| Learning Objective #1: describe a transdisciplinary approach to small, partial thickness burns with delayed dressings in children. | |||
| Learning Objective #2: list three steps in the delayed dressing change protocol for small partial thickness burns in children. |
DESCRIPTION: Historically, partial thickness burns covering less than 10% body surface area in children were treated by a number of different methods including debridement of the burn and application of an antibiotic ointment. Burns were treated by the physical therapist with whirlpool, or the emergency department physician, or by the pediatric surgeon. Each had a different protocol but all involved twice daily dressing changes. This treatment is painful and traumatic for the parent and child and confusing to the various healthcare professionals who did not use a standardized method. The nurse practitioners organized burn care into a transdisciplinary approach and delayed the time between dressing changes to once every 5-7 days. The child is initially seen in the emergency department, sent to whirlpool for debridement and application of oatmeal-impregnated matrix burn gauze. After 24 hours, the nurse practitioners examine the burn to ensure the gauze is well-positioned. The child is then seen by the surgeon. The burn is rewrapped and the parents are instructed to keep the gauze intact for the next 5-7 days. Instructions are given on removal of the gauze by soaking in a warm bath and application of a thick layer of Vaseline. The gauze slides off the burned area approximately 10 days after initial application, leaving behind re-epithelialized skin.
OUTCOMES: After multiple education sessions with the emergency department and physical therapy, burn care is now handled by a team approach. The delayed dressing changes have revolutionized burn care in our facility with a standardized transdisciplinary team protocol and greatly decreased pain and anxiety for children and families.
IMPLICATIONS
FOR NURSING
PRACTICE: Organization and education by nurse practitioners results in transdisciplinary protocols which revolutionize care of pediatric patients.