Factors Influencing Compliance with Triage Protocol in Trauma Patients
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Published:
Aug 8, 2018
Keywords:
compliance triage protocol trauma patients
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Abstract
A descriptive correlational design was used for this study. The objective was to determine factors influencing compliance with triage protocol in trauma patients who admitted at Faculty of Medicine Vajira Hospital from January 2015, 1 to December 2015, 31. The 200 trauma patients were eligible with purposive sampling. The research instruments were record forms for data of trauma patient, triage nurse and triage performance. Data were analyzed using descriptive statistics, Chi-square and binary logistic regression.
Results showed that most trauma patients received the compliance with triage protocol (81.5%). When considered each factors, most trauma patients received the compliance with triage protocol more than 80% except the older than 60 years (71.8%), fall/ assault/ harm themselves (79.2%), triage experience more than 10 years (78.6%), fail a trauma examination and assessment (75.4%), arrive between 4.00-11.59 pm (75.7%), and nurse patient ratio 1:>10 (60.5%). Factor influencing compliance with triage protocol in trauma patients was nurse to patient ratios (p<0.001).
Nursing personnel needed in emergency department should be managed according to actual workload for supporting compliance with triage protocol in trauma patients.
Article Details
How to Cite
พรหมดี อ., บุณยพัฒน์กุล ป., & กนกกาญจนะ พ. (2018). Factors Influencing Compliance with Triage Protocol in Trauma Patients. Vajira Nursing Journal, 19(1), 19–32. Retrieved from https://he02.tci-thaijo.org/index.php/vnj/article/view/138964
Section
research article
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวชิรสารการพยาบาลถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรง ซึ่งกองบรรณาธิการไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ ทั้งสิ้น
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวชิรสารการพยาบาล ถือเป็นลิขสิทธิ์ของวชิรสารการพยาบาล หากบุคคลใดหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด ๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากวชิรสารการพยาบาลก่อนเท่านั้น
References
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พิมพ์ภา เตชะกมลสุข, กาญจนีย์ ดำนาคแก้ว และอนงค์ แสงจันทร์ทิพย์. (2553). พฤติกรรมเสี่ยงและการประเมินผลการดำเนินงานควบคุมป้องกันอุบัติเหตุบนท้องถนน. วารสารสำนัก ระบาดวิทยากรมควบคุมโรคกระทรวงสาธารณสุข, 41(9), 129-132.
สภาการพยาบาล (พฤศจิกายน 2548). มาตรฐานบริการการพยาบาลและการผดุงครรภ์ระดับทุติยภูมิและระดับตติยภูมิ, http://www.tnc.or.th/files/2010/10/act_of_parliament-368/__14975.pdf
American College of Surgeons Committee on Trauma. (2009). Advanced Trauma Life Support for Doctors: ATLS student course manual (9thed), Chicago: American College of Surgeons Committee on Trauma.
Baker, S.P., O'Neill, B., Haddon, W.Jr. & Long, W.B. (1974). The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma , 14, 187-196.
Beveridge, R., Clarke, B., Janes, L., Savage, N., Thompson, J., Dodd, G. & et.al. (1999). Canadian Emergency Department Triage and Acuity Scale Implementation Guidelines. Canadian Journal of Emergency Medicine, 1(3 Suppl), S1-S24.
Bressan, S., Franklin, K.L., Jowett, H.E., King, S.K., Oakley, E., & Palmer, C.S. (2014). Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures. British Medical Journal. 7(21), 1-5.
Burke, R.J. (2003). Hospital restructuring, workload, and nursing staff satisfaction and work experiences. Health Care Manage, 22, 99–107.
Chan, T.C, Killeen, J.P., Vilke, G.M., Marshall, J.B., & Castillo, E.M. (2010). Effect of Mandated Nurse–Patient Ratios on Patient Wait Time and Care Time in the Emergency Department. Academic Emergency Medicine, 17, 545–552.
Chen, S.S., Chen, J.C., Ng, C.J., Chen, P.L., Lee, P.H., & Chang, W.Y. (2010). Factors that influence the accuracy of triage nurses’ judgement in emergency departments. Emerg Med J, 27, 451-455, doi:10.1136/emj.2008.059311
Considine, J., Charlesworth, D., & Currey, J. (2014). Characteristics and outcomes of patients requiring rapid response system activation within 24 hours of emergency admission. Critical Care and Resuscitation. 3(16), 184-189.
