Nurse driven protocol for head injured patients on warfarin

The trauma quality improvement committee at our facility identified a significant number of patients on warfarin presenting to the emergency center after minor head trauma that subsequently expired from their intracranial hemorrhage prior to appropriate intervention. An analysis of this patient population identified multiple areas of delay. A collaborative effort between the emergency center nurses and the trauma service personnel resulted in a formal protocol to address each component of delay and expedite the process. Since implementation of this nursing driven protocol we have dramatically decreased the time to (1) Emergency Center Physician evaluation, (2) completion of head computerized tomography, (3) reversal of anticoagulation with fresh frozen plasma (FFP), and (4) most importantly, patient mortality rate. We conclude that this nursing driven protocol is effective in decreasing the mortality rate by eliminating diagnostic and therapeutic delays in this high-risk patient population.