As trauma professionals, we are all aware of the devastating impact injuries can have. More than 28 million injuries require emergency medical care on an annual basis (Doll, Bonzo, Mercy, & Sleet, 2007). It is estimated that 1 in 4 children will have an unintentional injury that requires medical attention or intervention by the time they are 21 years old. Unintentional injuries remain one of the leading causes of morbidity and mortality in pediatrics (Borse et al., 2008). These cases result in more than 10 million emergency department (ED) visits annually (Valdez, 2009). Even more importantly, these injuries are preventable. The American College of Surgeons Resources for Optimal Care of the Injured Patient 2014 requires trauma centers to have an organized and effective approach to injury prevention.
As a Level 1 pediatric trauma center, we are committed to preventing injuries in the communities we serve. While our prevention efforts in our community are ongoing, our ED and trauma teams identified an opportunity to provide injury prevention messaging right at the bedside. With an annual ED patient volume greater than 54,000, we have the potential to reach a large number of individuals. Our audience includes not only our patients but also the families and caregivers who accompany these patients.
As we continue to better understand injuries, our prevention methods are improving. Following an injury, youth and their parents may be more receptive to intervention leading to teachable moments (Johnson et al., 2007). Using teachable moments is nothing new in health care. Teachable moments are described as the use of health events to motivate individuals to adopt risk-reducing behaviors (McBride, 2003). The time immediately following care for an injury allows the patient to think about the cause and how they can potentially make a behavior change (Johnson et al., 2007). Patient-centered care is becoming more prevalent and providing additional opportunities to engage our patients (Bensberg, 2002). Our ED staff identified these moments as prime teaching opportunities and worked with our trauma team to develop resources and education for patients and families who present to our department.
Time at the bedside offers an irreplaceable moment to provide verbal and written age-specific injury prevention education. Teachable moments have been used successfully in implementing interventions for smoking reduction programs, alcohol misuse programs, and cancer screening (Johnson et al., 2007). Our ED staff utilize the "teach back method" of education, ensuring that the family and patient, if able, are comprehending what is being taught. This method allows our staff to ensure that the patient and family understand the information that they are being provided. Having the caregiver and the patient (if age appropriate) repeat back in their own words what was taught allows staff to answer any further misunderstandings or give more instructions if necessary. According to the Agency for Healthcare Research and Quality, 40%-80% of medical information provided to patients during office visits is forgotten immediately and almost 50% of the information retained is not accurate (Health Literacy Universal Precautions Toolkit, 2nd Edition, n.d.).
Having staff who participate in an injured patient's care can better prepare a family or prevent another injury. This can be accomplished by providing safety equipment or safety education or even providing guidance about ways to prevent injuries in the future (i.e., seat belts, car seats, bike helmets, etc.). Not only are ED staff available and willing to provide education, but they are also in a unique position to identify potential risks for future injuries. This combination of teaching opportunities and risk-factor identification makes the ED an optimal location for injury prevention messaging (Meizer-Lange, Zonfrillo, & Gittelman, 2013).
As health care continues to push toward health promotion, the use of numerous strategies will be important (Bensberg, 2002). Our injury prevention efforts in the ED began with the creation of an Injury Prevention Committee. While a simple first step, the creation of our committee allowed us to use an existing structure to promote injury prevention messages. Each staff member in the department is required to participate in at least one committee. The injury prevention committee became one of those options.
The injury prevention committee obtained data from our trauma registry. These data were used to guide the injury prevention focuses of the department. Our initial strategies included department bulletin boards, digital signage, and participation in community events. In addition, we focused on several department-specific strategies.
