Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Susanna Rudy, DNP, MSN, MFS, AG-ACNP, FNP-BC, ENP, CCRN
• Committee Member Name & Credentials:
  Leslie Hopkins, DNP, APRN, BC, FNP-BC, ANP-BC

DNP Project Abstract

Integration of Point of Care Ultrasound in the Emergency Department for Shoulder Dislocation Management

Purpose
Musculoskeletal dislocations compromise neurovascular integrity promoting loss of limb function. Direct observation determined limited use of point of care ultrasound (PoCUS) in a rural emergency department (ED) for timely management of shoulder dislocation. The purpose of this quality improvement project aims to assess and improve the use, knowledge, and confidence of PoCUS in a rural ED with a focused musculoskeletal educational intervention managing shoulder dislocations.

Methods
Using a validated survey tool, Evaluation Tool for Ultrasound Skills and Development, survey data was disseminated and collected via a professional survey platform via Survey Monkey to maintain confidentiality. An educational intervention via PowerPoint lecture and survey was emailed to all ED providers inviting participation. Participation served as consent. Surveys contain self-reported data related to provider demographics, education, use, knowledge, confidence, and barriers using ultrasound at the bedside.

Results
The survey obtained a 60% response rate (N=3). For musculoskeletal complaints, respondents reported using POCUS less than five times per month. None of the participants were certified in ultrasound or emergency ultrasound.  After the educational intervention, participants reported they could use POCUS to identify shoulder dislocation. Results determined low confidence levels in two respondents before intervention and after educational intervention, two respondents improved confidence and knowledge levels. Barriers to use of POCUS include lack of education/training and time constraints.

Implications for Practice
This study demonstrates that a focused quality improvement educational intervention improves confidence and knowledge applied to musculoskeletal complaints in novice scanners. Limitations include a small sample size and time constraints. Further research is needed secondary to the gap in the literature related to use of POCUS in rural emergency departments. Recommendations include replicating this study in multiple rural ED locations with the ability to collect patient outcomes data.