Medical Screening Exam at triage by RN

RNinED,

Are you implying that the nurses will be doing the MSE that the MD's usually do? I have never heard of that, although when I googled it, sure enough one of the first things that came up was from the Oregon Board of Nursing stating it is within the scope of practice for an RN to complete the MSE and it seems that this decision is up to the facility. Not sure if it is state regulated.

http://www.oregon.gov/OSBN/pdfs/policies/EMTALA.pdf

"RN Role and Requirements

The Oregon State Board of Nursing affirms that it is within the role and scope of practice for the Registered Nurse (RN) to perform a medical screening examination (MSE). Further, the Board believes that MSEs are beyond the scope of practice for the Licensed Practical Nurse, or the tasks allowed for unlicensed assistive personnel. It also is the Board’s position that the RN completing the MSE is establishing the presence or absence of an emergency medical condition, and is not engaged in making an independent medical diagnosis or developing a medical treatment plan."

What other assessment steps beyond triage would you be required to perform to be considered an MSE?

EMTALA itself allows RN's to do the medical screaning exam. However the facility needs to have specific policies and procedures in place. Any time you impliment new policies and procedures, there should be some form of education and training to accompany it. However, it is usually up to the facility to determin what that training is. The facilty also gets to determine what is elegable for a MSE.

Nurses doing the MSE doesn't increas the risk and liability, but nurses doing it without protocols/procedures and policies does.

The MSE doesn't say they won't be seen, just says that if they want to be seen they ahve to pay the copay first and their insurance may not cover the visit.

Only an advanced practitioner can do a MSE. In our triage a FNP or PA comes over to do it, if they need it.

do you have some evidence to back that assertion up - as other posters have suggested that their BON and EMTALA it;self doesn't make that stipulation and have backed that up ?

EMTALA by itself does allow for RN's to do the screening. There MAY be some BON regulations out there that limit this. There ARE many facilities that don't allow this, for many reasons. Liability revenue, or other reasons.

I know or a fact that it is allowed under EMTAL itself. I was a DON for a multihospital organization and we looked into it. Decided not to allow RN's to do it, for political reasons.

I'm in Oregon and we do MSE's at our facility.

First and foremost we determine emergent vs. non emergent (MSE) - this may include some labs and/or Xrays. We then triage them into the order to be seen. It is 2 separate procedures, but you basically do them at the same time. You just chart it differently.

Say for example, you do an MSE on someone with ankle pain. We deem them non-emergent so we discharge them from the ER and recommend follow up in clinic the next day. We may have ordered an Xray or not per our clinical guidelines depending on swelling, deformity, etc.

Change that to MSE on someone with ankle pain with obvious deformity and open area in skin. Xray ordered per clinical guidelines shows fracture, possibly open so MSE = emergent. They are then triaged into the appropriate level and seen in the ED by the physician.

It gets confusing at times, but you really are doing it all at once. It just matters how you document. Clearly define your MSE in your documentation and then assign them a triage level separately.

just curious,...if the c/o is ankle pain,.the xray is done,..who reads the xray? ..are you suggesting the triage nurse reads the xray and decides there is no fx therefore no emergency??,..or does radiology read all the xrays stat? I can see where this could be a great thing to weed out many of the frequent flyers that come in with a different pain every week or the "I can't breathe" while talking on the cell phone, O2 sats 100% ORA,...but I can also see how this would add a huge amount of liability that I'm not sure I want,..too many lawyers in the world for me!