimizing ACP role Encourage feedback, develop practice to meet ACP needs Promote opportunities for extracurriculars

27 Education opportunities Onboarding and mentoring new learners ACP fellows, ACP student, NP/ RN shadow opportunities Resident learners

28 Autonomy Practice at highest scope of practice Appropriate oversight Opportunity for council Challenge of difficulty patients Uphold ACP value to members outside of the team

29 Correct utilization and engagement Onboarding and proper training Involvement in trauma team and institution Trust Institutional support

30 Teamwork Multiprofessional team Nursing/ RT/ PT/OT support MDs and ACPs Residents New Learners

31 Opportunities for organizational involvement Center for Advanced Practice ACP Fellowship Process Improvement/ Case Review Developing protocols for practice

32 Practice at top of educational level Provider respect Engagement and commitment Dedication to QI, Facility, team Autonomy and development of trust in skill level Procedural opportunities High acuity patient encounters Ongoing diagnostic proficiency (US) Opportunity to educate/ mentor

33 How its not done Limiting ACP decision making- ACP level patient Limited opportunity to learn Acting as scribes Minimal procedural opportunities Repetitive work Poor compensation

34 ACP overview ACPs filling gap in healthcare, aging patient population means more complex patients Able to work alongside MDs to increase productivity, function autonomously, training upcoming generation of practitioners Procedural abilities, Operative assist, Rounding, Family/ patient education Goal of care/ our mission- To improve health, elevate hope, and advance healing for all

35 Gena Brawley are.org 2017 NPSS ASHEVILLE, NC