How do you triage? Different admission forms?

[at your cervix]

I have been an L&D nurse for several years now and there is one thing that really troubles me and always has. It seems that I spend more time on wanna be's than on laboring pt's. Ok, so here is a hypothetical situation. Pt comes to L&D and says "I think I might be in labor" (first clue right there that she is SO NOT IN LABOR) you ask about ctx, she says that they are irregular, not painful, started about 20-30 min ago, was in office this afternoon and was 1 cm, 50%. OK, so under EMTALA, because she presented to the hospital possibly in labor, we must do a complete assessment which includes head to toe assessment, SVE, asking when her last bowel movement was etc, NST. The whole time she never once changes expression on her face or acts like she is even mildly uncomfortable, except when you check her cervix and she clamps her knees together, climbs the bed and screams bloody murder, because you can barely reach her 1cm thick firm cervix. So, a pt like this typically takes me about 1 to 1 1/2 hours to admit. We do the same admission procedures on every pt, whether they are full blown labor, wanna be or NST. So I guess my ultimate question is, do you have different admission forms for different types of pt's, or does everyone do it this way?

[GailWHNP]

Hi, at your . . .

We do not do a full admit on a triage pt . . . often don't have the time but would also hate to kill so many trees. We assess the pt's complaints and any OB problems she may have had. We do make sure she has a reactive strip before she is discharged. I try to get these pts out within 30 minutes. Most of the 30 minutes are spent on education . . . true s/s of labor, rom, why she really would not want to be induced given the choices, and why my exam shows her at 1cm/50 when she was 3-4 and 80 at the office a few days ago!

Gail

[L&D.RN]

We use Outpatient forms...they're not admitted unless they make cervical change within the hour (or unless something else comes up). They are basically treated as an NST, we want a reactive strip, take their vitals, dip their urine and do a SVE. If no change, call the doc and d/c them to home. We also spend some of that time doing education, so they know better what s/sx of true labor is. Waaay less paperwork and way less assessment. Sometimes if they are banging out contractions and haven't made change, but we "feel" something is up, we hang onto them longer to see.

[finallyRN]

We also have a seperate out patient form. We assess their complaints, SVE, NST, dip the urine. If they are not in labor they are out of there in 30 minutes. If it looks like they may be going into labor we walk them for 1-2 hours depending on the doc, if no cervical change the are d/cd.

[SmilingBluEyes]

We do much like the above w/the exception that we observe them 1 hour and call the dr and run the whole situation by them as soon as we have a definitive strip and status. After 1 hour's obsv, a reactive strip and reassurance they are not in labor, plus all the education mentioned above, we send em on their way, with all the instructions written, along with our phone number so then can call w/questions anytime. I don't find these rule-outs overtake me unless we are doing MULTIPLE ones in one shift.

[mark_LD_RN]

we use a different form ,actually computerized form, for observation patients and one for NST patients.

patients that come in thinking they are in labor are sent to observation area, unless they are grossly ruptured or very obviously in active labor all patients stop there first. we do the short observation form ,U/A ,vital signs, EFM, and SVE. get at least a 20 minute strip on all patients, we call the docs may walk them for 30 minutes to 2 hours depending on circumstances. then we either d/c them home or admit. observation form and process generally takes 20 to 30 minutes to complete

[sleepy247]

We have to complete a full admission form but it is computerized, so if you ask a pt's medical hx, allergies, etc, the information is retained so it just needs a quick update when the patient comes back. We have about 70 OB's and of course they all have different preferences. Some want to be called the minute a patient arrives, and some don't want to call until you are ready to admit or discharge. Almost all patients must stay a minimum of 30 minutes and have a reactive strip prior to discharge.

[NurseDianne, ADN]

Howdy!

We are a very small hospital. Usually I am working in the ER until an OB patient shows up.

This is what we do. We have standing triage orders. It is on a sheet we fill out. With a urine (either in/out cath or clean catch, according to which physician), 20 min. FM strip, if 36 wks or greater we do a vag. exam. If less, we still monitor. Also check about membranes ruptured, ect. We also try to get last US that was done to really determine gest. age. In our town, we have so many young/uneducated mothers sometimes our job is very difficult.

After all this is done, usually 30 mins tops, we phone the OB doc w/ our findings. It is his/her decision as to admit, observe or send home.

Of course if we feel anything looks suspicious we call the doc immediately!!

I don't know any other way to do it. Done it this way for years. Of course, I have delivered w/o doc due to his/her wanting to send them home and not taking what we (the nurse) said into consideration. Sometimes they (the doc) just want a few more hours sleep!:roll

[luv l&d]

we do alot of scheduled nst's and they have to be on the efm for 20 minutes at least. the rest, r/o labor, srom, bleeding must be here for 1 hr. otherwise it is an emtla violation. we often get people show up at the wrong hospital, and we still have to keep them an hr (the kaiser hospital is right across the street). they can sign out ama, but must be seen by a doc prior to discharge.

[sherryrn76]

we have a separate triage chart and standing orders..only 4 pieces of paper. much easier. We get a reactive strip, urine dip, cervical exam,complaints, etc. If less than 3 and no regular ctx,can go after reactive strip. if more than 3 or if having reg ctx, multip, really uncomf, etc. will let them walk for an hour and recheck. we have a separate triage area. Unless we have "positive wet sock signs" everybody goes to triage..even those who come in by ambulance unless transport from another hospital. Had one 3 weeks ago whose mother informed me her BP was up at home and she had ALL the signs of preeclampsia. Of course she was 35 weeks, neg protein, +2 dtrs, minimal edema, h/a relieved by tylenol, vomitting no one ever saw, and a uric acid of 3.1 ! but she was very tired of being pregnant. I told her mother to never ever take her BP at home because home cuffs are not properly calibrated for pregnant women..her BP sitting up in triage was 108/56! Needless to ay, she went home. she has been back daily since then c/o headache. Two days ago, we gave her tylenol and told her we were sending her for a CT scan since she kept having headaches. While I was checking in another patient, she went home..without the CT scan. Hopefully, she'll deliver on my day off!

[canoehead, BSN, RN]

One page assessment for a triage patient! And they go home after a reactive strip and vital signs if nothing else is going on.