Subhypnotic Intravenous Ketamine Improves Patient Satisfaction With Burn Wound Care: A Quality Improvement Project.

Despite advancements in pain management for burn injuries, analgesia often fails to meet our patients' needs. We hypothesized that low doses of intravenous (IV) ketamine as an adjunct to our current protocol would be safe, improving both nurse and patient satisfaction with analgesia during hydrotherapy. Burn patients admitted who underwent hydrotherapy from June 1, 2021, to June 30, 2023 were surveyed. Ketamine was administered with the standard opioid-midazolam regimen. Demographics, oral morphine equivalents, midazolam, ketamine doses and time of administration, and adverse events were collected. Patient and nurse satisfaction scores were collected. The ketamine and no-ketamine groups were compared. P < .05 was considered significant. Eighty-five hydrotherapies were surveyed, 47 without ketamine, and 38 with ketamine. Demographics, comorbidities, %TBSA, and hospital length of stay were not different. The median amount of ketamine given was 0.79 mg/kg [0.59-1.06]. Patients who received ketamine were more likely to receive midazolam (100% vs 61.7%; P < .001), and both oral and IV opioids (94.7% vs 68.1%; P = .002) prior to hydrotherapy and less likely to receive rescue opioids or midazolam during hydrotherapy. Two patients in the ketamine group had hypertension (defined as SBP > 180) that did not require treatment. Nurses tended to be more satisfied with patient pain control when ketamine was used (10 [8-10] vs 9 [7-10], P = .072). Patient satisfaction was higher in the ketamine group (10 [8.8-10] vs 9 [7-10], P = .006). Utilizing subhypnotic dose of IV ketamine for hydrotherapy is safe and associated with increased patient satisfaction.

Optimizing burn wound procedural pain control, efficiency, and satisfaction through integrated nurse and physician education.

Herein, we report the results of a quality improvement project (QI). Following a review of the burn unit practices, a nursing-led, physician supported educational intervention regarding optimal timing, dosage, and indication for medications used during hydrotherapy, including midazolam and opioids, was implemented. We hypothesized that such intervention would support improvement in both nurse and patient satisfaction with pain control management. Patients undergoing hydrotherapy were surveyed. Demographics, opioid dose prescribed (oral morphine equivalents), midazolam use, timing of administration, and adverse events were collected. Patient pain scores (1-10) before and after hydrotherapy and patient and nurse satisfaction scores (1-10) after hydrotherapy were collected. The pre- and post-education populations were compared. P < 0.05 was considered significant. Post-education, administration of opioids (59.1% v. 0%, p < 0.001) and midazolam (59.1% vs. 10.4%; p < 0.001) prior to hydrotherapy significantly improved, leading to fewer patients requiring rescue opioids during hydrotherapy (25% vs. 74%, p < 0.001). Hydrotherapy duration significantly decreased post-education (19 [13.3-30] min vs. 32 [18-43] min, p = 0.003). Nurses' ratings of their patient's pain control (9 [7.3-10] vs. 7.5 [6-9], p = 0.004) and ease of procedure (10 [9,10] vs. 9 [7.8-10], p = 0.037) significantly improved. Patients' pain management satisfaction rating did not change, but the number of subjects rating their pain management as excellent tended to increase (36.4% vs. 20%, p = 0.077). Nursing led, physician supported, education can improve medication administration prior to and during hydrotherapy, increasing the ease of the procedure as well as staff satisfaction.

Identifying and Assisting Burn Patients and Their Families With Needs Through Administration of an Assessment Tool on Admission.

Using a modified Safe Environment for Every Kid Questionnaire (Needs Survey), we previously showed a significant correlation between adverse childhood experiences (ACEs) and family needs. Herein, we retrospectively assessed whether patients' and their families' needs identified using the Needs Survey were addressed prior to discharge. We hypothesized that, without the knowledge gained by administering this tool, many basic needs may not have been fully addressed. Seventy-nine burn patients and families previously enrolled in our ACE studies were included. Answers to the Needs Surveys were reviewed to identify families with needs. Medical records were reviewed to determine if a social worker assessment (SWA) was completed per standard of care and if their needs were addressed prior to discharge. Of the 79 burn patients who received inpatient care and completed the Needs Survey, family needs were identified in 67 (84.8%); 42 (62.7%) received an SWA, and 25 (37.3%) did not. Those who did not receive a SWA had a shorter hospitalization and suffered less severe burns. Demographics, socioeconomics, ACEs, and identified needs were similar between the groups. Our study showed that SWA was performed on many patients with basic needs. However, with the focus of SWAs being on discharge arrangements, not all needs were addressed, and individualized resources were often not provided. Administering the Needs Survey on admission may help our social workers streamline and expedite this process to help support successful recovery for our burn patients and their families.

Biallelic Optic Atrophy 1 (OPA1) Related Disorder-Case Report and Literature Review.

Dominant optic atrophy (DOA), MIM # 605290, is the most common hereditary optic neuropathy inherited in an autosomal dominant pattern. Clinically, it presents a progressive decrease in vision, central visual field defects, and retinal ganglion cell loss. A biallelic mode of inheritance causes syndromic DOA or Behr phenotype, MIM # 605290. This case report details a family with Biallelic Optic Atrophy 1 (OPA1). The proband is a child with a severe phenotype and two variants in the OPA1 gene. He presented with congenital nystagmus, progressive vision loss, and optic atrophy, as well as progressive ataxia, and was found to have two likely pathogenic variants in his OPA1 gene: c.2287del (p.Ser763Valfs*15) maternally inherited and c.1311A>G (p.lIle437Met) paternally inherited. The first variant is predicted to be pathogenic and likely to cause DOA. In contrast, the second is considered asymptomatic by itself but has been reported in patients with DOA phenotype and is presumed to act as a phenotypic modifier. On follow-up, he developed profound vision impairment, intractable seizures, and metabolic strokes. A literature review of reported biallelic OPA1-related Behr syndrome was performed. Twenty-one cases have been previously reported. All share an early-onset, severe ocular phenotype and systemic features, which seem to be the hallmark of the disease.

The Burden of Adverse Childhood Experiences in Children and Those of Their Parents in a Burn Population.

The aim of this study was to determine the prevalence, type, and associations of parental and child adverse childhood experiences (ACEs) in children presenting with burn injuries. Parents of burned children completed an ACE-18 survey, including questions on parent and child ACEs, needs, and resiliency. Demographics, burn injury, hospital course, and follow-up data were collected. Family needs and burn outcomes of children with and without ACEs' exposure (no ACE vs one to two ACEs vs three or more ACEs) were analyzed. P <.05 was considered significant. Seventy-five children were enrolled-58.7% were male, 69.3% white. The average age was 6.0 ± 5.2 years. The average total burn surface area was 4.4 ± 5.7% (0.1-27%). Parent ACE exposure correlated with child ACE exposure (r = .57; P = .001) and this intensified by increasing child age (P = .004). Child ACE exposure showed a graded response to family needs, including food and housing insecurity and childcare needs. Stress and psychosocial distress of the parents was significantly associated with their children's ACE burden. The ACE burden of parents of burned children can affect the ACE load of their children. Burned children with more ACEs tend to have significantly more needs and more family distress. Awareness of past trauma can help identify a vulnerable population to ensure successful burn recovery.