'Quick kits' speed care of emergent conditions
The ED at Gifford Medical Center in Randolph, VT, was crowded when a patient presented with acute anaphylaxis. The patient was treated immediately, and no errors occurred.
"However, I found myself in a high-stress situation trying to figure out appropriate dosing and administration guidelines," says Andra T. Perreault, RN, BSN, an ED nurse who cared for the patient.
This situation prompted Perreault to create "quick kits" to treat various emergent conditions. The ED's Anaphylaxis Kit contains the appropriate medication, materials to draw up the medication, and a one-page, large-print laminated medication dosing guide for adults and children.
You might need to talk to the ED physician about dosing when caring for a patient with acute anaphylaxis, but he or she might not be readily available. Using the kit, ED nurses can draw up appropriate medications while awaiting the physician's order.
"You are always second-guessing yourself when things are stressful," says Perreault. "This is why I developed the quick reference guide. The ED staff can take the kit and bring it right to the bedside."
First, Perreault performed a literature search on current treatment for acute anaphylaxis. She created "quick cheat" sheets and had them laminated by the hospital's marketing department. Next, she asked pharmacy staff to review the treatment guideline, and the director of the ED approved the dosing guidelines.
The last step was buying a plastic container from the supermarket. "I filled it with the medications, syringes, and needles for drawing up," says Perreault.
ED nurses created similar kits for acute myocardial infarction (AMI), acute stroke, and for specific medication drips that require time and concentration to draw up. [The contents of the Anaphylaxis kit and guideline and the AMI and acute stroke kits used by ED nurses are included.]
"When a patient presents with a life-threatening condition, we are able to get the kit and treat the patient immediately," says Perreault.
Meds and pre-printed physician order set
The ED's AMI Quick kit has all the appropriate medications and a pre-printed physician order set. "This helps facilitate rapid treatment and transfer to the tertiary care facility," says Perreault. "Our acute stroke kit has tPA [tissue plasminogen activator] and everything you need to draw it up." Another kit is used for amiodarone maintenance dosing.
When Perreault worked in a large ED in Boston, she knew the dosing of all these medications by heart, due to repetition. Also, there was always another staff member readily available to double check dosages. "Because we live in a rural area, it can be months before we use these medications. In a small ED it is usually just the ED doc and one other nurse, who both may be busy," says Perreault.
Kits and quick dosing guidelines are helpful in this kind of environment, says Perreault, but she says to keep this in mind: "When you make these kits, make sure that someone is responsible for checking expiration dates and that the treatment is up to date."
For more information about use of quick kits for emergent conditions, contact:
- Andra T. Perreault, RN, BSN, Emergency Department, Gifford Medical Center, Randolph, VT. E-mail: firstname.lastname@example.org.