Trauma Team Eval/Survey

[joyful_wanderer]

Hey all, I was just wondering if anyone had some suggestions of questions I could ask for our trauma team evaluation. We are technically a level 2 trauma center but our trauma activations and resuscitations are kinda falling apart. We have had a lot of turn over lately and talking to staff people are really frustrated with how the traumas are run. There is lack of communication, poorly defined roles, confusion. The most recent one was a trauma --> PEA ---> coded and then called. Afterwards it was noted that the patient was never given fluids. Another one was a resuscitative thoracotomy in our trauma bay versus the patient being in the OR. The room is stocked with surgical trays but the ER nurses don't know any of the items in the trays.

Anyway, Im trying to create a survey (we currently don't evaluate the traumas afterwards either) for the nurses to take in order to get better feed back. I was just wondering if anyone had suggestions of questions or if you have done something similar for your hospital.

[DayDreamin ER CRNP]

Sounds like you need to revamp your trauma team program. You need more defined roles for the members. For our Level 2 traumas our TT has a primary and secondary RN and a scribe which is also generally an RN. We also have a tech. For level 1s we have the same crew but add a procedure nurse and an infuser nurse. We also have a respiratory therapist. Techs from u/s and an X-ray depts stand outside until the team is ready for these. There are a few more details but this is our room team in a nutshell.

Each of these positions have a very well defined role for the trauma and before being allowed on the TT, each member has to take a test - written and skills.

meredith

[Lunah, MSN, RN]

If you are a Level II, you should have a trauma program manager and a performance improvement (PI) coordinator. There must also be a trauma medical director. Where are they? These are the people who would/should help drive improvement.

How are your trauma rooms staffed? What are the qualifications for being a nurse in the trauma room? Do you have protocols for trauma care in place?

[joyful_wanderer]

We have them but there are no reviews and the trauma program manager has never worked in a ER or doing trauma. So far we have no requirements, or training for the trauma nurses. Its kinda watch one, do one. Its horrible. The last trauma I went to assist with had two ER nurses who "just finished TNCC" and this was their first trauma. I work ER and ICU. For the traumas we have an ICU nurse come down to assist with the level 1 infuser, massive blood transfusion.

[Lunah, MSN, RN]

If your trauma program is not doing performance improvement, it won't remain a Level II. What about the trauma medical director?

[DayDreamin ER CRNP]

We have them but there are no reviews and the trauma program manager has never worked in a ER or doing trauma. So far we have no requirements, or training for the trauma nurses. Its kinda watch one, do one. Its horrible. The last trauma I went to assist with had two ER nurses who "just finished TNCC" and this was their first trauma. I work ER and ICU. For the traumas we have an ICU nurse come down to assist with the level 1 infuser, massive blood transfusion.

You need DEFINED roles. Whomever is responsible for that trauma room is the primary. The primary is on the right side of the patient and the doc is usually at the head. The primary is responsible for the assessment and management of the room and directing what needs to be done. She calls out her assessment to a scribe at the back of the room. Primary also get a full history and some other info for the patient. She moves to the head and is responsible for c-spine while rolling.

A secondary nurse should be assigned when there is a trauma.

In our L2s, the 2ndary is on the left side of the patient and starts a large bore IV and gets blood, she manages the meds (ABX, tetorifice) / RSI drugs if needed, she also helps to log roll the patient to remove him/her off of the back board. This is just the "basics" in a L2.

The assigned tech exposes the patient: cuts off clothes, removes shoes, etc. Places the patient on the monitor and gets a temp. Can also get a blood draw if needed. Puts warm blankets on the patient and gets the portable monitor to go to cat scan.

This is just a very basic overview of how L2s should be managed.

The primary is 100% responsible for the room for that day and assures that it is stocked and ready to go at a moment's notice.

Our TT is more specialized and it is by choice to be on it. Choosing the TT path means that nurses have on-going education requirements and has to keep up her skills. It is certainly not a free-for-all kind of patient care.

[LadyFree28, BSN, LPN, RN]

How about reaching out to your trauma coordinator, and finding your trauma programs policy and procedures?

I work ore at a Level I Trauma ED and we have clearly defined roles for all Level I and Two Traumas, and even for pts who are coming in that are not considered trauma, anyone who needs expedited care and ends up in our resus room assume the position of the trauma role: at least a med/IV nurse, a monitor nurse, and a documentor.

Tour peers may need to learn the roles more clearly; since you seem interested in improving the practice, how about suggesting that people have a "trauma room" inservice, with the roles and a few case studies in order to understand the roles more clearly?