Evidence and Practice
Why you should read this article: • To recognise the issues that patients and family members commonly experience in the emergency department (ED) • To enhance your knowledge of the main factors that can influence patients and family members’ satisfaction with ED care • To identify the improvements that could be made to care in the ED Background Patient experience and satisfaction are often used to evaluate the quality of care provided in emergency departments (EDs). Several studies have evaluated the experiences of patients and their family members in EDs internationally, but few studies have investigated the experiences of those attending EDs in Iran. Aim To investigate patients and family members’ experiences of care in one ED in Iran. Methods Semi-structured interviews were conducted with 17 patients and ten family members in one ED in Tehran, Iran. A qualitative content analysis approach was used to analyse the data. Findings Three themes emerged from the data: quality of nursing care; satisfaction with medical care and waiting times; and adequate diagnostic testing and equipment. Participants reported several issues in relation to the care provided in the ED, including a lack of attention from nursing staff, long waiting times, delays in symptom management, and family members’ involvement in care to compensate for high staff workload and overcrowding. Conclusion The findings of this study demonstrate that the most important determinants of patients and family members’ experiences in EDs are the quality of nursing and medical care, the length of waiting times, and adequate diagnostic testing and equipment. While it may be beneficial to involve family members in patient care, regular communication with them is essential to explain challenging situations that may affect the quality of ED care, such as low staff levels.
Why you should read this article: • To enhance your knowledge of the different types of mallet finger injury • To explore the different splints available for immobilising a closed tendinous mallet finger injury • To understand the importance of optimal patient education and patient adherence Mallet finger injuries are a common presentation in the emergency department. These injuries result from a forced flexion at the distal interphalangeal joint (DIPJ) that causes extensor tendon disruption, and possibly bone avulsion, at the base of the distal phalanx. This article describes the anatomy, mechanisms, classification and assessment of mallet finger injury. It reviews different types of splints used in the conservative management of closed tendinous mallet finger injury and discusses the latest evidence regarding immobilisation methods and treatment duration. Maintaining the DIPJ in extension during treatment is essential, so the article stresses the importance of patient adherence to treatment.
Strategies to address knowledge deficits and negative attitudes
Why you should read this article: • To recognise why timely medicines reconciliation is important in the emergency assessment unit (EAU) • To understand the barriers to timely medicines reconciliation in the EAU • To identify potential methods of improving medicines reconciliation in the EAU Background Medicines reconciliation is the process of creating and maintaining the most accurate list possible of all medicines a patient is taking. If medicines reconciliation cannot be completed in a timely manner in hospital emergency assessment units (EAUs), delays in treatment can occur, potentially leading to deterioration of long-term and acute conditions, patient distress and complaints. Aim To obtain the perspectives of staff working on an EAU regarding the time patients wait for their medicines to be prescribed, including their awareness of practice and protocols. To determine the time from admission to the EAU until medicines reconciliation, and to identify if there was any time difference in medicines reconciliation according to the day of admission. Method This was a service evaluation in which staff working in one EAU in a teaching hospital in the north east of England were asked to complete a survey in December 2017. The staff survey aimed to ascertain: whether staff were aware of any guidance relating to medicines reconciliation times; how long they thought the average waiting time was for medicines reconciliation; and if they thought there were implications for patients or staff as a result of time spent waiting for medicines reconciliation. In addition, an audit was performed analysing medicines reconciliation times for all patients admitted to the EAU during the month of December 2017. Results A total of 30 staff members responded to the survey. While 40% (n=12) of respondents believed that the EAU had an efficient system in place for timely medicines reconciliation, 90% (n=27) believed the unit could still improve. Almost half the respondents (47%, n=14) perceived a delay in medicines reconciliation could result in exacerbation of patients’ physical conditions. The clinical audit identified considerable variation in medicines reconciliation times, ranging from seven minutes to almost 24 hours. However, most medicines (82%) were reconciled within six hours. Conclusion This service evaluation found that the median time after arrival in the EAU until completion of medicines reconciliation was two hours 48 minutes. However, almost one fifth of patients had to wait for more than six hours, and in one instance almost 24 hours. One potential solution could be increasing the involvement of hospital pharmacists or pharmacy technicians in medicines reconciliation.
A case management approach of a new frequent service user manager service
Identifying what emergency nurses perceive as barriers to nurse-patient communication
The care needs of homeless people attending EDs are frequently misunderstood
Why you should read this article: • To enhance your knowledge of the signs and symptoms of mallet finger injuries, including common presentations and the mechanism of injury • To understand how to assess a patient with a suspected mallet finger injury, and the options for management • To count towards revalidation as part of your 35 hours of continuing professional development (CPD), or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.
Sepsis is a medical emergency that should always be considered in acutely unwell patients
This article aims to increase emergency nurses’ knowledge of acute aortic dissection
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines ( BTS/SIGN) (2016) .
Over the past ten years there has been a significant rise in the number of people who present to emergency departments with Lyme disease. Although some patients remain asymptomatic many present with a rash around a previous tick bite and others may present with a range of debilitating symptoms that can be problematic if left untreated. Due to the growing prevalence of Lyme disease in the UK and the US this article gives an overview of the vector-borne condition and provides emergency nurses with information about the pathophysiology, prevention, presenting signs and symptoms and management.
Mistakes made in healthcare settings and the challenges to staff that arise from them can harm service users, consume time and money, and often receive bad publicity. However, by learning from these mistakes and meeting these challenges, practitioners can improve the quality of the care they provide. This article explores what is meant by mistakes and challenges in the context of health care. It suggests that front line managers are best placed to prevent and learn from mistakes, and thereby improve care for patients.