V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
DOD AND VA NURSING Expanding Techniques and Technologies for 21st Century Care
n IN ANSWERING THE QUESTION “What is Nursing?” on the American Nurses Association website, it states: “21st Century nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual.” That description is clearly evident throughout the multitude of nursing roles and venues in the Department of Defense (DOD) and the Department of Veterans Affairs (VA). While nurses’ commitment to highly skilled and compassionate care never waivers, the techniques and technologies utilized to deliver that care are continuously evolving. DOD TRAUMA DOCUMENTATION STUDY: FROM PAPER TO ELECTRONIC In one example of an evolving technology, trauma staff at Brooke Army Medical Center (BAMC) in San Antonio, Texas, have been conducting a performance improvement study since August 2018 using T6, an electronic trauma documentation application created by T6 Health Systems. U.S. Air Force (USAF) Lt. Col. (Dr.) Valerie Sams, trauma critical care surgeon at BAMC and the T6 study lead, explained the reason for the study, based on her observations and experience during deployment to Afghanistan a few years ago. Sams said that standard trauma documentation in the United States is still predominantly a paper process. The problem she noted while deployed, “with military health care being a continuum of care, from the point of injury through the Role 4, Role 5 level of care both in Germany and in the States, is that that paper documentation becomes very cumbersome in terms of data capture,” she said. “This is a process that follows people from the battlefield to wherever they’re going for their definitive care. A lot of the documentation was pretty poor, given the fog of war and difficult operational environments.” Sams continued, “In order for us to make decisions about resources, practice guidelines, and casualty care, we really rely on accurate data.” In an effort to improve data capture along the continuum of military trauma care, Sams worked with company representatives to explore an “electronic version of what we’ve been
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doing on paper for a very long time.” With improved efficiency and accuracy of data capture, she said, “combat casualty care is only going to get better.” Sams categorized the T6 as a nursing documentation tool, with the application extending “beyond documentation into things like clinical support, clinical practice guideline compliance, supply and logistics chain management, personnel management, coding and billing, and registry data capture,” she said. While those T6 capabilities exist, this yearlong, off-line study focuses solely on the documentation aspect. Because the trauma nursing community is passionate about ensuring accurate and complete documentation, Sams said, “finding an application that they can use and feel confident in was huge.” To evaluate the T6 application as a pilot at BAMC, nursing staff are documenting trauma care both electronically and with the paper method in a head-to-head comparison. Recently, the study has been extended to trauma care in Afghanistan, where Sams was again deployed. In use, Sams said the T6 application is loaded on Apple Inc. iPads® that are mounted to stands in the trauma bays, but are removeable for continuing documentation as patients are transported to other locations for diagnostic studies, such as X-rays. Large monitors also display the documentation in the trauma bay, including checklists, algorithms, warnings, and decisions, so everyone involved “can be on the same page with what is going on with that patient.” “The systematic approach to the T6 design is ideal for the general nursing environment,” said USAF Capt. Seana L. Gerald-Ellsworth, NC, BSN, RN, CEN, emergency/trauma nurse at BAMC. “The wheel set-up allows for head-to-toe guided assessments. It is very user friendly when time allows for the structured flow the T6 provides. The system flags abnormal values in the vital signs flow sheet and also allows for trending of vital signs in a graph format, which adds a visual component to the long-term observation of the patient.” Gerald-Ellsworth also identified challenges in implementing the T6 into their trauma practice. For example, she noted that it does not allow for easy navigation if a patient’s condition requires parts of the assessment to be done out of order, adding, “This also is partially attributed to the comfort or
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By Gail Gourley
