bluuebunny/crossref_metadata_2025_split huggingface dataset:
33 Effectiveness of Caregiver-oriented Transitional Care Program (CTCP) in Promoting Preparedness of Caregivers for Home Care of Burn Patients
Authors: Dualan Jun Jun A 
Published: March 2020

Abstract

Introduction
Unpreparedness of caregivers of burn patients can result to several complications at post-discharge period (Zwicker, 2010; AHRQ, 2012). Some burn centers in resource-scarce countries had documented several burn morbidity and mortality that occurred post hospital discharge. Psychological conditions, contractures, infection and even death are just some of the complications. One of the current trends in burns involves sending patients home with a burn dressing and following them up as outpatients for wound inspection. This could significantly reduce cost of hospitalization with shortened hospital stay and allows burn units to accommodate the overflow of acute and complex cases for admission. Although there are advantages in early discharge, this approach requires a change in the health teaching method and contents since hospital-to-home transition is expedited. Considering this dilemma, the investigator developed the CTCP to address the gap in transitional care of burns. This study aimed to compare the preparedness of caregivers before and after CTCP; and compare caregivers’ handwashing competency, wound dressing competency and medication administration hassle before and after CTCP.

Methods
One-group pre-and-posttest quasi-experimental design was used to study thirty adult caregivers of burn patients that were recruited via convenience sampling in a burn center between November 2017 to March 2018. CTCP was conducted in three sessions with the aid of videos and written instructional materials. Caregivers were evaluated in terms of preparedness (primary outcome) and handwashing competency, wound dressing competency and medication administration hassle (secondary outcomes). All measurement instruments were content valid and reliable.

Results
At alpha 0.05, data analysis revealed statistically significant results supporting the use of CTCP. Preparedness (p&lt; 0.001), handwashing competency (p&lt; 0.001), wound dressing competency (p&lt; 0.001) and medication administration hassle (p&lt; 0.001) improved after receiving the structured teaching intervention.

Conclusions
The study supported the relevance of the interventions to prepare caregivers for home care of burn patients to help prevent potential complications after hospital discharge. This is therefore recommended to be adapted by burn units that recognize primary caregivers as extended team members.

Applicability of Research to Practice
Since there is a limited evidence in nursing discharge education programs specific to burns, the results generated from this study can help practitioners effectively prepare caregivers for home care of burn patients as educational intervention is supported with strategies that increase learning retention.
36 Developing Burn Specific Documents in the Electronic Medical Record
Authors: Gabehart Kari , Tuvell Sara , Cook Christina L , Roggy David , Sood Rajiv 
Published: March 2020

Abstract

Introduction
The challenge with burn documentation needs in electronic medical record systems is recognized and often limited in the foundation of commercial electronic systems. In October 2016, our institution transitioned to a new all-inclusive electronic medical record. The transition to this new Electronic Medical Record (EMR) afforded us the opportunity to develop and build burn specific documentation needs in the new EMR system. In this paper, we share our experiences and the keys to our successful builds to streamline burn patients’ documentation and information.

Methods
In January 2013, the EMR build team was composed of corporate contractors, dedicated clinical staff from all areas of the hospital that transitioned to the build team, and private contractors experienced in the EMR build process. To our great fortune, our burn team was provided access to four dedicated build team members that worked specifically on meeting our burn team documentation needs. With high level collaboration our team was able to assess foundation abilities of the new system, identify gaps to burn care and collaboratively create and build automated documents to meet our burn needs. In October 2016, the EMR system was implemented with our burn specific documents, flowsheets, and reports.

Results
Through working with our dedicated build team, we were able to create an electronic Lund-Browder Chart with an avatar that is completed with each admission by our medical team. We developed a fluid resuscitation flowsheet that is documented in real-time; displays fluid resuscitation goals; displays urine output goals. The creation of a standardized wound care note template was necessary as the wound template within the existing EMR system was too cumbersome. Burn wound photo-documentation to include inpatient, outpatient, intra-operative and emergency department needs automatically uploads into the patient’s medical record from an encrypted portable handheld device connected to the EMR. Burn specific reports were developed to meet the specific needs of inquiry whether it is for performance improvement or research. Additionally, the same EMR is used in all phases of care to include the burn clinic which allows for ease and continuity of care.

