RN Medical Guidelines for ER

[ghostrider]

I would appreciate knowing what guidelines / protocols / standing orders do other Emergency Departments utilize. The ususal trauma and ACLS are well known so do not need to send. Looking for such things as what are RN's allowed to initiate by standing orders. ie- IV fluids, select lab work, medications, x-rays, CT scans, etc.

This is not addressing advanced practice RN's.

Thank you.

[maggieelaine]

From Austin Tx, ACLS, PALS, And, our guidelines in our P & P book spell out what we initiate. Signed by MD. Including when we can start IV's, give NTG sl, Chest Pain protocol, etc. What are you looking for?

Will be back Tuesday.

MaggieElaine

[ERRNTraveler, RN]

I'm a traveler, and every ER I've worked at has standing order protocols for various pt. complaints. Examples:

Chest pain: EKG, IV, O2, Labs (CBC, BMP, Cardiac Panel, PT/PTT), Chest X-Ray. Some hospitals allow us to give Aspirin & Nitro.

Abd Pain/N/V: IV, Labs (CBC, CMP, Amylase, Lipase). Some hospitals will allow us to hang 1 L NS wide open on otherwise healthy adults w/ no history of CHF or renal problems.

Fever: Tylenol/Motrin

Falls/Injuries: X-Rays of affected body part(s), Head CT for head injuries

[ghostrider]

Thank you for your timely responses. I need something more aggressive in medical guidelines and how this accepted by ER physicians. We have too many hours/days/weeks that we are essentially on Waiting Room and Chart Rack Divert (as opposed to EMS divert). These pt's are waiting to be seen up to hours as we continue to receive EMS pt's. Even with up to 5 board certified ER physicians working, we still have long waits. Yes, we have changed process for CT, lab, admit, etc. The problem exists that pt's continue to wait treatment in the Waiting Room or ED room for a MD to get to a point they can see another pt. What is unique? Innovative? Do you have dedicated RN's / PA's / NP's that initiate orders/treatments until an ED MD can see the patient? Special training? Standing guidelines that go beyond the usual ACLS, Trauma, Chest Pain, Abdominal Pain? If yes, would you be willing to share them? What creative ways are working to reduce wait time, increase pt. satisfaction without adding more staff? We are pushing hard against our ED MD's to rethink their practice. ie-start managing a pt then report off (they worry about medical/legal ramnifications), expanding nursing medical guidelines beyond what has been traditional, creating a whole new way to manage ED patiets. We cannot continue to practice ED care like in the past...add more staff, rooms, MD's, lab, x-ray, hospital beds, etc. This is not working. Processes for admiting pt's, registering patients, labs, CT scans have worked but the probem remains. Thank you.

P.S. If you are interested in my ideas that I presented to the management team on implementation of the PIT Team approach and ED Capacity Alert Code, let me know.