Nurse experiences and confidence in treating critically ill and injured patients following the completion of the First Line Emergency Care Course.

INTRODUCTION: The geographical vastness of Australia in rural and remote regions provides challenges for hospital nursing staff when a medical officer is not immediately available. Delaying treatment until a medical officer arrives can potentially impact on patient outcomes. Some Registered Nurses in rural and remote New South Wales have received advanced training and credentialing through the First Line Emergency Care Course (FLECC) enabling them to initiate treatment prior to the medical officer's arrival. Despite operating since 1990 the course and subsequent model of care has received limited evaluation. PURPOSE: The aim of this study was to evaluate whether undertaking the First Line Emergency Care Course (FLECC) improves confidence in rural and remote registered nurses' (RN) ability to provide and to initiate extended scope of practice for emergency care of critically ill adults in the absence of a medical officer. PROCEDURE: A voluntary electronic cross sectional 19 question multi-centre survey was emailed to all nurses FLECC accredited since 2008 and employed in rural and remote Local Health District in New South Wales. FINDINGS: A response rate of 60% was obtained (225/375). Since credentialing 93.3% nurses had commenced emergency treatments under the approved guidelines. The majority (97.4%) agreed that the course provided the required knowledge. The mean Likert nurse's self-assessed confidence score (1-5) for providing first line response rose significantly (Wilcoxon signed rank test V=375, p-value<0.0001) from 2.47 and up to 3.98 after the course. The majority (83.9%) now had "high" or "very high" confidence. PRINCIPLE CONCLUSIONS: The FLECC provides registered nurses in rural and remote areas with skills, confidence, knowledge and ability to initiate potentially lifesaving treatment for critically ill or injured patients prior to the arrival of a medical officer. The FLECC model of care helps provide timely care delivery by nurses in rural and remote areas. Further research could examine the differences in outcome in patients treated at sites with FLECC nurses.

Optimizing triage consistency in Australian emergency departments: the Emergency Triage Education Kit.

OBJECTIVE: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. METHODS: A postal survey of 237 paper-based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was kappa >or= 0.6. RESULTS: Data were collected during 2 April to 14 May 2007. Agreement for the set was kappa = 0.412 (95% CI 0.410-0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6-45.3) showed concordance >or=70% to the modal triage category (kappa = 0.632, 95% CI 0.629-0.636) and 155/237 (65.4%, 95% CI 59.3-71.5) showed concordance >or=60% to the modal triage category (kappa = 0.507, 95% CI 0.504-0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (kappa = 0.243, 95% CI 0.237-0.249; kappa = 0.319, 95% CI 0.310-0.328). CONCLUSION: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task-related factors influence consistency of triage.