Cowan, R.M. & Trzeciak, S. (2005). Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Critical Care, 9, 291-295.
Dehli, T., Fredriksen, K., Osbakk, S.A., & Bartnes. K. (2011). Evaluation of a university hospital trauma team activation protocol. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine. 19(18), 1-7.
Fathoni, M., Sangchan, H., & Songwathana, P. (2013). Relationships between Triage Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses in East Java, Indonesia, Nurse Media Journal of Nursing, 3(1), 511- 525.
Fitzharris, M., Stevenson, M., Middleton, P. & Sinclair, G. (2012). Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting. Injury, 43, 1368–1376.
Hasler, R. M., Nuesch, E., Juni, P., Bouamra, O., Exadaktylos A. K., & Lecky, F. (2011). Systolic blood pressure below 110 mmHg is associated with increased mortality in blunt major trauma patients: Multicentre cohort study. Resuscitation. 82, 1202-1207.
Hobgood, C., Villani, J., & Quattlebaum, R. (2005). Impact of Emergency Department Volume on Registered Nurse Time at the Bedside. Ann Emerg Med, 46, 481-489.
Janssen, M., Achterberg, T., Adriaansen, M., Kampshoff, C.S., Schalk, D., & Groot, J. (2011). Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study. Journal of Clinical Nursing, 21, 437–447.
Kim, H., Jung, K. Y., Kim, S. P., Kim, S. H., & Noh, H. (2012). Changes in Preventable Death Rates and Traumatic Care Systems in Korea. The Korean Society of Emergency Medicine. 23(2), 189-197.
Lemeshow, S., Hosmer, D.W., Klar, J., & Lwanga, S.K. (1990). Adequacy of Sample Size in Health Studies. W.H.O.: John Wiley & Sons.
Mathers, C.D. & Joncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods, and results. http://www.who.int/ healthinfo/statistics/bod_projections2030_-paper.pdf
Merz, T. M., Etter, R., Mende, L., Barthelmes, D., Wiegand, J., Martinolli, L., et al. (2011). Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department. Critical Care, 15(25), 1-9.
Moore, L., Turgeon, A.F., Sirois, M.J., & Lavoie, A. (2012). Trauma centre outcome performance: A comparison of young adults and geriatric patients in an inclusive trauma system. Injury, 43, 1580–1585.
Nakahara, S., Matsuoka, T., Ueno, M., Mizushima, Y., Ichikawa, M., Yokota, J., & Yoshida, K. (2010). Predictive Factors for Undertriage Among Severe Blunt Trauma Patients: What Enables Them to Slip Through an Established Trauma Triage Protocol?. J Trauma, 68, 1044–1051.
Paw, R.C. (2008). Emergency department staffing in England and Wales, April 2007. Emergency Medicine Journal, 25(7), 420–423.
Pearson, A., Pallas, L., Thomson, D., Doucette, E., Tucker. D., Wiechula, R. & et.al. (2006). Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments. Int J Evid Based Healthc, 4, 337–384.
Peng, L., Mayner, L. & Wang, H. (2014). Association between trauma patients’ severity and critical care nursing workload in China. Nursing and Health Sciences, 16, 528–533.
O’Connor, E., Gatien, M., Weir, C., & Calder, L. (2014). Evaluating the effect of emergency department crowding on triage destination. International Journal of Emergency Medicine, 7(16), http://www.intjem.com/content/7/1/16
Ryb, G. E., Cooper, C., & Waak, S. M. (2012). Delayed trauma team activation: Patient characteristics and outcomes. The Journal of Trauma and Acute Care Surgery, 7(3), 695-698.
Spanjersberg, W. R., Berge, E. A., Mushkudiani, N., Klimek, M., & Schipper, I. B. (2009). Protocal compliance and time management in blunt trauma resuscitation. Emergency Medicine Journal, 26, 23-27.
Sucov, A., Sidman, R. & Valente, J. (2009). A cost-efficiency analysis to increase clinician staffing in an academic emergency department. Academic Medicine, 84(9), 1211–1216.