Conclusions
An EMR that is all-inclusive has benefitted our team and patient safety by streamlining the review and documentation of information. Having specific and dedicated EMR build specialist allocated to focusing on the needs of the burn unit was invaluable in the build, implementation, and maintenance phases. We continue to work with our EMR specialist to improve processes and documentation practices that impact patient outcomes. Our burn EMR specialist meets with the burn team on a monthly basis to evaluate and assess ongoing needs to further outcomes.

Applicability of Research to Practice
Within this presentation, we will share our journey, challenges, and successes.
38 A Retrospective Review Evaluating the Institution of Nurse Clinic Visits for the Treatment of Burn Patients Being Managed at Home
Authors: Solis-Gonzalez Stacy , Osborn Suzanne , Sirrine Robert P , Richey Karen J , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Most burn injuries can be managed at home, however appropriate follow up care is vital to prevent complications. Our center developed an outpatient dressing and care algorithm aimed at improving patient outcomes and optimizing the use of healthcare providers. The algorithm consisted of scheduling patients discharged home from the burn emergency department with a nurse visit (NV) within 3 days of discharge and a provider visit (PV) 1 week later. All NV could be converted to PV prn. The purpose of this study was to evaluate the effectiveness and safety of our nurse clinic visits.

Methods
This was a retrospective study of outpatients managed using the new care algorithm over a 1-year period. Patients whose NV was converted (CV) to a PV were compared to those who were not converted (NCV). Basic descriptive statistics were calculated.

Results
The charts of 259 patients scheduled for NVs were reviewed, mean age was 24.3 years and 51% were male. The population consisted primarily of Caucasians (47%) and Hispanics (35%). Most patients had a payor source with private insurance (40%) and Medicaid (31%) being the most common. Initial presentation to the burn ED was 1.56 days post injury, mean TBSA was 1.58% and most injuries involved the hands (36%) and arms (28%). The most common mechanism was scald (56%) followed by contact (28%). The most common dressing was petroleum gauze (41%) followed by silver impregnated foam (39%). NVs were converted to PV for 16% of the population. The most common reason for conversion was discharge from clinic (33%), followed by worsening (24%), therapy needs (24%) and change in dressing (19%). When CV patients were compared to NCV there were no significant difference in age, gender, past medical history, burn history (time to presentation, TBSA, mechanism, area of injury) or dressing type with the exception of enzymatic debriders (p=.0226). Native Americans (p=0.0257) and patients with Workman’s Compensation (p=0.026) were more likely to be converted to a PV. Hispanic patients were less likely to be converted to PV (p=.0357). The charges for NV ranged from $120-$185/visit with an average reimbursement of $60.88.

Conclusions
Overall compliance with the scheduling of nurse visits was poor. However, when scheduled per the algorithm, nurse visits were safe and effective, decreasing provider workload while still allowing for patients to be seen in a timely manner.

Applicability of Research to Practice
Ongoing education and monitoring of compliance is needed to further evaluate the safety and utility of nurse visits.
39 Nurses Can Resuscitate
Authors: Cooper Cheryl , Cochran Amalia , Coffey Rebecca 
Published: March 2020

Abstract

Introduction
Fluid resuscitation in the first 48 hours post burn is crucial in the management of burn shock. Hourly titration of fluids is needed to avoid complications of over or under resuscitation which can increase morbidity and mortality. Historically these titrations have been driven by the burn physician; we hypothesized that given protocols with specific resuscitation parameters the burn nurse can accurately resuscitate the burn patient without complications.

Methods
This quality improvement project at our ABA verified adult Burn Center tracked performance of a nurse-driven protocol for all inpatients with burns who underwent formal fluid resuscitation. Education regarding the nursing-driven protocol was provided to 90 surgical intensive care nurses. Badge buddies with both the Parkland formula and the Modified Albumin formula were made for the staff. Burn order sets were updated to reflect burn resuscitation guidelines with fluid adjustment parameters. A 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses and all resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow up and education reinforcement was done in real time by the clinical nurse specialist following each burn resuscitation.

