APN
Directed Arthrocentesis Program
Cleopatra
C. Aquino, RN, MSN, ANP
West-LA VA Medical Center
Problem
Limited resources, lack
of streamed line process, and unpredictable need for arthrocentesis
resulted to long waiting time and frequent ER visits.
Evidence
APNs reduced cost,
increased patient satisfaction, and proficiently performed
procedures. In a survey of 96 APNs >50% preformed procedures
in clinical practice learned on the job. Based on the evidence,
the rheumatology team launched an APN- directed arthrocentesis
(DA) program.
Strategy
The APN-DA program involves
protocol development and 6 month training. The protocol
outlines the detailed arthrocentesis procedure, indication
and limitations. The training consists of lectures on diseases,
treatment, radiographic interpretation and microscopic exam
of fluid.
Practice change
The APN-DA program
was implemented between 1999-2001 at West- LA VA hospital,
outpatient clinic supervised by 2 rheumatologists.
Results
Total of procedures (115), 101 male, 14 female, mean age
62, SD 15.37. Specific sites; 70%, 12%, 18% for medium-large
joints, small joints, and soft tissue, respectively. Bleeding
and infection rate combined were 3%, 97% without adverse
effects.
Evaluation
Arthrocentesis preformed
by APN was safe. The APN-DA program rates efficiently and
safely and broadened the APN's knowledge and skill. An annual
peer-review established competency.
Recommendations
To measure ER
visits, waiting time and patient satisfaction for future
study.
Reference
Stevens, K.R. (2002). ACE Star Model of EBP: The Cycle
of Knowledge Transformation. Academic Center for Evidence-based
Nursing. www.acestar.uthscsa.edu.
Previous
Abstract | 2003 Summer Institute Winner's List | Return to ACE
| Next Abstract
|
