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Impossible standards

Emergency   (6,131 Views | 30 Replies)

canoehead has 30 years experience as a BSN, RN and specializes in ER.

2 Followers; 49,581 Profile Views; 6,679 Posts

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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

16 Articles; 7,358 Posts; 72,098 Profile Views

Wow, that's a risk management nightmare, canoehead!! I've recently had several procedures and signed consent forms even for simple things. Seriously, I can't imagine the crap storm that would ensue if someone decided to take this issue to court. Does your province have whistle-blower protection? Maybe the College of Physicians and Surgeons need a little whisper in their ear.

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Esme12 has 40 years experience as a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

6 Followers; 4 Articles; 20,908 Posts; 148,327 Profile Views

Hi Jan!

We have consent forms, but I have yet to see one used. It seems like bad practice, especially with major surgeries, but I am not the boss. The docs dictate or write that verbal consent was obtained. On rare occasions I've gone into the room after that conversation to do a preop checklist, and the patient has no idea that they're going to the OR. Everything stops, and the doc goes in to chat again, but still no paperwork was signed.

IN the US they get no where near the OR without a signed consent....even phone consent....a witness listens in and the consent is signed.....that is crazy!

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CodeteamB has 5+ years experience and specializes in Emergency.

473 Posts; 6,447 Profile Views

Hello, fellow Canadian here!

CTAS guidelines recommend that Level 1 patients receive continuous care, Level 2 q15 minute reassessments, Levels 3 and 4 q60 minute reassessments and Level 5 q120 minutes.

That being said, it is widely recognized, even by CAEP, that these are an ideal, and not always, or even often, achievable in real life.

My department policy is

Level 1: continuous until stabilized

Level 2: q1 hour

Level 3, 4 and 5: q 2 hours in waiting room q1 in department.

Some days even this is difficult to manage. A department setting out the standards you posted needs a serious rethink, they are setting you up for failure, and not even following the nationally recognized impossible standard.

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turnforthenurse has 7 years experience as a MSN, NP and specializes in ER, progressive care.

3,364 Posts; 36,898 Profile Views

Anyway, I agree with most here, level 3s are Q2, unless they are in the lobby. In the lobby, they are Q1, in case their condition has changed while waiting for MD eval.

Our policy is to repeat vitals Q2H for patients in the waiting room to watch for condition changes. I guess it just varies between institutions.

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ayla2004 has 5 years experience as a ASN, RN.

782 Posts; 9,865 Profile Views

the person doing the procedure obtains the consent in the UK. only operations and sedated procedures have signed consent forms with plan and reason alongside risks of procedure. Ours are deparment of health stanard.

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Emergent has 25 years experience.

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Hi, this is my first post here. For an ESI of 3, we would be expected to have VS charted at least every hour, although it's not always don't on the dot. I've never heard anything negative about what I have charted, even though I don't always do it by the book. Every 15 minutes sounds totally unrealistic.

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Pixie.RN has 12 years experience as a MSN, RN, EMT-P and specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

8 Followers; 32 Articles; 13,353 Posts; 130,345 Profile Views

Hi, this is my first post here.

Welcome to allnurses! :) Yeah, I can't imagine Q15 for ESI 3s, unless it's a scenario where the monitor automatically flows vitals into an electronic charting system -- but we all know that even those need validation because they're not perfect, nor can they chart a pain score.

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