ER - Emergency department triage policy

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  Health Care quality improvement isn't a destination! Here, patients shouldn't wait, select priorities to supply care is a must,
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  • 1. 14 - September - 2012 Prepared By Dr Gamal Soliman 1 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A EemergencyEemergency DepartmentDepartment Triage PolicyTriage Policy
  • 2. 14 - September - 2012 Prepared By Dr Gamal Soliman 2 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A OBJECTIVEOBJECTIVE 1.1. To classify different illness and injuries.To classify different illness and injuries. 2.2. To ensure proper management of the emergency.To ensure proper management of the emergency. 3.3. To prioritize those in need of immediate treatment.To prioritize those in need of immediate treatment. 4.4. To stabilize and provide critical treatment,To stabilize and provide critical treatment, and prompt transfer to appropriate settingand prompt transfer to appropriate setting (ICU, OR, General Unit).(ICU, OR, General Unit).
  • 3. 14 - September - 2012 Prepared By Dr Gamal Soliman 3 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 1.1. The triage nurse does a brief evaluationThe triage nurse does a brief evaluation of the patientof the patient to determine a level of acuity or priority of care.to determine a level of acuity or priority of care. 2.2. She acts as a caretaker,She acts as a caretaker, sorting patients into categories,sorting patients into categories, ensuring that the more seriously illensuring that the more seriously ill are treated firstare treated first.
  • 4. 14 - September - 2012 Prepared By Dr Gamal Soliman 4 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 3.3. Routine hospital triage directs all availableRoutine hospital triage directs all available resources to the patient's who are most critically ill,resources to the patient's who are most critically ill, regardless of potential outcomeregardless of potential outcome.
  • 5. 14 - September - 2012 Prepared By Dr Gamal Soliman 5 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 5.5. The primary focus of a triage is toThe primary focus of a triage is to stabilize life threatening conditionsstabilize life threatening conditions.
  • 6. 14 - September - 2012 Prepared By Dr Gamal Soliman 6 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 6.6. The triage system consist of 3 levels ofThe triage system consist of 3 levels of activity:activity: 6.1 Emergent I – Conditions requiring6.1 Emergent I – Conditions requiring immediate medical interventionimmediate medical intervention 6.1.1 Airway compromise6.1.1 Airway compromise 6.1.2 Cardiac arrest6.1.2 Cardiac arrest
  • 7. 14 - September - 2012 Prepared By Dr Gamal Soliman 7 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A Conditions requiringConditions requiring immediateimmediate medical interventionmedical intervention 6.1.1 Airway compromise6.1.1 Airway compromise 6.1.2 Cardiac arrest6.1.2 Cardiac arrest TRIAGETRIAGE INDEX NUMBERINDEX NUMBER SNR-ER-004SNR-ER-004PAGE NUMBERPAGE NUMBER 2 OF 32 OF 3 6.1.3 Severe shock6.1.3 Severe shock 6.1.4 Cervical spine injury6.1.4 Cervical spine injury 6.1.5 Multisystem trauma6.1.5 Multisystem trauma 6.1.6 Altered level of consciousness6.1.6 Altered level of consciousness 6.1.7 Eclampsia6.1.7 Eclampsia
  • 8. 14 - September - 2012 Prepared By Dr Gamal Soliman 8 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 6.2Urgent II- Patients who present a stable but whose condition requires medical interventions within a few hours. There is no immediate threat to life or limbs for these patients.
  • 9. 14 - September - 2012 Prepared By Dr Gamal Soliman 9 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A Management III – Patients who presents withManagement III – Patients who presents with chronic or minor injuries.chronic or minor injuries. There is no danger to life or limb byThere is no danger to life or limb by having these patients wait to behaving these patients wait to be seen. These patients are in no obviousseen. These patients are in no obvious distress.distress. 6.3.1 Chronic low, back pain6.3.1 Chronic low, back pain 6.3.2 Routine medical refills6.3.2 Routine medical refills 6.3.3. Dental problems6.3.3. Dental problems 6.3.4 Missed menses6.3.4 Missed menses
  • 10. 14 - September - 2012 Prepared By Dr Gamal Soliman 10 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 7.1 Red- Emergent7.1 Red- Emergent 7.2 Yellow- Immediate7.2 Yellow- Immediate 7.3 Green- Urgent7.3 Green- Urgent 7.4 Blue – Fast- track or7.4 Blue – Fast- track or psychological support needed.psychological support needed. 7.5 Black- Either dead or progressing7.5 Black- Either dead or progressing rapidly toward deathrapidly toward death.
