My ER is starting "immediate bedding". For those of you who don't know what this is, it's when the patients walk in, state their symptoms, and are immediately placed into an available bed without being triaged by the triage nurses. The bedside nurse is then responsible for doing the triage in addition to the full bedside assessment. The triage includes an extensive med reconciliation where you need to get all names, dosages, etc of all meds (can take quite a bit of time if you have someone on hoards of meds). Our manager says immediate bedding is here to stay and we have a committee working on making the transistion easier. Right now its a bit of a disaster. Patients are being plopped into beds, the bedside nurse is busy and doesn't find out she has a new patient until 20 minutes later. The docs end up seeing the pt before the nurse does, they are confused because the pts are not gowned, not on monitors, have no initial vitals, and there is no nursing assessment to look at.
My question is do any of you have experience with successful immediate bedding at your facility? Can you tell me what components make it work successfully? I'd like to bring some ideas to the table when the committee meets.
PTs don't get put into gowns until they come back to a room. The triage area is too open of an area to put them in a gown out there. As for how the triage process is to go, I think that's where all the confusion is coming from. It used to be that pts were triaged in the triage area and those not needing an immediate bed placed back into the waiting room until called. Now the triage nurses are supposed to eyeball each pt coming in, get the chief complaint and put them in both computer systems, then send them back to a bed. The assigned nurse then is responsible for gowning, obtaining vitals, and getting all data the triage used to get (previous med hx, med rec, etc). We do try to help each other out but often it is simply not possible. Its not unusual for each nurse to be getting 1-2 admits and/or discharges at the same time. I like the idea someone mentioned of having techs gown and obtain initial vitals. Any other suggestions?
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I spoke of once the patient is in the room. You mentioned the doc goes into see the patient and they are not in a gown....That is what I was referring to
When I walk someone back from triage, I walk into the room with them, make sure there's a gown available, and ask them to put it on with instructions about what clothing needs to be removed based on their chief complaint. Can your triage nurses not do this?
I spoke of once the patient is in the room. You mentioned the doc goes into see the patient and they are not in a gown....That is what I was referring to
Sorry for the confusion. Usually it is a CNA who walks them back to the room and they will instruct them to put on a gown. The PTs only listen about half the time and the bedside nurse often has to physically help them into a gown. I think what really gets the MDs riled up is that nothing has been done and they are going into a room blind with no nursing triage or assessment to look at first. And right now every triage team seems to be doing something different which makes it confusing. One team may do just rapid triage, another the full triage, yet another nothing. Honestly, if the triage nurse can do a full triage, then right after place the patient into a bed doesn't that technically meet the criteria for immediate bedding? Thanks for all your input. It's been really helpful hearing from you all.
we have been told in the past that only an RN can get initial sets of vitals. this is in AZ......are there other states that require this ? (Or maybe this is only required in the mind of our old director??)
Our hospital has been doing this recently - and it was chaos at first. It's gotten slightly better. Most of the time, we have a second triage nurse who goes from bed to bed triaging patients, we also get a heads up from the charge nurse if someone is being brought back - and will arrange for a PCA to get initial signs at least. Our docs and PAs have been in our corner with concerns about untriaged patients -- and inappropriately triaged patients, and their input has helped with regards to getting us the staffing that we need.
I believe that there are some patients that can wait in the waiting room as opposed to blocking the halls with all their assorted relatives and suitcases and snacks - arms folded staring and huffing at the staff to "hurry up already". The rush back to an open bed gives non-urgent walk ins a sense that something is "super wrong" and jumps their stress level through the roof.
I found a new doc taking a bp on a hallway patient the other day because we were swamped. I said thanks and that the next intubation was on me... So at least our docs are sensitive to our added stress and are helping to solve the problem. I like this bunch - I hope they don't vote with their feet.
i agree; it is confusing. We just started it & were basically given no "ground rules"; just get them to a bed, "maybe" put the cuff on them, push the button & walk away. So far the nurses are ******, the patient's seem confused & the docs want "at least a set of vitals and a weight" before they go in the rm. Ideally athe assigned nurse & a doc are supposed to go in the room at the same time. How often does that happen? Not very; actually more closer to never.
we have been told in the past that only an RN can get initial sets of vitals. this is in AZ......are there other states that require this ? (Or maybe this is only required in the mind of our old director??)
According to our BON they can get initial vitals and place on monitors.
At least our management has heard our concerns and has a committee in place now to review the issue and try to come up with some solutions. Right now immediate bedding is really not being done. The triage nurses have gone back to triaging in the triage area and then escorting the pt back to a room. Only EMS and flights go straight in without triage. For me, being a new grad too, its important for me to have that second set of eyes looking at a pt as often as possible. We had a guy come in complaining of a toothache and the experienced triage nurse got an immediate EKG. He was a STEMI. Thanks all you guys for your input.
At my facility we have what's called "triage on" and "triage off", which basically means that if there are available beds we are triage off and pts are sent right back to a room, usually just given a piece of paper with a room number and sent through the doors to wander aimlessly throught the department. The charge nurses, I have to say are really good at telling you when a new patient is being sent to one of your open beds. If there are no beds, we are "triage on" which means all walk in pts are triaged by the triage nurse and then sent to fast track or the waiting room. If they need to be seen sooner rather than later, the are either placed in a hall bed, or a pt is moved into a hall bed so the new patient can be put in a room. The only drawback I have come across so far is a LONG wait to see the doctor or PA. I have seen in room wait times up to 5 hours. We have standing protocols and can do basic labs, and basic films. If meds are needed, we can usually get a one time order from the doc or PA. Obviously if the pt is acute, the nurse grabs the doc and he or she goes in right away. But it takes teamwork. Sorry I'm so long winded, but this is our "immediate bedding" at our facility.
We keep an experienced RN at the front desk to "greet and sort". We do immediate bedding until our rooms are full, then the triage nurse switches and does the full triage assessment. We keep the docs happy with immediate bedding by getting a chief complaint and doing a set of vitals on the way back to the room or as soon as the patient is in the bed. Critical patients are escorted to the back by the triage RN, non-critical by the aides. Usually an aide helps us with getting the patient settled. Everyone gets a gown and help if needed.
With a quick hand off report the RNs prioritize who can wait a couple of minutes and who to drop and run for. It's ok if the docs beat us in to see the patient. Our docs are also responsibile for doing their own histories and assessments. Most of the time the RN and MD staff share information with each other so it doesn't get too tedious. Our goal is to get the patient moving quickly no matter who sees them first.
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So at least our docs are sensitive to our added stress and are helping to solve the problem. I like this bunch - I hope they don't vote with their feet.
TraumaNurseRN
497 Posts
I spoke of once the patient is in the room. You mentioned the doc goes into see the patient and they are not in a gown....That is what I was referring to