DEPARTMENT STRATEGIES
Bike Safety
As our group gained momentum, we were able to focus directly on interventions that could be completed at the bedside. The first program developed was a bike helmet program. This program targeted patients who presented as a result of a bicycle injury. According to the Insurance Institute for Highway Safety, helmet use can reduce the risk of a head injury by up to 85%. Each patient and family presenting as a result of a bicycle injury was provided with specific information related to bicycle safety and proper fit of helmets. In addition, our trauma program provided the department with replacement helmets for those who had been involved in a crash. This enabled ED staff to provide not only information on when to replace a helmet, but also to replace the helmet and ensure that it is fitted correctly. Despite existing laws in many states requiring children younger than 18 years to wear a helmet when riding, only 26% of pediatric patients treated at a trauma center are reported to be wearing a helmet at the time of collision (Adams, Drake, Dang, & Le-Hinds, 2014).
Continuing with our bike safety education, our injury prevention committee started the Emergency Department Star Program. This program focuses on rewarding good behavior for a patient who has been involved in a bike injury and was wearing their bike helmet. Each eligible patient gets a certificate and a star with his or her name, which is hung in our ED. The stars signify the importance of wearing helmets when riding bikes and how they help save children from more significant or severe injuries.
Child Passenger Safety
Motor vehicle crashes remain one of the leading causes of death for pediatric trauma patients nationally (Borse et al., 2008). In addition, according to our trauma registry, motor vehicle crashes are our second leading cause of injury and represent 18% of our trauma patients. Our organization implemented a child safety seat station in 2005 as a way to prevent these injuries. This service is offered several times throughout each month. Unfortunately, there are still times that patients do not have the appropriate child passenger safety seat when leaving our pediatric ED. Through our partnership with the trauma program, we are able to ensure that these patients have the appropriate seat and that families receive education to keep their most precious cargo safe. We continue to provide education to our nursing staff to ensure that we are providing the most up-to-date information to caregivers in our department.
Community Outreach
While our trauma program leads our community outreach efforts, our injury prevention committee plays a role in supporting these events. The hospital Injury Prevention Coordinator has developed a training program to ensure that ED staff are armed with the necessary skills and information to effectively promote injury prevention at community events. These events include participation in school health fairs, Safe Kids Days, conferences, and community events. In addition, our organization offers a benefit of volunteer time off. This time should be used for volunteer activities with public entities during an Associate's regularly scheduled work hours. We believe that the addition of this benefit encourages more associates to engage in injury prevention education.
Family Education
Our patient and family education strategy is multipronged. We utilize an electronic system called the GetWell Network, to engage families in safety videos, safety video games, and safety information. This electronic system is available in each patient room both in the department and throughout the hospital.
In addition to educating families throughout their ED visit, we also ensure that injury prevention information is included in the discharge education provided to families. Utilizing our Center for Children's Health Media, we are able to provide current best practices for injury prevention in addition to discharge instructions. This information can be reviewed with family and distributed as a resource for the family once they have left the ED.
CHALLENGES
While the implementation of our ED injury prevention efforts is important, it has not been without challenges. As with many prevention programs, evaluation of the program's success has been difficult. Knowing exactly if these methods have prevented injuries is not an easy task. In addition, it is challenging to maintain the engagement of our staff. Rotating themes and developing new projects have been one way we have attempted to promote staff involvement.
CONCLUSION
Injury prevention is the responsibility of all team members. An ED experience does not have to be just about the care that is provided to return our patients to the community. Our health care teams play a vital role in ensuring that these patients do not repeat their injuries. Additional research is needed to ensure that best practices are used to provide the most appropriate intervention during a teachable moment (Zonfrillo, Melzer-Lange, & Gittleman, 2014). Using staff involved in caring for the injured patients to teach prevention allows the education to be focused on the needs of the learner and ultimately change the risk-taking behavior that made them a patient to begin with. Providing injury prevention messaging at the bedside can serve as an innovative way to carry your message and prevent future injuries.
KEY POINTS
* Unintentional injuries remain one of the leading causes of morbidity and mortality in pediatrics. These preventable injuries result in several million ED visits annually.
* Following an injury, youth and their parents are often more receptive to prevention education. This serves as an irreplaceable moment to provide specific injury prevention education.
* Emergency department nurses are in a unique position to educate injured patients, while providing patient care.
* Our ED team utilizes the moment at the bedside as an opportunity to provide pertinent prevention education.
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