  • 11. 14 - September - 2012 Prepared By Dr Gamal Soliman 11 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A MATERIALS & EQUIPMENTMATERIALS & EQUIPMENT 1.1. Oxygen , airwayOxygen , airway 2.2. Cervical collarCervical collar 3.3. ECG machineECG machine 4.4. Urinary cathetersUrinary catheters 5.5. Splints for fracturesSplints for fractures 6.6. Suction machineSuction machine
  • 12. 14 - September - 2012 Prepared By Dr Gamal Soliman 12 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A Position the patient.Position the patient. 2.2 Administer O2 immediately2.2 Administer O2 immediately resuscitation, if necessaryresuscitation, if necessary Check and monitor vital singsCheck and monitor vital sings and neurological assessmentand neurological assessment by using Glasgow coma scale.by using Glasgow coma scale. 2.1To establish patent airway.2.1To establish patent airway. 2.22.2 To provide adequateTo provide adequate VentilationVentilation
  • 13. 14 - September - 2012 Prepared By Dr Gamal Soliman 13 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 2.32.3 To determine neurological disabilityTo determine neurological disability 3.3. Apply cervical collar for patients suspectedApply cervical collar for patients suspected of spinal cord injury.of spinal cord injury. 3. To prevent further trauma3. To prevent further trauma 4.4. Initiate fluid replacement:Initiate fluid replacement: 4. To control bleeding, prevent and treat4. To control bleeding, prevent and treat shock,shock, and restore effective circulation.and restore effective circulation. 5.5. After priorities have been done, do theAfter priorities have been done, do the following:following: 5.1 History and head- to-toe assessment5.1 History and head- to-toe assessment.
  • 14. 14 - September - 2012 Prepared By Dr Gamal Soliman 14 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 5. To assess patient's condition5. To assess patient's condition for further evaluationfor further evaluation 5.2 Diagnostic and laboratory5.2 Diagnostic and laboratory testingtesting 5.3 ECG monitoring5.3 ECG monitoring 5.4 Cleansing and dressing of5.4 Cleansing and dressing of woundswounds 5.5 Look for suspected fractures.5.5 Look for suspected fractures. 6.6. Document all procedures inDocument all procedures in the nurse's notesthe nurse's notes.
  • 15. 14 - September - 2012 Prepared By Dr Gamal Soliman 15 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A Female Observation Room – exclusively for female patients forFemale Observation Room – exclusively for female patients for further evaluation without male attendance inside.further evaluation without male attendance inside. Observation Room for patients–Observation Room for patients– for further work up and evaluation.for further work up and evaluation. Treatment Room – suturing, dressing, injections to beTreatment Room – suturing, dressing, injections to be done.done. Triage – where patients are screened for priority ofTriage – where patients are screened for priority of cases.cases. Resuscitation/Trauma Room –Resuscitation/Trauma Room – for serious patients and code blue.for serious patients and code blue. Documentation is emphasized properlyDocumentation is emphasized properly
  • 16. 14 - September - 2012 Prepared By Dr Gamal Soliman 16 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 4.6.14.6.1 A & E form is accomplished properly toA & E form is accomplished properly to include telephone number,include telephone number, relative's name and address.relative's name and address. 4.6.24.6.2 Vital signsVital signs 4.6.34.6.3 Time and dateTime and date 4.6.44.6.4 Proper entering in the registry book and where to fill theProper entering in the registry book and where to fill the patient's chartpatient's chart 5.5. Charge nurse will be responsibleCharge nurse will be responsible for the overall supervision of the orientationfor the overall supervision of the orientation and assign allocation per shift,and assign allocation per shift, per week if necessary.per week if necessary. 6.6. Technical skill checklistTechnical skill checklist will be the responsibility of the charge nursewill be the responsibility of the charge nurse to be completed within the first weekto be completed within the first week.
  • 17. 14 - September - 2012 Prepared By Dr Gamal Soliman 17 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 7.7. At the end of the two-week orientationAt the end of the two-week orientation the charge nurse may discuss with the orienteethe charge nurse may discuss with the orientee any problems encounteredany problems encountered and may give oral testand may give oral test to ensure that the orientationto ensure that the orientation has been satisfactory.has been satisfactory. 8.8. At the end of the two-week orientation,At the end of the two-week orientation, the orientee should be a functional memberthe orientee should be a functional member of the staff and if not so, the chief nurse orof the staff and if not so, the chief nurse or supervisor should be informed,supervisor should be informed, for information and planned action.for information and planned action.
  • 18. 14 - September - 2012 Prepared By Dr Gamal Soliman 18 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
  • 19. 14 - September - 2012 Prepared By Dr Gamal Soliman 19 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
  • 20. 14 - September - 2012 Prepared By Dr Gamal Soliman 20 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
  • 21. 14 - September - 2012 Prepared By Dr Gamal Soliman 21 S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
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