[mitzilasner]

Hi there. I have to admit, I've never posted to any kind of forum before, so bear with me. I'll give you a thumbnail profile of myself. I am supposed to be retired, but I couldn't take the hours, so now I've got myself involved in weekly health assessments of incarcerated persons at a county jail. I really enjoy it, and am working for a contracting agency. I began my nursing career in a single physician family practice, then to a Residential Treatment Facility for troubled and abused children, then as a Nurse Reviewer for the State, and retired from there this past summer.

I would like to have comment on the situation at the jail. I feel I'm kind of out on a limb in not working under the direction of a physician. The jail has a specific physician with whom they consult but he does not make visits there. There are no standing orders, or policies concerning the nursing assessments or treatment modalities. I met with the physician today to discuss my concerns, and he reassured me verbally, but I'm looking to put together a standing order protocol for common patient complaints. The purpose of the nursing assessment is to screen those who do or do not need to see the physician. I'd appreciate some information or guidance from those who know, and if there is a standard protocol where no physician is available, i.e., a facility. Thanks. I'll be taking a look at the other forum topics.

[TheCommuter]

[Tweety]

Welcome. Good luck to you.

[Reigen]

Welcome and hello!

I am not sure if the following is what you are looking for or not, but I'll post an abridged version of what we use at my place of employment. We do have specific standing orders ofr certain "presents with" for example chest pain : Vitals signs 12 lead EKG Nitro glycerian tablets 0.4 mg SL times 3 5 minutes apart. If no relief after second tablet call 911 and transport to nearest medical facility for follow up rule out MI.

Here is the "basic" ones

Nursing Assessment Protocols: Written instructions or guidelines that specify the steps to be taken in evaluating a patient's health status and providing interventions. Such protocols may include acceptable first-aid procedures for the identification and care of ailments that ordinarily would be treated by an individual with over-the-counter medications or through self-care.
They also may address more serious symptoms such as chest pain, shortness of breath or intoxication. They provide a sequence of steps to be taken to evaluate and stabilize the patient until a clinician is contacted and orders are received for further care.

PHYSICIAN STANDING ORDERS Program: ______________________
Listed below are first aid and comfort treatments provided for each Inmate.
The following medications and treatments will be administered per package directions and recommended doses.

Circle what one was used/given and sign date at bottom of form. Form placed in permament record, copy placed in physican's "box" for review.

1. Pain or fever: Adults: Tylenol tabs (acetaminophen) 500 mg. 1-2 tabs every 4-6 hr.
Children: acetaminophen liq.10-15mg/kg every 4-6 hr. See package for age appropriate dose.
2. Inflammation / pain: Ibuprofen 200 mg.1-2 tabs every 4-6 hours
Do not give if history of ulcer or other stomach problems. Discontinue use and see physician if black-colored stools.
3. Sore throat / cough Cough drop if unable to gargle with warm salt water.
Tussin DM cough syrup or equivalent as directed for non-diabetic.
4. Nasal congestion: Pseudoephedrine 30 mg. 2 tabs every 6 hours or Sudafed liquid.
5. Abdominal distress: Maalox (liquid antacid) or Tums; do not use for more than 24-48 hours without consulting a physician.
6. Diarrhea: Clear liquid diet; avoid dairy products X24 hrs. Bland diet first day after symptoms subside.
If no response: Imodium or equivalent of (loperamide) if no blood in stools and no fever.
7. Constipation: Milk of Magnesia ½-1 oz. as needed
If no response: Fleets enema
8. For medication error or accidental poisoning call Poison Control and FOLLOW INSTRUCTIONS.
Activated Charcoal is available if recommended to administer.
9. Itching due insect bites or rash: Anti- itch lotion or gel or Hydrocortisone 1% cream (with application of cold compress for insect bites)
Benadryl tabs (Diphenhydramine) or Liquid Benadryl or Claritin (loratadine)
May apply Meat Tenderizer paste for bee sting.
10. Athlete’s feet: Lotrimin cream or equivalent.
11. Irritated eyes: Artificial Tears or lubricating eye drops.
12. Minor cuts and scrapes, cleanse with soap and water or half-strength Hydrogen Peroxide.
Apply Bacitracin or equivalent, then apply dressing.
13. Chapped lips: Lip Balm or equivalent.
14. Mosquito Repellent cream/lotion to skin or spray to clothing to control insect bites.
15. Sunburn prevention: Sunscreen SPF #15 - #30. Sunburn discomfort: Aloe gel applied to skin.
16. Dry Skin: A & D Cream or moisturizing lotion for emollient effect.

signature: ______________________________________
Date: _____________Time:__________
Physicians Signature:________________
Updated/Reviewed:_____________

[mitzilasner]

Yes, thank you. This information is very useful. For what it's worth, I go to the jail a few hours one day per week. They do not have any medical protocol at all, nor do they have anything formal. I do the assessments in a jail cell that contains an exam table. I just take my briefcase full of stuff into the room. Most of the cases are methmouth for which I apply temporary fillings until they see a dentist. I'm fairly new there so I'm just trying to get some ideas put together that will protect not only me but the staff that are there when I'm not. A new jail is being built that will have a medical wing to it. Ought to be interesting. Again, thanks for your response.