Spots and Rashes: Can You Spot Disseminated Herpes Zoster?

Purpose:
The goal of this project was to improve the recognition of disseminated herpes zoster presentations. During the summer of 2014, 3 patients presented to ED triage with disseminated herpes zoster. None of these patients with this low volume/high risk syndrome of varicella, received a mask.

Relevance/Significance:
A time intensive notification process took place to make staff, patients, and families who were in the waiting room aware that they may have been exposed to varicella. Further investigation revealed an extensive staff knowledge deficit. Inpatient implications were also identified if isolation was not initiated at the onset. In a high-quality health care environment, both nurses, patients, and their families should feel safe. With proper knowledge, they can be kept safe from varicella syndromes.

Strategy and Implementation:
A root cause analysis revealed that the staff members involved with these cases were unfamiliar with disseminated herpes zoster. By understanding the causes, the most effective solutions were identified and implemented. An action plan containing both educational and prevention components was developed. A new process of masking all rashes to prevent the spread of airborne illnesses was implemented by the triage RN greeter. Staff needed to be competent in the care patients with syndromes of varicella. During September 2014, each nurse met individually with the advanced practice manager to review case scenarios and determine what precautions were needed. A verbal pre-test format was utilized. An educational session that reviewed varicella, different syndromes of varicella and appropriate precautions was provided. A post-test was given on the same day as the educational session. This information has since been reinforced during huddles and in a computer based learning module.

Evaluation:
Only 9.4% (8/85) of staff nurses were able to answer all 10 questions correctly on the pretest. Staff were required to get 100% on the post test. Following the education component, 97.6% (83/85) of the staff were able to answer the same 10 questions correctly. Those who did not score 100% were remediated. Four subsequent presentations have been identified and proper precautions were taken.

Implications for Practice:
It is important to identify low volume/high risk events. Emergency department and inpatient nursing staff need to have an understanding of varicella presentations and required precautions. The varicella syndrome computer based learning module also has been assigned to inpatient nurses.