Protocols/Standing Orders

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

We have a bunch of general protocols that are mostly related to the triage nurse ordering labs and x-rays. For example, for a patient who comes in with symptoms of ACS, the triage nurse orders the EKG, Labs, O2 as necessary, IV, etc. The one thing that we can't do in our protocols is order medications. So if the patient needs ntg. etc, we have to get the doctor to do that.

2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example)

We do not have a pain protocol as the nurses are not allowed to order medicaitons. However, for suspected fractures the nurse does order the xray, etc.

3. Does it make a difference in how fast patients can be seen, treated and released.

Yes, if the diagnostic studies are started in triage, it speeds treatment time.

4. Do they empower you as a nurse or make you life harder

They can make life easier for everyone. The only time it might make life harder is when triage is really busy; then, the time it takes to make the orders will slow the nurse down.

5. How often do the powers that be check to make sure your following protocols.

It depends on how much time the powers have to do this. Our protocols are not mandatory--the word "may" is used a lot.

6. How often do your Doc's disagree or stray from the protocol

They are always grateful that the nurse has started the ball rolling.

7. What are your thoughts on protocols? Pos, neg etc.

I think they are great.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

We have abd pain, vag bleed, fever, CP, and SOB protocols. As standing orders we have deformed limb gets an x-ray and anti-pyertics for fevers.

2. How invasive are your pain protocols.

No narcs, or we would end up with alot of frequent flyers LWOBSing

3. Does it make a difference in how fast patients can be seen, treated and released.

In general, yes. But it depends on the MD working, some order an additional lab that holds things up (exp: d-dimer on a SOB 75yo) or the dreaded CT abd w/wo contrast. But if we are busy I use the protocols to an inch of their lives to help dispo pts.

4. Do they empower you as a nurse or make you life harder

Makes my life easier, and it helps that pts know that they aren't forgotton about.

5. How often do the powers that be check to make sure your following protocols.

They don't as long as the LWOBS rate is low (it's their magic number on how good the ER is).

6. How often do your Doc's disagree or stray from the protocol

They may stray, but not far (see #3 above)

7. What are your thoughts on protocols? Pos, neg etc.

I like them, along with the walk by consult of the ER doc, makes things move a lot smoother.

Major Domo

We start lines on everybody that walks in the door as well as go ahead and draw a full set of labs based on their c/o.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example)

3. Does it make a difference in how fast patients can be seen, treated and released.

4. Do they empower you as a nurse or make you life harder

5. How often do the powers that be check to make sure your following protocols.

6. How often do your Doc's disagree or stray from the protocol

7. What are your thoughts on protocols? Pos, neg etc.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

We have a Chest pain with meds listed, Fever with meds, Pneumonia with beeper alerts to charge nurse if infiltrate shown on CXR, Extremity(Ortho), SOB almost complete, and a few others i cant remember can check at work tom.

2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example) All mostly are for orders of labs, x rays, etc.

Chest pain protocol goes more in depth with meds it actually is a 2 page in depth set of orders. We have biosite meters so we can have CKMB,Myoglobin,Trop I, and BNP readouts in 15 minutes. The fever protocol calls for tylenol motrin of course.

3. Does it make a difference in how fast patients can be seen, treated and released. Makes for quicker dispos thats for sure.

4. Do they empower you as a nurse or make you life harder

5. How often do the powers that be check to make sure your following protocols.

6. How often do your Doc's disagree or stray from the protocol

7. What are your thoughts on protocols? Pos, neg etc.

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

We have a Chest pain with meds listed, Fever with meds, Pneumonia with beeper alerts to charge nurse if infiltrate shown on CXR, Extremity(Ortho), SOB almost complete, and a few others i cant remember can check at work tom.

2. How invasive are your pain protocols. i.e. Can you give an isolated extremitiy injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example) All mostly are for orders of labs, x rays, etc.

Chest pain protocol goes more in depth with meds it actually is a 2 page in depth set of orders. We have biosite meters so we can have CKMB,Myoglobin,Trop I, and BNP readouts in 15 minutes. The fever protocol calls for tylenol motrin of course.

3. Does it make a difference in how fast patients can be seen, treated and released. Makes for quicker dispos thats for sure.

4. Do they empower you as a nurse or make you life harder

Empower us. We really did these things before but now its "signed off on"

5. How often do the powers that be check to make sure your following protocols. All the time.

6. How often do your Doc's disagree or stray from the protocol

All our board cert er docs have signed off on the protocols and helped develop them.

7. What are your thoughts on protocols? Pos, neg etc.

I think they are great. Allow us to use our nursing judgement and help move things along in an er that sees 170 - 200 a day.

In preparation for a lecture, I'm acquiring information on protocols/standing orders that are used in ER's. (this is an informal survey, some poor grad student will get the pleasure of doing a formal one )

1. What protocols do you use. i.e. Abd pain gets a line, labs, etc,

*** basically our protocol give us the right to collect blood and start a line. In some instance, we can give bolus or start NS at 125 cc/h. We have one for CP, abd. pain, CO intoxication,renal flank pain, sepsis, overdose. We also have the right to defibrillate one shock without MD order. We have protocol for the use of restraint as well.We also can initiate ventolin on specific patient and send them for x-ray in the fast track.We also have guideline for spinal board and at triage.

2. How invasive are your pain protocols. i.e. Can you give an isolated extremity injury i.e. obvious fx get narcotics in triage. (This is just a hypothetical example)

*** we have a pain pilot protocol. That would give us the right to use fentanyl, up to 200 mcg, without an order . we also can give 1000 mg of Tylenol without an order. we use that one alot for triage.We can use lidocaine gel for foley insertion.

3. Does it make a difference in how fast patients can be seen, treated and released.

*** Not so much seen, but in a busy day alot of time the MD can see the patient and already have all the blood result so he can take a decision quicker. Also, alot of patient already got a liter or so of fluids.

4. Do they empower you as a nurse or make you life harder

***Well like everything in life moderation is the key. The problem some

RN

send every blood test on everybody without really thinking. So the lab get over work. Never study it but my guess it that could slow down the department.

5. How often do the powers that be check to make sure your following protocols.

**** never!

6. How often do your Doc's disagree or stray from the protocol

*** Just when the want to be a/$$!

They are usually very appreciative that we did them. Some of them tell us when we shouldn't have send blood.

7. What are your thoughts on protocols? Pos, neg etc.

*** They have there place but also there limits. If use in a right manner they are very useful, especially for new

RN

. But the danger with them is you become that hypnotize

RN

that regurgitate instead of thinking.