Evidence based practice projects in the ED

[agt25]

I am recently a new graduate and had a tough time when someone asked me what kind of evidence based practice project I would like to work on in the future. I have been doing my practicum in a small, rural, community hospital and haven't been exposed to any types of evidence based practice projects there. I was wondering if anyone had any ideas or experiences with these types of projects and what there topics were/how they worked out in the ER. all help welcome! thanks!

had one idea.... IV push medications being pushed too fast--> make syringes that only allow medications to be pushed at a certain rate, do away with IV administration instructions "IV push" for more clear alternatives, such as "IV over 1-2 minutes" to improve patient safety and decrease medication errors/events.

[LegzRN]

I like your idea... but what about the times when you need to push meds fast like adenosine or basically any drug during a code?

[Bumashes, MSN, APRN, NP]

I agree that some folks will push meds too fast. So that idea may have some merit. But, there are certain drugs that must be pushed SUPER FAST, such as atropine. So the regular syringes would still have to be available for meds such as that. The other part about orders I'm not so sure about. As an RN, you are responsible for knowing how to administer these IV meds, and if you're unsure then you look it up or ask. If we started asking docs to specify how fast on every IV push med then that would take away from the practice of nursing, I believe. The docs in my ER will write Morphine IVP (IV push) or something general like that normally. And if they really do want you to be careful then they do other things like SIVP (slow IV push,) or they will place IVPB (IV piggy-back) after the drug to let you know they'd rather it be diluted in 50-100cc and run in that way (like sometimes with phenergan.)

Not trying to talk you down from this idea, but I just wanted you to get a picture of what you're asking since you aren't in a position to get the real experience of it right now. Here's one for you that we recently did in our ER. We now place temperature sensing foley caths in every trauma pt for continuous temp monitoring b/c it has been shown to lead to more favorable pt outcomes when you can catch their temp falling or climbing sooner rather than later. We also just switched to a new (regular) foley cath kit. In this kit, it comes with a tear out pt education sheet about how to help care for the cath and why it was placed. It also has a new cleansing step in it as well. Before donning sterile gloves, it has you first don nonsterile gloves and use some packaged castille soap wipes to pre-cleanse the perineal area. Then you proceed with the whole sterile glove, betadine, insert, etc. This kit has been shown to lead to better pt understanding and lower catheter associated UTI rates. Those are 2 pretty good examples of EBP projects. Good Luck!

[Vanillanut, DNP, RN, APRN]

A lot of research has yet to be done around therapeutic cooling, especially in pediatric populations.....

I also see a lot of controversy as to when to administer Integrilin (Eftifibatide) in an MI..... some places do it asap, while others wait until much later....

There is tons of areas in emerg to expand on :)

[agt25]

Thanks for all of your suggestions! I really appreciate it and welcome any other ideas!

[jdmrn1]

Evidence Based ED Project Question:

Has anyone done an evidence based project with ED throughput?