title: Nurse driven protocol for head injured patients on warfarin.
abstract: The trauma quality improvement committee at our facility identified a significant number of patients on warfarin presenting to the emergency center after minor head trauma that subsequently expired from their intracranial hemorrhage prior to appropriate intervention. An analysis of this patient population identified multiple areas of delay. A collaborative effort between the emergency center nurses and the trauma service personnel resulted in a formal protocol to address each component of delay and expedite the process. Since implementation of this nursing driven protocol we have dramatically decreased the time to (1) Emergency Center Physician evaluation, (2) completion of head computerized tomography, (3) reversal of anticoagulation with fresh frozen plasma (FFP), and (4) most importantly, patient mortality rate. We conclude that this nursing driven protocol is effective in decreasing the mortality rate by eliminating diagnostic and therapeutic delays in this high-risk patient population.
authors.affiliation: Division of Trauma Services, William Beaumont Hospital, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Bair
authors.forename: Felicia
authors.initials: F
authors.lastname: Ivascu
authors.forename: Randy
authors.initials: R
authors.lastname: Janczyk
authors.forename: Tara
authors.initials: T
authors.lastname: Nittis
authors.forename: Philip
authors.initials: P
authors.lastname: Bendick
authors.forename: Greg
authors.initials: G
authors.lastname: Howells
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000150:complications / Q000451:nursing*; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology / Q000517:prevention & control*; D014218:Triage; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects* / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014812:Vitamin K; D014859:Warfarin