Triage Decisions Involving Pregnancy-Capable Patients: Educational Deficits and Emergency Nurses' Perceptions of Risk.

BACKGROUND: In areas where obstetric services are not available, emergency departments often become the default for unplanned obstetric care, yet emergency nurses are not universally trained in the identification and treatment of obstetric emergencies. The purpose of this study was to explore emergency nurses' perception of acuity in the triage of pregnant or postpartum patients presenting to the emergency department with high-risk complaints and to identify facilitators and challenges to the accurate identification and treatment of these patients. METHOD: A mixed-methods study was conducted using chart review data (N = 12,766) and focus group data (N = 39) from five emergency departments in the eastern United States. RESULTS: In 86.5% of cases, pregnancy status was not documented. Ninety-four percent of pregnant patients with a systolic blood pressure over 140 mmHg were under-triaged. The overall theme of the qualitative data was acuity blindness, with identified barriers to assessment that included educational needs and triage processes and workflow issues. CONCLUSION: There are significant knowledge deficits in the care of patients presenting with high-risk conditions associated with pregnancy. [J Contin Educ Nurs. 2021;52(1):21-29.].

Achieving Outcomes With Innovative Smart Pump Technology: Partnership, Planning, and Quality Improvement.

BACKGROUND: A 5-time designated Magnet academic medical center partnered with its infusion systems supplier to successfully integrate 1327 smart pumps across 45 departments with an aggressive 3-month timeline. The team also achieved quality improvement (QI) outcomes through increased drug library compliance and decreased alerts with their new technology. PROBLEM: This large academic medical center needed to implement innovative wireless infusion pump technology in a short time frame. APPROACH: The approach involved a strong partnership from the medical center and the supplier, with extensive planning and collaboration among the clinical nurse specialists and consultants from both organizations to accomplish QI goals. Lean principles were also followed to enhance efficiency and accountability. OUTCOMES: Quality improvement outcomes included 100% drug library compliance across all 6 intensive care units, a decrease in pump alert rates from 4.18% to 0.79%, and a decrease in pump programming correction rate from 0.36% to 0.06%. CONCLUSIONS: A partnership led to a large implementation being completed efficiently across an academic medical center. Through these joint efforts, quality of care was improved within a short period of time.