428 Implementing Early Posttraumatic Stress Disorder Screening in an Inpatient Burn Unit

Abstract

Posttraumatic Stress Disorder (PTSD) is the most common psychological disorder for the burn survivor. The patient’s perceptions of the injury events, their perceived threat of death, acute stress symptoms, and pain are predictors of PTSD. Interestingly, total body surface area burned, is not necessarily a reliable predictor of PTSD. Establishing routine psychosocial screening of all burn patients is advocated as early recognition and treatment of PTSD is critical to optimal recovery and reducing healthcare costs. In addition, the American Burn Association and the American College of Surgeons have significant criteria for burn centers related to performance of screening for PTSD and depression. The following describes the process for implementing PTSD screening in an inpatient burn unit as well as preliminary results. The Primary Care-Post Traumatic Stress Disorder (PC-PTSD 5) is a brief psychometrically valid screening tool which is easy to administer and acceptable to patients. The PC-PTSD-5 screening tool was incorporated into the electronic medical record (EMR). The bedside nurse performed a screen on post burn injury day 3 (+/- 1 day) using the PC-PTSD 5 tool. Patients were considered “positive” if they answered “yes” to any three of the 5 items. A positive screen indicates a patient may later develop PTSD or other trauma-related psychological problems a social work referral and psychology consult are generated. Since the implementation of PTSD screening July, 2017, there were 90 admissions, 37 met screening criteria. Of these, 17 patients were appropriately screened with two patients who scored positive. 20 patients were missed due to early discharge or missed opportunities during the learning curve for staff. The patients with positive scores were referred to the social worker and the psychologist for follow up. Despite increased awareness, PTSD continues to be under-diagnosed and under-treated, adding to the suffering and financial burden of burn injury recovery. This quality initiative seeks to improve detection rates and mental health referrals for those experiencing PTSD symptoms. Early detection and early treatment likely lead to better outcomes. Directly applicable.