Twigg, D., Duffield, C., Bremner, A., Rapley, P. & Finn, J. (2011). The impact of nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 48(5), 540–548.
Wibulpolprasert, A., Sittichanbuncha, Y., Sricharoen, P., Borwornsrisuk, S., & Sawanyawisuth, K. (2014). Factors Associated with Overcrowded Emergency Rooms in Thailand: A Medical School Setting. Hindawi Publishing Corporation Emergency Medicine International, http://dx.doi.org/10.1155/2014/576259
Williams, G., Crilly, J., Souter, J., Veach, K. & Good, N. (2014). A state wide validation and utilisation study of the Queensland emergency nursing workforce tool. Journal of Nursing Management, 22, 1076–1088.
Zolnierek, C.D. & Steckel, C.M. (2010). Negotiating safety when staffing falls short. Critical Care Nursing Clinics of North America, 22(2), 261–269.
พิมพ์ภา เตชะกมลสุข, กาญจนีย์ ดำนาคแก้ว และอนงค์ แสงจันทร์ทิพย์. (2553). พฤติกรรมเสี่ยงและการประเมินผลการดำเนินงานควบคุมป้องกันอุบัติเหตุบนท้องถนน. วารสารสำนัก ระบาดวิทยากรมควบคุมโรคกระทรวงสาธารณสุข, 41(9), 129-132.
สภาการพยาบาล (พฤศจิกายน 2548). มาตรฐานบริการการพยาบาลและการผดุงครรภ์ระดับทุติยภูมิและระดับตติยภูมิ, http://www.tnc.or.th/files/2010/10/act_of_parliament-368/__14975.pdf
American College of Surgeons Committee on Trauma. (2009). Advanced Trauma Life Support for Doctors: ATLS student course manual (9thed), Chicago: American College of Surgeons Committee on Trauma.
Baker, S.P., O'Neill, B., Haddon, W.Jr. & Long, W.B. (1974). The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma , 14, 187-196.
Beveridge, R., Clarke, B., Janes, L., Savage, N., Thompson, J., Dodd, G. & et.al. (1999). Canadian Emergency Department Triage and Acuity Scale Implementation Guidelines. Canadian Journal of Emergency Medicine, 1(3 Suppl), S1-S24.
Bressan, S., Franklin, K.L., Jowett, H.E., King, S.K., Oakley, E., & Palmer, C.S. (2014). Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures. British Medical Journal. 7(21), 1-5.
Burke, R.J. (2003). Hospital restructuring, workload, and nursing staff satisfaction and work experiences. Health Care Manage, 22, 99–107.
Chan, T.C, Killeen, J.P., Vilke, G.M., Marshall, J.B., & Castillo, E.M. (2010). Effect of Mandated Nurse–Patient Ratios on Patient Wait Time and Care Time in the Emergency Department. Academic Emergency Medicine, 17, 545–552.
Chen, S.S., Chen, J.C., Ng, C.J., Chen, P.L., Lee, P.H., & Chang, W.Y. (2010). Factors that influence the accuracy of triage nurses’ judgement in emergency departments. Emerg Med J, 27, 451-455, doi:10.1136/emj.2008.059311
Considine, J., Charlesworth, D., & Currey, J. (2014). Characteristics and outcomes of patients requiring rapid response system activation within 24 hours of emergency admission. Critical Care and Resuscitation. 3(16), 184-189.
Cowan, R.M. & Trzeciak, S. (2005). Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Critical Care, 9, 291-295.
Dehli, T., Fredriksen, K., Osbakk, S.A., & Bartnes. K. (2011). Evaluation of a university hospital trauma team activation protocol. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine. 19(18), 1-7.
Fathoni, M., Sangchan, H., & Songwathana, P. (2013). Relationships between Triage Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses in East Java, Indonesia, Nurse Media Journal of Nursing, 3(1), 511- 525.
Fitzharris, M., Stevenson, M., Middleton, P. & Sinclair, G. (2012). Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting. Injury, 43, 1368–1376.