Results
Over a one-year period, 23 patients’ resuscitations were tracked and reviewed by the burn quality team. One patient was excluded because of early transition to comfort care. After the initial three tracked resuscitations, the data collection tool was evaluated and modifications made to more effectively capture relevant findings. Mean age of patients was 45.1 (18–82) with a mean TBSA burn injury of 32.5 (15–42.5) In the first 24 hours patients (n=22) received a mean volume of 3.47 ml/kg/%TBSA (0.66 – 8.39) with a mean urine output of 0.95 mL/kg/hr (0.30 – 2.16 ml/kg/hr). For patients who remained on resuscitation during the second 24 hours (n = 16), they received a mean volume of 2.68ml/kg/%TBSA (0.56- 8.44) and had a mean urine output of 1.31 mL/kg/hr (0 .30–2.16). There were no complications related to fluid administration. Appropriate hourly fluid adjustments were made in 21 of the 22 patients. The one patient who did not have fluids titrated appropriately was attributed to resident physician education because the resident failed to provide the burn order set that includes the fluid resuscitation protocol.

Conclusions
Using a multidisciplinary approach and preparatory and real time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow up in real time can improve the process.

Applicability of Research to Practice
The use of nurse-driven protocols can improve outcomes for burn patients.
60 Contact Hand Burns in Children: Still a Major Prevention Need
Authors: McBride Jaclyn M , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Greenhalgh David G 
Published: March 2020

Abstract

Introduction
Since toddlers explore with their hands, contact burns continue to be a major pediatric problem. The purpose of this report is to review a pediatric burn unit’s 8-year experience with contact burns of the hand.

Methods
After IRB approval, a review of pediatric contact hand burns that occurred between 2006–2014 was performed. We examined the causes and outcomes in pediatric contact hand burns in a single pediatric burn program.

Results
In the 8-year span, 535 children suffered contact burns to the hand (67 per year). The majority suffered hands burns from an oven or stove (120). The other etiologies included burns from a fireplace (76), clothing iron (65), curling or straightening iron (50), and firepit or campfire (46). The mean age at time of injury was 2.62 years old, with a range of 2 months old to18 years old. Male children (339) typically burned their hands more than females (197). Locations of injury included the palmar surface, dorsal surface, fingers tips/thumb, wrist or a combination of several different areas. Most children burned the palmar aspect of their hand (384) compared to the dorsal aspect (61). These burns typically cover small total body surface areas (mean 1.08% TBSA), with only 2% of burns comprising &gt;5% TBSA. Approximately, 84% of these patients did not need surgery, but 86 (16%) had skin grafting (usually full-thickness) and 26% needed a secondary surgery. Of those that needed more than two, the average number of procedures was 3.6. Approximately 4.1% of patients needed a tertiary surgery. Causes for tertiary surgeries included contractures and graft loss. Out of twenty-two patients that needed a third surgery, 59% were due to graft loss and 41% were due to contractures.

Conclusions
Contact burns to the hand continue to be a major problem for toddlers. Children are most likely to burn themselves on an oven or stove, fireplace, clothing iron or curling/straightening iron. The palmar surface of the hand is the most likely site. While most children do not require surgery, approximately 16% require grafting. A significant number of those patients need reconstructive surgery. Clearly, current prevention efforts have failed to reduce these injuries.

Applicability of Research to Practice
Palm burns are common in young children. Efforts should focus on preventing these injuries.
69 Outbreak of Carbapenem-polymyxin-quat-resistant Acinetobacter Baumannii Associated with Mafenide Acetate Shortages: An Interdisciplinary Approach to Eradication
Authors: Fleming Irma D , Tang Carla , Remington Lois , Lewis Giavonni 
Published: March 2020

Abstract

Introduction
In the wake of Hurricane Maria, many US hospitals experienced massive drug shortages requiring substitution with alternative therapies. Our regional center experienced an increased incidence of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter baumannii(CPQRA) infections, compared to a previous year of no infections. Here we describe a successful interdisciplinary approach to its eradication.

Methods
We conducted a retrospective review of CPQRA outbreaks for November and December 2018 in the burn ICU. De-identified data was collected and analyzed. In collaboration with the state’s department of health and epidemiology section, whole-genome sequencing was carried out on bacterial isolates. In addition, we instituted adenosine triphosphate (ATP) monitoring on all surfaces, a process of rapidly measuring actively growing microorganisms.

