A Spoonful at a Time

Julie Fulcher, R.N., developed what she learned as a mom into a first nurse protocol

As a mother, Julie Fulcher, R.N., follows her children's pediatrician's advice: give Pedialyte to rehydrate children who have gastroenteritis (diarrhea).

As an LVH-Muhlenberg emergency department nurse, she often wondered why the same wasn't done for young patients with gastroenteritis. Instead, the protocol called for nurses to rehydrate children through an IV, which often resulted in crying children and frustrated parents.

Then Fulcher came across an article about a study in Australia that reviewed the benefits of oral rehydration with products like Pedialyte. She was struck with an idea: to research whether this is a better practice for our patients. Fulcher shared her idea with the emergency department practice committee, which reviews best practices. With help from committee members, Fulcher embarked on an evidence-based approach to develop an oral rehydration protocol.

The first step: an extensive literature search, in which she read numerous articles and research projects that weighed the advantages and disadvantages or oral rehydration. One study reported that almost half of American and Canadian pediatric emergency medicine directors who participated in a survey used IVs because they thought parents preferred them. Other research showed oral rehydration is just as effective and less traumatic on children and their parents. "Overwhelmingly, the evidence showed oral rehydration is the way to go," Fulcher says.

Fulcher and the practice committee developed evidence tables to document the research and summarize the evidence. Then it was time to present the findings to an interdisciplinary team that included a pediatrician, emergency department physician and a clinical nutritionist. Together, they developed an evidence-based first nurse protocol that is being initiated at LVH-Muhlenberg.

"For a long time, nurses gave care based on what they were taught," Fulcher says. "Now, when we have an idea, we have a formal process to discover what's best for our patients and create better practices. It's empowering to know we can make such an impact on our patients."

The protocol, which applies to children ages 6 months to 14 years, begins with an evaluation by a nurse who determines the patient's dehydration status. From there, Pedialyte is administered in small amounts, based on the patient's weight, every 15 minutes. If the child tolerates the fluid, the nurse gradually increases the amount the child drinks. Part of this process also involves educating parents about oral rehydration to reduce future emergency department visits.

Writing the first nurse protocol was just the beginning step for Fulcher in determining what's best for her patients. She's now turning her attention to monitoring and evaluating the results over a one-year trial period. Part of what she'll look at is: are there less return visits to the ED for gastroenteritis and did patient (parent) satisfaction scores improve? "This project has been so rewarding," Fulcher says. "I already have my next idea in mind."

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This page last updated 2/12/08 04:08 PM