Rash triage

[CeciliaBlue]

Hello fellow nurses. I work in a community clinic, but I'm sure this issue comes up in a variety of care settings. When a patient checks in with the receptionist with a complaint of rash, they are asked to wait outside, and a nurse goes out to triage the rash. The goal is to determine if sx are suspicious for highly contagious illness. Most of the time, rashes are not suspicious and patients are then allowed in lobby/tx areas as usual. If sx are suspicious, we observe the appropriate precautions. Understandably, some patients find this to be embarrassing and confusing. I'm wondering how this is handled in other places?

[Lemon Bars]

At the clinic where I work, we have some seldom used appointment rooms at one end of the building. That is where I take patients like this, and where I do most of my nurse-only visits just to stay out of the way of the MDs, NPs and PAs who are seeing patients in the more centrally-located rooms.

There is also a small office right off the lobby that is seldom used by other staff and I sometimes take a patient in there for a quick triage or consultation.

Sometimes, if we have a patient that we suspect is contagious, we have that patient enter from a back or side door and go into the closest room to minimize contact with other patients and staff.

It's not a perfect system and I hope we never get a patient with Ebola, but this seems to work pretty well for us.

[guest464345]

The "wait outside" approach is definitely awkward, but it seems to be the most common ... Because of course even if you quickly bring them to a room right off the lobby, in a case of measles every person in the clinic at that time and for two hours afterward is considered to have been exposed.

Maybe your scheduling staff can explain this procedure to anyone calling for a rash appointment, so that at least it's not a surprise? With all the outbreaks in the news, I have found patients to mostly be understanding.

[lpn164]

I definitely think it is rather insulting to anyone to tell them to wait outside the lobby. If they are in the hall/elevator etc the people in the lobby will likely travel those same places within 2 hours anyway. Also if they have the rash in awkward places - could lead to a risk issue trying to take a look in a hall or lobby. Our practice has a dedicated room for these type of situations and a prepared bag of disposable gown, shoe covers, and mask for the patient and staff if needed. Usually more triage is done prior to appt to get a better idea of what to expect.