Results
Resistant Acinetobacter was isolated from five ICU patients, two of whom died with CPQRA bacteremia, producing a case-fatality rate of 40%. The two cases that died both suffered traumatic injuries with multiple fractures in addition to an average TBSA of 58%.Non-fatal cases suffered no other traumatic injuries and had an average TBSA of 51%.During this period, genitourinary irrigant (neomycin-Polymyxin B) and polymyxin ointment were the primary topical agents for wound care. Whole genome sequencing revealed a qacEdelta1 positive strain and identified the primary source as a patient that returned from a long-term care facility carrying the converted A. Baumannii infection. ATP testing also showed increased levels in patient rooms and surgical suite.

Conclusions
As a result of these findings, we achieved eradication by developing new and reinforcing traditional practices of infection control. This included UV light therapy to all ICU rooms and surgical suite, oversight of environmental services procedures, rigorous enforcement of hospital infection control procedures, auditing hand hygiene, increased efforts in antibiotic stewardshipand discontinuing Polymyxin containing topicals. By January 2019 there were no new cases of CPQRA in the ICU. This study shows that the resistance and rapid spread of CPQRA can be controlled with the cooperation of hospital staff, environmental services, infection control, pharmacy and the state’s department of health. With the coordinated efforts of all parties, we were able to successfully eradicate a virulent and fatal resistant A. baumannii strain.

Applicability of Research to Practice
Describe an approach to eradicating resistant organisms and provide a roadmap to characterize the source, implement control measures to terminate an outbreak, and institute preventive measures.
70 Chlorhexidine Gluconate for Burn Wound Cleansing: Reduction in Multi-drug Resistant Organism Acquisition
Authors: Miller-Willis Kelsey L , Thomas Mini , Joe Victor C 
Published: March 2020

Abstract

Introduction
Daily wound care is an important part of burn wound management to help prevent infection. Literature suggests that daily Chlorhexidine Gluconate (CHG) bathing can reduce the risk of acquiring Multi-Drug Resistant Organisms (MDRO). The purpose of this study was to identify change in overall MDRO acquisition in the Burn Unit with the addition of a 1% CHG solution for wound care to the CHG bathing protocol for burn patients.

Methods
Prior to March 2018, routine bathing and wound care involved use of CHG-incompatible antibacterial soap and water followed by 2% chlorhexidine gluconate cloths to intact skin. In March 2018, the bathing protocol changed, in consultation with the hospital’s infection prevention program, to involve a 1% CHG solution for burn wounds followed by 2% CHG cloths to intact skin in order to prevent the loss of protective residual CHG due to rinsing with CHG-incompatible soap and water. A solution of 1% CHG was chosen by staff as an acceptable concentration for wound bathing. Adherence was measured through review of daily documentation of bathing in the electronic medical record. Incidences of burn unit-attributable hospital-onset MDRO cultures were reviewed for the following periods: Baseline (Aug 2016-Aug 2017), Phase-In (Sept 2017 – Aug 2018) and Post-Implementation (Sept 2018 – Aug 2019).

Results
Adherence was &gt;85% throughout the intervention period. No adverse events were noted. Incidences of hospital-onset burn unit MDROs during the following time periods were: 22 cases (Baseline), 15 cases (Phase-In), and 10 cases (Post-Implementation). The most common organisms in the baseline period were Extended-Spectrum b-Lactamase (ESBL) Escherichia coli, MRSA, and Multi Drug Resistant Pseudomonas; and post-implementation, the most common organisms were: MRSA and MDR-Pseudomonas.

Conclusions
A change to a 1% CHG solution for rinsing burn wounds in the setting of 2% CHG cloths to intact skin was well tolerated and associated with a decline in MDRO acquisition attributable to the burn ICU in the one-year post implementation.

Applicability of Research to Practice
The use of a 1% CHG solution for burn wounds may help prevent MDRO acquisition in the highly susceptible and unique burn population.
76 The Effect of Splinting of Metacarpophalangeal Joints After Skin Grafting: A Review of the ACT Database
Authors: Welsh Ashley M , Dewey William S , Casey James C , Cunningham Kyle B 
Published: March 2020

Abstract

Introduction
Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting.

Methods
This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted.

Results
A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures.

Conclusions
Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%.

Applicability of Research to Practice
Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.