This podcast explores the challenges of queuing in emergency care and the need for a potential revolution in pre-hospital care. It discusses addressing infections, sorting and organizing medical lines and tubes, medication management in the emergency department, and the importance of prolonged field care in the healthcare system.
Performing a thorough head to toe examination and addressing infections are crucial during prolonged care.
Organizing lines and tubes, securing them properly, and optimizing patient positioning help maintain patient safety and comfort.
Administering medications, monitoring fluid intake, attending to toileting needs, and prioritizing patient comfort contribute to effective care during waiting periods.
Deep dives
Head to Toe Examination and Infections
Performing a thorough head to toe examination is crucial to identify any subtle clinical signs or injuries that may become relevant during prolonged care. Additionally, addressing infections is essential. This includes considering systemic infections and ensuring timely administration of antibiotics. Dressings should also be assessed and changed as needed, reducing the risk of pressure ulcers and infection. Regularly monitoring vital signs is important to detect any physiological changes or concerns, and documenting these findings for reference.
Tubes and Tidy
Organizing lines and tubes is important for troubleshooting and ensuring patient safety during extended periods of care. Differentiating and securing lines help prevent tangling and confusion. Labeling infusions and documenting their administration is essential. Properly securing lines to the patient's body reduces the risk of displacement. Additionally, attention should be given to minimizing pressure areas and optimizing patient positioning to prevent pressure sores. Regular repositioning, every 30-60 minutes, helps offload pressure and maintain patient comfort.
Medications and Nursing Care
Administering and monitoring medications is crucial. Address systemic infections with appropriate antibiotics, considering the risk-benefit balance. Ensuring proper hydration and nutrition for patients is essential, monitoring fluid intake, and offering oral fluids when appropriate. Attention should be given to toileting needs, determining suitable options for bedside toileting or involving the hospital team for assistance. Addressing these aspects of care helps maintain patient well-being during prolonged waiting periods and lays the foundation for effective handover and future care planning.
Importance of Intentional Rounding and Patient Comfort
Intentional rounding, where nursing staff regularly check patients and ask key questions, helps improve patient experience and reduce adverse events like pressure sores and falls. Patient comfort, particularly thermal control, should be prioritized during waiting periods in both ambulance and emergency department settings, taking into account individual temperature preferences. Effective communication and rapport-building with patients are vital to alleviate anxiety and foster a sense of connection. Shared responsibility between pre-hospital and in-hospital teams is essential to ensure continuity of care and address challenges posed by delays.
Caring for Patients in a Broken System
As healthcare systems face increased pressure and delays, providers must adapt their practices to embrace prolonged field care. This involves planning for extended patient care, recognizing the precarious situation patients face during delays, and promoting collaborative working and communication between teams. The HITMAN framework (Interventions and Management) guides providers in delivering appropriate care within and beyond their scope of practice, with support from emergency department staff. Despite the challenges, it is crucial to continue caring for patients as fellow human beings, upholding the principles of compassionate care.
We know it's the festive season but we thought we’d try and cover an issue from which there appears to be no escape and is a particular problem at this time of year, queuing!
Whether we like it or not, this has become a factor for all of us working in emergency care, whether its delays getting your patient into the department, queueing down the corridor into ED, a prolonged stay in ED for an appropriate ward, or even in a physical queue to get out of the ED and onto an appropriate bed!
We are looking after our patients for significantly longer than we’re used to and this pushes the patient and the clinician into an area of care in which we have limited experience and comfort.
Rather than accepting delays and ignoring their inevitable impact on patient care, we need to move towards equipping ourselves with the skills and knowledge to fill that care vacuum and ensure that excellence in patient care continues throughout their time with the ambulance service.
So with that in mind, in this episode we’re going to think about some of the considerations and interventions that are required to ensure our patients remain safe and comfortable throughout their queueing experience. And to do that we’re going to draw on the concept of prolonged field care.
An article by Aehbric O’Kelley and Tom Mallinson recently authored a paper published in Journal of paramedic practice entitled “Prolonged field care principles in UK paramedic practice”. That article really provided the idea and stimulus for this episode, so thanks to them for all of the hard work and once you’ve listened to us waffle on you should head across to their paper for a far more eloquent explanation of it all!
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon, Rob & James
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