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LPN or EMS triage

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In our triage area we have the RN triage nurse and either an LPN or advanced EMS member to do reassessments. At times they will also do triage if the RN is busy, but the RN is expected to sign the triage sheet confirming the score.  Does anyone else do this?

I have confidence in most of my coworkers, but there's a big difference in actually seeing the patient, and seeing a piece of paper. If the hospital wants them to triage, I think they should accept their assessment without my signature.

https://clpnns.ca/faq/can-lpns-work-in-triage/

Edited by canoehead

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14 hours ago, canoehead said:

If the hospital wants them to triage, I think they should accept their assessment without my signature.

Agree.

I don't think this is a particularly new thing overall but I do think that it deserves major pushback. It's been years since I was in a similar workplace set-up; at that time I did enough of a (re-) assessment to be able to verify what I was signing - - in other words, it was not very helpful for someone else to have done it in the first place.

I will not countersign work/assessments others have done which I can't verify. It's on my "never" list.

Now for my diatribe: The issue makes me particularly angry because there is no nursing organization of any type anywhere that would officially condone the practice of countersigning information that the nurse can't verify. But in these real-life situations there is no expectation that the RN will have the opportunity to do that. And if we did have the time to do that, there would've been no need for a different person to do it in the first place.

I am against all instances of this practice (including physicians  being required to countersign other providers' charts in the ED).

This is a budgeting preference issue that is always made at the expense of the people expected to countersign.

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If you are being handed a piece of paper to sign (or are expected to electronically countersign an EMR triage) without having seen the patient, there's no way in H- I would do that. Zero chance.

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I won't sign off on someone else's assessment unless I have seen the patient. This was annoying to the LPNs and they eventually stopped asking me to do it, but I just didn't feel comfortable doing it any other way! 

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Fortunately I've never worked in an area where we have used LPNs or EMS staff to perform triage. Triage should be performed by someone who really can understand the whole picture, because you're essentially inevitably going to delay care to patients who need it based on risk and consequence.

The Emergency Nurses Associate has a position statement on it, but in a very short summary should be performed by registered nurses who have at least one year of ED experience who also have additional training and validations.

In my personal opinion I wouldn't work in a system where LPNs or Paramedics are expected to triage. This is not a cost saving measure I would ever accept in my emergency department, and if it was forced on us I would leave quickly.

One of my former systems would place a NP and EMT in triage to very rapidly assess and discharge patients who's complaint likely dictated the need for no resources. In these cases EMTs could fill out much of the triage including ESI at the delegation of the NP, but never in their absence. If the patient was too sick to discharge from triage they would go back in the waiting room with their triage as assigned by the NP.

triagequalificationscompetency.pdf

Edited by PeakRN

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Scary...not a chance I'd sign.

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There are plenty of medics and LPNs that could safely triage.  An understanding of the process and an ability to understand sick vs not sick is far more important than the level of certification.

 

That said-  What on earth does your signature mean in this context?  Clearly it does not mean you saw the patient- you didn't.  Honestly, this doesn't even make sense.  

How does management explain the process?

 

 

Edited by hherrn

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19 hours ago, hherrn said:

...That said-  What on earth does your signature mean in this context?  Clearly it does not mean you saw the patient- you didn't.  Honestly, this doesn't even make sense.  

How does management explain the process?

It identifies who administration throws under the bus if something undesirable happens...

 

 

 

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On 1/29/2019 at 3:34 PM, hherrn said:

That said-  What on earth does your signature mean in this context?  Clearly it does not mean you saw the patient- you didn't.

They (people who put others in this position) aim to make it appear that one was indeed in a position to be adequately able to oversee the process such that s/he can vouch that it was done correctly. That is the purpose of this practice. Good luck saying, "but they knew I had no way to directly observe it...." should you ever be called to account for something. The answer will be, "Then why did you sign it? What did you intend your signature to mean?"

It doesn't matter how management explains it. Their purpose is to make it appear that an RN has vouched for the information contained within. (Although asking them to explain it might be a first step in getting the process changed. In utopia).

It also doesn't matter whether some EMTs and LPNs are/could be fantastic at triage. If that were a legit thing the hospital wanted them to do, the policy should allow them to do it.

 

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8 minutes ago, JKL33 said:

They (people who put others in this position) aim to make it appear that one was indeed in a position to be adequately able to oversee the process such that s/he can vouch that it was done correctly. That is the purpose of this practice. Good luck saying, "but they knew I had no way to directly observe it...." should you ever be called to account for something. The answer will be, "Then why did you sign it? What did you intend your signature to mean?"

It doesn't matter how management explains it. Their purpose is to make it appear that an RN has vouched for the information contained within. (Although asking them to explain it might be a first step in getting the process changed. In utopia).

It also doesn't matter whether some EMTs and LPNs are/could be fantastic at triage. If that were a legit thing the hospital wanted them to do, the policy should allow them to do it.

 

Like I say..it identifies who to throw under the bus...

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Unfortunately the LPN and RN boards have both signed off on LPNs triaging. So, it's hard to fight, no matter how crazy the idea seems. We're going through issues in my ER. I love my coworkers, but our saturation tonight was 500%. No help from above, just slog through and cross your fingers.

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