Standards of Care in the ER
- 0Does your ER specify how often to vital and reassess your pt? Or is it just an expectation that you will know how often to vital (without it being a written policy)?
I am just curious about this....
- 2Oct 25, '11 by ~*Stargazer*~I've only worked in one ER, so I don't really know what ERs do generally, just the one I work at. We are required to re-vital stable patients every two hours and reassess hourly. Unstable patients or those undergoing conscious sedation require more frequent vitals and assessments. Patients in the lobby are to be re-vitaled and assessed hourly.
I'm not sure why they would be reluctant to have a written policy in place. My cynical self tends to associate it with staffing. If the written policy would increase the amount of time each RN spends at each patient's bedside, then the nurse to patient ratio would have to decrease, which would mean hiring more staff.
I could be way off base, though. I have no idea what staffing levels at your facility are like.
- 0Oct 25, '11 by Esme12, BSN, RN Senior Moderatorgoogle is your friend and so is the ena......
http://www.mssm.edu/static_files/mss...nual/sub38.pdf this has pain/vitals standards.
i am surprised that you have no policy for the assessment of pain as that is a focus of the jc, ahrq, and other quality measures. if you have no set policy, how do you document response to intervention and response time to treatment for quality and not get in trouble with the jc (joint commission)? which measures of the standards and adherence to the standards are just as important.
is your facility accredited? then they must have a policy to measure the quality of interventions and how frequently you need to reassess to measure compliance. if they really don't have one in this day and age with standards of care and minimizing delay of care i'd be looking for anothrer position because where else do they lack in quality.....and if anything ever happens and there is a bad outcome or delay intreatment the lack of a policy and standard of care will place you at a higher risk for being sued and thrown under the bus.Last edit by Esme12 on Oct 25, '11
- 0Oct 25, '11 by VICEDRNq4 hours on hall patients and patients waiting in triage. q 4 hours on all patients in monitored beds (say a syncope or seizure) and
q2 hours for all critical care/trauma patients.
personally, i think only a nutcase sticks with these guidelines.
I obviously chart responses to any medications such as vitals for all patients that received narcotics, bp meds, fluids, anti-pyretics, etc.
Every patient in our dept also gets a set of discharge vitals. must be taken within 15 prior to departure
- 1Oct 26, '11 by Altra GuideQuote from RN1980The extremity sprain who gets an xray and some p.o. pain meds needs hourly vitals?all routine pts get vs recorded q 1hr, urgent pts get vs q 30min, every emergent vs q15min. we are lucky enought that our monitors atomatically update our computer charting system with vs, so we just apply the cuff, leads and probes set the timer and go. every pt get d/c vs.
- 1Oct 26, '11 by SanukIsn't it interesting how practices vary? We do q2 on stable workups (belly pain, etc), at least q1hr on chest pain and the like, q15-30 on most cp and neuro/trauma, and q4 on holding pts. Discharge vitals need to be within the hour, but at least 20 minutes after any narcs.