I just started back in the ER, and part of our triage assessment includes doing a nutrition screening. There is a box that we check yes or no, and if we check yes the ER doctor is supposed to follow up by asking the patient more questions about the issue in addition to assessing the patient for what he/she came to the ER for. I was told that the nurses are to screen the patients by asking them if their diet has changed, how their appetite is, and if they had any recent weight changes. No matter what they are in for we are supposed to do this. We also screen for domestic violence by asking them if they feel safe at home. It seems silly to do this on everyone, but it is apparently required now. I don't know if this is a JCAHO requirement or a state law, but I was told that if we do not document these screenings that the hospital could get significant fines.
If any of you do these screenings with triage, how do you handle it? Do you have guidelines for what you ask patients during screening? If someone says they would like to talk to a dietitian about weight loss would you tell them to follow up with their doctor or would you refer them to a dietitian? This seems to be a bit much to ask us to do with every patient, and I can see how this can get out of hand. Apparently it is the doctor's responsibility to assess the situation further after we do our screening, but I can't imagine doing anything other than telling the patient to follow up with his/her doctor about the nutritional concern. Thank you all in advance!
Mar 9, '02
We do this screen when the pt is up on the floors. Isn't that more appropriate? If their score is high we call nurtrition in for their input.
Mar 9, '02
furball your right, it's probably more appropriate on the floor..............if they get admitted.
well the "are you safe at home" question, is something devised by the jcaho, and in our state a law. i love asking the 6-5 280lb guys that question, while their 5'-0" 110lb soaking wet wife is sitting there next to them! :chuckle then they say what do you mean? then i get to say, sir does your wife kick your butt around the house? lmao! :chuckle
the nutritional thing, i don't believe has anything to do with jcaho or anybody else. not sure where that came from? of course squirrel......you could just give everybody nuts to go? lol! just kidding squirrel.............you know i couldn't pass that one up!
Mar 9, '02
Thanks guys for your input!
I agree that a nutritional screening is more appropriate on the floor, and it is usually included in the initial assessment/data base. I am guessing that the nutritional screening in the ER must be a state requirement. Any New Mexico ER nurses out there?
(The nutritional thing, I don't believe has anything to do with JCAHO or anybody else. Not sure where that came from? Of course squirrel......you could just give everybody nuts to go? lol! Just kidding squirrel.............you know I couldn't pass that one up!)
CEN35: That is hysterical!
Mar 10, '02
We not only have to do a nutritional screening as part of the triage assessment, we also have to do a full page pain evaluation if their pain is above a 4 on a scale of 1-10.(Some of us when asking tell the pt to rate their pain on a scale of 1-4 to avoid extra writing Ha-Ha-) We also now ask where they work and the zip code to track possible bioterrorism. I think now that we've added 2 more pages to the triage assessment sheet and who knows how many questions maybe the pt's will get tired of all the questions and either feel better by the time we're done or get tired and leave.
The nutritional screening and the pain assessment are JCAHO requirements. I don't know what idiot thought up the work thing. We do also ask the do you feel safe at home thing too.
When I started in the ER 20yrs ago, our chart was 2 pages. Now it is 5. Pretty soon it will be too heavy to carry.
Mar 10, '02
holy crap! five pages? kaycee.......ours is two pages period, clean and cut. :d
Mar 11, '02
Beleive it or not, in our level II trauma center, our triage note is still 1 page...although we get a lot in on that one page. No nutritional assesment yet. Even with that ONE page I still have patients who feel they are to sick to answer ANY questions......"Do we need to do this?!......I can't answer questions I'm dying!!" says the toothache patient who's allergic to EVERYTHING but demerol.
Mar 13, '02
ours is half a page - name, age, sex, allergies, meds, hx, date and time of s/sx, the dv question, and check boxes (home, other, ems) for their arrival, and of course b/p, p, r, t, pox.
then you have about 4 lines for a narrative. although some of the older people with the long involved issues, that are more complicated.........can take a whole page! :chuckle
Mar 13, '02
OK, so if you DO do a nutritional assessment, what then? Does that mean you're supposed to plan some sort of intervention, and evaluate the results? :roll
Methinks this is yet another example of JACHO going waaaay, way too far.
Mar 13, '02
jahco going to far?????? really????? nawwwww you don't really mean that?
Mar 17, '02
Thank you for your responses!
Our triage sheet is 1/2 page including the boxes to check for domestic violence and nutrition screening. What I have found to work the best is after I triage the patient saying something like: "I am required to ask you 2 questions even though they have nothing to do with why you are here..."
Some people get very offended when they are asked about domestic violence, and I try my best to let them know that everyone needs to get asked these questions so they do not feel like they are being singled out. I agree that patients who are very sick or in alot of pain get aggravated with questions that have nothing to do with why they are in the ER. Why can't we be able to use our disgression when doing these screenings? If we see a patient with suspicious bruising or other indications of domestic violence, then we should be asking further questions, or if we see an anorectic person in the ER then we could ask more about nutritional issues and food security.
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