hollysunshine

We have triage protocols that are complaint driven. Anyone not being seen for crisis or urgent care gets lined and labbed. We can give IV/PO narcs, antiemetics, and fluids. I've really only given Zofran. Makes me too nervous to give IV Dilaudid to someone that I can't keep my eye on. Our triage area is fairly far removed from the waiting area and behind several closed doors. I've given Percs to some orthopedic injuries that we couldn't get back right away. The triage protocols were designed by our group of docs.

We self schedule 8 weeks at a time with the following rules: 3 Mondays 3 Fridays 5 W/E shifts We have a holiday package (A or B) that flips each year. We get one request off per week.

I'm convinced there is aerolized THC and Imodium in our department. Every patient who has had diarrhea for days is suddenly unable to provide a specimen and everybody has the munchies.

When those of you who are new look back in a year, you won't recognize yourself. I've been a nurse for 18 years, and spent the last 5 in the ED. I was an experienced nurse when I went to the ED, but it's a completely different animal. I remember spending many of my first few days in the ambo bay in tears and thinking I'd made the biggest mistake of my life. I missed the "luxury" of getting my pt's to the floor, and they already had their IV in place and were relatively stable. We start our pt's from scratch for the most part. It gets better. Don't give up. I wouldn't want to work in any other department.

Anything can be a suppository if enough force is applied.

They show up unannounced all day long. We only get called on the box if the pt is critical or the medics are requesting the doc to order a med they can't give just based off protocol, like Cardizem.

I think we might be at the same hospital. We got an email about the 5 P's. Can't remember the 5th one either.

We just started this in my ED about a month ago. I was already seeing my patients at least every hour, but now we have to document that we updated the plan of care with the patient. We only actually have to document every 2 hours. The nurses document rounds on the odd hours and the techs on the even hours. I guess we have to have documentation that someone has seen the patient every hour. I'm sure it all goes back to those precious Press Ganey scores. Sometimes I feel like more of my time is spent doing documentation than patient care.

#? No, I can't give everyone of your family members a work note because they came with you to get your stitches out.

I couldn't have said it any better. Thanks!!

I recently had an 18 y.o. female come in via EMS. She had been seen several days before and given a script for Cipro for a UTI. She got it filled at the pharmacy and when she got home, realized the cap had a crack in it. She didn't think she should take it, so came back to the ED for a new script.

Amen!!!

Platon20 is very wrong about Franklin Square. The ED sees between 350 and 400 patients per day. I would definitely not recommend it for a new grad. Other ED's in the vicinity see approx 160 to 200 per day. Franklin Square ED practices team nursing, so depending upon your team members, you could have up to 6 patients. Worked up patients are often pulled to the hallway which is getting to be the norm for all ED's. I work agency in many Baltimore ED's and with the exception of trauma centers, Franklin Square if by far the busiest.

A fellow nurse brought this in the ED where I work and I thought it was cute. THe C.R.A.P. Score by D. Slow P., MD CRAP=(OPS+AF)(SC)(EC) OPS=Old Pain Score AF=Adjustment Factor SC=Story Credibility EC=Exam Credibility Situation: We are supposed to documents our patients' pain on a 10 point scale in order to objectify if and make sure we address it and provide timely and appropriate analgesia Observation: There sure seems to be a lot a variability in the way people measure their pain. It's enough to make you want to throw the whole pain scale away. We all know it's true. Some people not only verbalize their pain more effectively, they also seem to experience it more effectively. These patients may come to the ER once a month with "10 out of 10 pain". They also seem to require more work notes. It seems that what was meant to be an objective scale, couldn't be more subjective. Assessment: If the pain scale is to survive-and I'm by no means suggesting that it should-but if it is, I'm sorry to say we may have to find a way to adapt it to each individual patient. We used to think that "mild, moderate, or severe" was adequate, but now we know better, a ten point scale is quite superior. But, is it good enough? If you want to practice cutting edge medicine, get ready for yet one more complexity. Plan: I propose that a formula be developed to enhance the functioning of the current pain scale so that each patient can be treated as an individual. The Canadian Relativity Adjusted Pain, or CRAP for short, will be calculated as noted above. The key value here is the Adjustment Factor. For "LPT" patients (Low Pain Threshold" this will be calculated as follows: For every point over 10, which the patient reports, subtract one. If they say their pain is a "12" then subtract 2 points and start with an 8. For every visit the patient has had to your ER in the past 12 months for a painful condition that was either chronic or went undiagnosed, subtract 1 point. If you push on a non-painful or uninjured area of the patient's body, the shin for example, and they say "Ouch", subtract 1 point. For every allergy to a non-narcotic medication that could be effective for their condition, subtract 1 point. If they are wearing sunglasses, subtract 1 points. If they still have tape or EKG lead residue on their body from a prior hospital visit, subtract 2 points. For "HPT" patients (High Pain Threshold" you will be adding numbers to their pain score. If a spouse fo family member forced them to come in, add 1 point. If you check their records, and every time they've come to your ER for a painful condition something was torn, broken, ischemic, or perforated, add 2 points. If they have no allergies add 1 point. If they are tachycardic or hypertensive and 1 point. Here is an example. A young man presents to your ER for his 7th visit this year for a migraine headache and reports his pain as "12" on a 10 point scale. He is allergic to Reglan, Imitrex, Toradol, Prednisone and Tylenol. He also has been to the ER 5 other times in the past year for back pain or abdominal pain, all times sent home with normal studies. When you enter the room he is yelling at someone on his cell phone and eathing Cheetos, but tells you, "This is a bad one doc." On exam his VS are normal and his abdomen and back are both tender. "I didn't even notice they were hurting," he says. His CRAP score sould be (10-6-2-5-5-1)(0.5)(1) which would be negative 4.5, but since his number is negative, you decide to leave out the credibility conversion for a score of negative 9. You tell him that pain medications are not indicated for his headache because his CRAP score in negative 9 and he can go home whenever he is ready.

We use Meditech for documentation and the program generates a report. When we get a bed assignment, we call the nurse to let her/him know that report is in the computer. This gives them an opportunity to review and ask question. The pt is transported 15 minutes after the nurse is notified. It has expedited the transfer process. Unfortunately, our main problem is being able to get a bed assignment and we often board 8-10 pts in a 21 bed ED for an entire shift. Very frustrating.