Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

Abstract

In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.

Standardising Clinical Caremaps: Model, Method and Graphical Notation for Caremap Specification

“…More recent caremaps are specified as a flow diagram made up of clinical options for a particular condition. Thus, modern caremaps contain multiple possible paths based on: (i) symptomatology; (ii) diagnostic results, and; (iii) how the patient responds to treatment [88,89].…”

“…Numerous contemporary caremap examples were found annexed to hospital-based clinical CPGs. Contemporary caremap literature tended to focus on establishing the clinical condition justifying creation of the caremap, such as: determination of incidence, risk factors and patient outcomes [88]; diagnosis and stabilisation of patients with an acute presentation [89]; and, protocolising of ongoing treatment [85]. Presentation or discussion of a development process or the elements used in construction were rare, and more often had to be inferred from a thorough reading of each paper.…”

“…Caremaps are found in many healthcare domains, including: paediatric surgery[88], nursing[89], oncology [90], diagnostic imaging [91], obstetrics…”

Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting

“…Alternative dosing by weight range (Deforest & Thompson, 2012;Freedman, Adler, Seshadri, & Powell, 2006): < 8 kg: not recommended 8-15 kg: 2 mg 15-30 kg: 4 mg > 30 kg: 8 mg…”

Clinical Caremap Development: How Can Caremaps Standardise Care When They Are Not Standardised?

“…More recent caremaps have tended towards representation as a flow diagram made up of clinical options for a particular condition and resulting in multiple possible paths based on: (i) symptomatology; (ii) diagnostic results, and; (iii) how the patient responds to treatment (BCCancer, 2012), (Chan, et al, 2005), (deForest & Thompson, 2012). Caremap examples can be found in many healthcare domains, including: paediatric surgery (Chan, et al, 2005), nursing (deForest & Thompson, 2012, oncology (BCCancer, 2012), diagnostic imaging (WAHealth, 2013), obstetrics (Comreid, 1996) and cardiology (Hampton, 1993).…”