An advanced practice registered nurse (APRN)-led initiative to improve post-splenectomy education and vaccine follow-up in adult trauma patients
The spleen is a commonly injured immune organ in the abdomen. Traumatic injury to the spleen often causes life-threatening bleeding, which necessitates emergent removal. After splenectomy, patients are vulnerable to a rare but lethal overwhelming infection that is largely preventable through vaccination. Despite this well-documented, lifelong mortality risk; many patients are undereducated about their condition and fail to receive preventative vaccines. This quality improvement project aims to improve post-splenectomy care through evidence-based changes in vaccine practice and refinement of provider education in a level I trauma center intensive care unit. Patients were contacted post-discharge to confirm they received follow-up vaccines and were monitored for readmission. In 36 months, 12,086 trauma patients were observed in a before and after comparison of post-splenectomy care. Forty-seven patients underwent splenectomy following trauma. Of those who survived to discharge, all (100%) received vaccines in the hospital. Patient education improved from 10% to 100% with standard materials and advanced practice registered nurse (APRN) involvement. In the after group, 12% of patients confirmed they received follow-up vaccines, while 88% were unable to be contacted. No readmissions for septicemia were observed in the study period. The APRN is in an ideal role to lead practice change in trauma and critical care populations. Consistent, high-quality provider education can be achieved using an evidence-based model on a busy academic trauma service. Despite improving education strategies, post-ICU follow-up is poor in trauma patients and the inability to contact patients post-discharge prevents gathering accurate outcome data.