Piersanti, Megan. Increasing emergency department nurse awareness and use of the Respiratory distress observation scale. Retrieved from https://doi.org/doi:10.7282/t3-qkzy-qj72
DescriptionPurpose of Project: Barriers to providing end-of-life and palliative care interventions in an emergency department (ED) setting include inadequate time, poor interdisciplinary collaboration, environmental chaos, and insufficient education (Alqahtani & Mitchell, 2019). The Respiratory Distress Observation Scale (RDOS) assists clinicians with an objective assessment of patients who are unable to communicate the severity of dyspnea that they are experiencing (Campbell, 2010). Use of a standardized tool such as the RDOS is essential for consistent assessment and communication of patient outcomes that result from nurse-driven palliative interventions (e.g., medication administration, oxygen, and repositioning) (Campbell, 2010). The RDOS allows healthcare providers to objectively evaluate a patient’s level of dyspnea from a quantitative standpoint, but it only serves a purpose if the staff is aware of its existence in the electronic medical record (EMR).
Methodology: A pre-intervention survey of nursing staff in a level 1 trauma ED identified three barriers to using the tool: location within the EMR, lack of awareness, and insufficient time. A quality improvement project incorporated staff huddle education, relocation of the tool within the EMR, and quick-reference flyers to increase nurse awareness of the RDOS.
Results: Retrospective chart reviews conducted pre- and post-intervention demonstrated a modest increase in use of the RDOS and no change in palliative medication administration. Nurses identified location of the tool as a remaining barrier to using the RDOS, despite a significant increase in knowledge and awareness of the tool.
Implications for Practice: Although improving familiarity of an assessment tool has the potential to enhance provider communication and patient outcomes, additional research is suggested to investigate more successful approaches to increase the use of documentation tools such as the RDOS.