chief complaint based orientation

I am not sure what this model looks like.

We chart by exception. This means that if a system is normal or not indicated by their complaint we do not chart about it in our assessment. So in the case of a laceration I may not check lung sounds unless they are wheezing and it looks like the reason the pt fell and cut themselves.

Is that what you are looking for?

We are also computerized so the format is driven by the software. We were the first ones live on this program so we have had a lot of opportunity to have input on what it does. As much as this process was painful there were good things about being the 'pilot'

I hope this helps.:Melody:

I don't think I made it very clear what I was talking about.

When new hires or transfers start in the Emergency Department we want to do an orientation based on chief complaints. For example if a patient comes in with abd pain think about or do the following: could it be surgical? Important for picking IV sites and gauges, is it a female that might need a pelvic?, urine sample obtained, pt in gown, nausea, vomiting or diarrhea? Could it be GI bleed? Appy, ovarian cyst. etc.

Currently we use a checklist. checked off for IV starts, checked off for placement on monitor, checked off for catheter completion, etc. but we have found that nurses aren't preparing pt's very well or being proactive when the physician arrives.

We do have the same expectations for getting the patient ready. It simply helps the flow.

but we use checklists for orientation and socialization to get the new to the dept nurses up to speed with what can be done before the MD actually sees the pt.