Abstract TP396: Improving Documentation of Blood Pressure and Neurological Assessments in Post Alteplase Patients

Introduction: Patients who receive alteplase for acute ischemic strokes are at a high risk for conversion to a hemorrhagic stroke and must be monitored closely through frequent vital signs and neurological checks. Documentation of these measures was found to have a low compliance due to various factors such as a new electronic medical record (EMR) and lack of knowledge related to required documentation. Methods: A team was created to address this issue which included the Emergency Department Nurse Manager, a Clinical Nurse Expert, and the Stroke Program Director. Inservices were provided to the ED and Critical Care nursing staff. Daily review of all alteplase patients and chart audits were performed and real-time feedback was given to the staff and leadership caring for the patients. This real-time feedback allowed for corrections to be made if necessary and served as both an educational and accountability opportunity. The feedback was not limited to just missed opportunities but was also used to praise staff for complete documentation. Results: Concurrent monitoring of blood pressure and neurological checks was completed from September 2018 to June 2019 on all alteplase patients. The overall compliance of documentation for blood pressure checks improved from 88% to 93.1% and the compliance for the neurological checks improved from 81.5% to 85.7%. Conclusions: Providing real time feedback is an effective way to notify staff of both missed opportunities and successes. Overall, when the staff has a better understanding of what is required, the patients are given more comprehensive care.

O papel do enfermeiro na classificação de risco nos serviços de urgência e emergência

Objetivou-se conhecer a atuação do enfermeiro na classificação de risco dos serviços de urgência e emergência. Trata-sede uma revisão integrativa, realizada a partir de consultas nas bases de dados LILACS, MEDLINE e BDENF, em artigosredigidos em inglês, espanhol e português, no recorte temporal de 2008 a 2018. Foram selecionados 18 artigos, por meiode leitura crítica dos textos na íntegra. Os dados foram analisados através de estatística descritiva e Análise de Conteúdo.Verificou-se que dos 18 artigos analisados, nove (50%) foram indexados na base de dados MEDLINE, seis (33,3%) na LILACS e três (16,7%) na BDENF. Percebeu-se variação de uma a três publicações por ano, com exceção dos anos 2009 e 2014,em que não houve publicações. Após Análise de Conteúdo, identificaram-se três categorias: o enfermeiro no contexto daclassificação de risco, capacitação do enfermeiro atuante na classificação de risco e a atuação do enfermeiro na classificação de risco. Concluiu-se que o enfermeiro da classificação de risco dos serviços de urgência e emergência participa naassistência, tomada de decisões, monitoramento dos pacientes, registros, gerenciamento, educação e resolubilidade dosproblemas e/ou encaminhamento dos pacientes aos serviços adequados. Espera-se contribuir para melhor compreensãoacerca da atuação do enfermeiro nesses ambientes.Descritores: Enfermagem em Emergência; Papel do Profissional de Enfermagem; Triagem; Serviço Hospitalar de Emergência; Enfermagem.ABSTRACTThe objective of this study was to know the nurse’s roles in the risk classification of the emergency departments. An integrative review carried out on LILACS, MEDLINE and BDENF, in articles written in English, Spanish and Portuguese, from2008 to 2018. Eighteen articles were selected through critical and integral reading of the text. Data were analyzed throughdescriptive statistics and Content Analysis. It was verified that of the 18 analyzed articles, nine (50%) were indexed in theMEDLINE database, six (33.3%) in LILACS and three (16.7%) in BDENF. It was found a variation from one to three publications per year, except for the years 2009 and 2014, in which there were no publications. After Content Analysis, threecategories were identified: the nurse in the context of the risk classification, the nurse’s performance in the risk classification and the nurse’s training in the risk classification. It was concluded that nurses acting in risk classification of emergencydepartments participate in care, decision making, patient knowledge, records, management, education and problem solvingand/or referral of patients to the appropriate services. It is hoped to contribute to a better understanding of the nurse’sperformance in these places.Keywords: Emergency Nursing; Nurse’s Roles; Triage; Emergency Department; Nurse.