Hasler, R. M., Nuesch, E., Juni, P., Bouamra, O., Exadaktylos A. K., & Lecky, F. (2011). Systolic blood pressure below 110 mmHg is associated with increased mortality in blunt major trauma patients: Multicentre cohort study. Resuscitation. 82, 1202-1207.
Hobgood, C., Villani, J., & Quattlebaum, R. (2005). Impact of Emergency Department Volume on Registered Nurse Time at the Bedside. Ann Emerg Med, 46, 481-489.
Janssen, M., Achterberg, T., Adriaansen, M., Kampshoff, C.S., Schalk, D., & Groot, J. (2011). Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study. Journal of Clinical Nursing, 21, 437–447.
Kim, H., Jung, K. Y., Kim, S. P., Kim, S. H., & Noh, H. (2012). Changes in Preventable Death Rates and Traumatic Care Systems in Korea. The Korean Society of Emergency Medicine. 23(2), 189-197.
Lemeshow, S., Hosmer, D.W., Klar, J., & Lwanga, S.K. (1990). Adequacy of Sample Size in Health Studies. W.H.O.: John Wiley & Sons.
Mathers, C.D. & Joncar, D. (2005). Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods, and results. http://www.who.int/ healthinfo/statistics/bod_projections2030_-paper.pdf
Merz, T. M., Etter, R., Mende, L., Barthelmes, D., Wiegand, J., Martinolli, L., et al. (2011). Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department. Critical Care, 15(25), 1-9.
Moore, L., Turgeon, A.F., Sirois, M.J., & Lavoie, A. (2012). Trauma centre outcome performance: A comparison of young adults and geriatric patients in an inclusive trauma system. Injury, 43, 1580–1585.
Nakahara, S., Matsuoka, T., Ueno, M., Mizushima, Y., Ichikawa, M., Yokota, J., & Yoshida, K. (2010). Predictive Factors for Undertriage Among Severe Blunt Trauma Patients: What Enables Them to Slip Through an Established Trauma Triage Protocol?. J Trauma, 68, 1044–1051.
Paw, R.C. (2008). Emergency department staffing in England and Wales, April 2007. Emergency Medicine Journal, 25(7), 420–423.
Pearson, A., Pallas, L., Thomson, D., Doucette, E., Tucker. D., Wiechula, R. & et.al. (2006). Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments. Int J Evid Based Healthc, 4, 337–384.
Peng, L., Mayner, L. & Wang, H. (2014). Association between trauma patients’ severity and critical care nursing workload in China. Nursing and Health Sciences, 16, 528–533.
O’Connor, E., Gatien, M., Weir, C., & Calder, L. (2014). Evaluating the effect of emergency department crowding on triage destination. International Journal of Emergency Medicine, 7(16), http://www.intjem.com/content/7/1/16
Ryb, G. E., Cooper, C., & Waak, S. M. (2012). Delayed trauma team activation: Patient characteristics and outcomes. The Journal of Trauma and Acute Care Surgery, 7(3), 695-698.
Spanjersberg, W. R., Berge, E. A., Mushkudiani, N., Klimek, M., & Schipper, I. B. (2009). Protocal compliance and time management in blunt trauma resuscitation. Emergency Medicine Journal, 26, 23-27.
Sucov, A., Sidman, R. & Valente, J. (2009). A cost-efficiency analysis to increase clinician staffing in an academic emergency department. Academic Medicine, 84(9), 1211–1216.
Twigg, D., Duffield, C., Bremner, A., Rapley, P. & Finn, J. (2011). The impact of nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 48(5), 540–548.
Wibulpolprasert, A., Sittichanbuncha, Y., Sricharoen, P., Borwornsrisuk, S., & Sawanyawisuth, K. (2014). Factors Associated with Overcrowded Emergency Rooms in Thailand: A Medical School Setting. Hindawi Publishing Corporation Emergency Medicine International, http://dx.doi.org/10.1155/2014/576259
Williams, G., Crilly, J., Souter, J., Veach, K. & Good, N. (2014). A state wide validation and utilisation study of the Queensland emergency nursing workforce tool. Journal of Nursing Management, 22, 1076–1088.
Zolnierek, C.D. & Steckel, C.M. (2010). Negotiating safety when staffing falls short. Critical Care Nursing Clinics of North America, 22(2), 261–269.