524 Traveling Pediatric Burn Care on Wheels

Abstract Introduction Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider. A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department. Methods • A process developed for burn unit nurses to respond to the emergency department to evaluate all pediatric burn patients was implemented. • A survey was sent to burn nurses looking for the most used supplies while caring for a pediatric burn patient. • Collaborative efforts with the pharmacy department to obtain space in the medication pyxis for the most used ointments in burn care. • Collaborative efforts with the Child Life Specialist to stock the cart with stickers, small toys, and distraction items for pediatric patients. • Collaborative efforts with the attending burn surgeon to develop and implement a protocol for burn team response. • Collaborative efforts with infection control department to ensure proper regulation standards of the cart. Cart Contents: • Gauze • Securement wraps • Wound cleansers • Silver impregnated foam dressing • Non-stick petroleum gauze • Staplers • IV start supplies • Paper tracking tool • Discharge & dressing change instructions • Stickers, small toys, & distraction items Results The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022. A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available. Conclusions Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider. Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department. Applicability of Research to Practice The burn unit plans to continue this approach to improve patient and family satisfaction & patient outcomes Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.

Introduction: Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider.
A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department. The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022. A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available. Conclusions: Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider. Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department. Applicability of Research to Practice: The burn unit plans to continue this approach to improve patient and family satisfaction & patient outcomes Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.

Introduction:
As an acuity adaptable unit is is sometimes difficult to get nurses through an orientation in a manner that doesn't scare them off but still covers all their educational needs. The number of fluid resuscitations seen is approximately 30 per year which means that when one occurs new nursing staff needs to have exposure. However, it is a difficult experience to work through a large ICU admission as a new nurse even with preceptor support. Due to these issues the unit adopted a tiered orientation process. This process set forth task blocks as a focus during orientation versus entire patient care. For example, the new nurse and preceptor assignment could be the new fluid resuscitation in week one of orientation. However, the new nurse would only work on documentation of patient care. The preceptor would be responsible for procedures, dressing changes, fluid, and pharmacologic management that goes into caring for the acute burn. the new nurse could also be a part of these processes but that is not their focus during Tier 1. In Tier 2 the new nurse would start providing more patient care in addition to their documentation, the preceptor would still perform ICU level care items. In the final tier the orientee would do all direct care of the patient including documenation. This tiered approach allowed nurses to experience all levels of patient care without overwhelming them. Methods: The process was brought to the shift coordinators to give them all a sense of how staffing assignments would be made during orientation. Education was presented to preceptors at unit council meetings and then in 1 on 1 meetings as needed. Additional, touch base meetings occurred every other week during the start of this process starting in May of 2022. During this time 7 new nurses were on-boarded. 7 unique preceptors were utilized. New hires were met with weekly on an informal basis from weeks 1-5 by either the clinical educator or the nurse manager. Each new nurse and their preceptor had formal meetings with the nurse manager, clinical educator or both at 6, 10 and 12 weeks. A short survey was sent to all preceptors following the initial 5 months of this new process. Results: 50% of all preceptors found this new model to be an improvement over the previous model. 33% did not agree or disagree on if the process was an improvement. 2 out of the 7 preceptors had not precepted before which might account for the 33%. 40% of the preceptors felt satisfied with the overall process for orientation. 83% of the preceptors felt that they had adequate resources to orient new nurses to the unit.
Conclusions: It appears that the adoption of a tiered process worked well during the initial evaluation phase. However, the n was small and additional evaluation would be beneficial to further address how impactful a tiered orientation process is for on-boarding new nursing staff. Applicability of Research to Practice: It important for nursing leaders to evaluate and update how to best meet the needs of staff to create competency and safety.

526
Results of Implementation of a Nurse Driven Fluid Resuscitation Protocol in a Regional Burn Center Our prior research has demonstrated the effect of nurse driven fluid resuscitation on provider and nurse team dynamics. Our primary purpose with this new research on our nurse driven fluid resuscitation protocol is to determine the effect of the nurse-driven fluid resuscitation protocol on resuscitation associated complications (i.e., acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and abdominal compartment syndrome). The study hypothesis is that the rate of resuscitation associated complications will remain stable or not increase post-protocol implementation.

Methods:
Retrospective review for all patients within a oneyear period pre-protocol implementation and post-protocol implementation was completed. 44 patients were included in the total sample, 22 in the pre-implementation group and 22 in post-implementation group. Exclusion criteria for patients included in nurse driven fluid resuscitation included delayed presentation, morbid obesity, electrical injury, cardiac history, DKA, polytrauma, and renal failure. Results: Pre and post nurse driven fluid resuscitation implementation samples of 22 patients with total body surface area (TBSA) greater than 20% were analyzed. The incidence of serious complications including ARDS, compartment syndrome, and wound conversion was not statistically significantly different between samples. Rates of acute kidney injuries were similar across groups. In addition, the mean and median TBSA were not statistically significantly different pre and post implementation. The length of stay for the preimplementation sample was on average longer than for the post-implementation sample. Our results are limited by the significant comorbidities of the pre-implementation group. Please note tables and graphs were not yet available by time of submission. Attached tables are from prior analysis at approximate half-way of study. Updated graphs and tables will be complete by conference time.
Conclusions: As hypothesized, there were no differences in outcomes between patients receiving nurse driven fluid resuscitation. Our results indicate that nurse driven fluid resuscitation is a safe and clinically effective practice in the burn center. Coupled with our previous results that indicate a significant increase in nurse satisfaction with interdisciplinary communication associated with nurse driven, these results signal the importance of implementing nurse led resuscitations. Applicability of Research to Practice: Nurse driven fluid resuscitation is a safe and effective. Further research into barriers to implementation is warranted.