I am a surgical floor nurse visiting you all with a question about how skin assessments are done in the ED. The hospital where I work has initiated a protocol that a head to toe skin assessment should be done on all admits at point of entry (the ED) before being admitted to their respective unit. Here is the kicker: we are to report any patient who arrives without an assessment done and also if skin alterations are found to exist but were not noted or measured. We were ignoring this and doing our own regular admission assessment until they began to do chart audits of why we're failing to report 'missing documentation'.
Can anyone give me some insight about how your assessment/charting works in the ED? I imagine that it depends on the patient's complaint, the happenings at the time, and what took priority, but are skin assessments even routinely done? Not that it matters, but our ED admits are nearly entirely GI complaints, (obstructions, appys, gallstones; no active bleeders.)
Pardon my ignorance, but I work the floor and really don't know! I appreciate anything you all can tell me about what's it's like for you. Relations already tend to be poor between the ED and the floor and this is only making things worse.
Ohh please tell me you are joking?! Sadly, I could see my ER forcing one more juggling act on the ER staff nurse. The ONLY time I note skin assessment is if there is reason. For instance, my patient comes in with altered mental status I will note the decub on his buttocks as he could be septic. But it he comes in with respiratory distress and gets himself a tube, then no I did not get past The "B" in my ABC's, his skin tear is besides the point. The ER should be a focused assessment and take care of the emergency at hand, not the besides the point diagnosis. When do the ER nurses perform these detailed assessments? In between intubating room 1, getting the MI in room 2 to the cath lab in
Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.
We actually did this where I used to work with one inpatient unit with which relations were becoming particularly strained. You could bring this up to your shared governance council as well.
If you're really going to get a feel for it, though, you need to come at the predictably busiest times -- usually from 3pm to 11pm. Or ... at 7am on a day when we have held 15+ admissions overnight because there are no beds upstairs ... and you can see what it's like trying to provide inpatient care in an outpatient setting.
Thanks for wanting to understand the whole problem!
[quote=amarilla;511777I remember thinking, 'who's looking at a AOx3, walky talky 38 year old appy's feet in the EMERGENCY department?!'
UG!! This is exactly why I'm here to gather some info, because there are some who seem to be under the impression that you guys strip everyone naked and know and see all.
Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.
And you're welcome to come to the Dark Side anytime you wish, should you feel like you want a change of scenery. :heartbeat
See, now *this* is what gets missed even though it seems like common sense. I had another nurse pass on in report that newly admitted patient 'had two small, closed sores - one in-between third and fourth toe and one on the bottom of second toe that the ED didn't catch." I remember thinking, 'who's looking at a AOx3, walky talky 38 year old appy's feet in the EMERGENCY department?!'
UG!! This is exactly why I'm here to gather some info, because there are some who seem to be under the impression that you guys strip everyone naked and know and see all.
Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.
I agree with everyone else on the topic, but what I really want to say is that, as an ED nurse, I really appreciate your insight and attitude in a difficult situation. You sound like a great nurse and I hope your co-workers appreciate you.
EDrunnerRN
25 Posts
Ohh please tell me you are joking?! Sadly, I could see my ER forcing one more juggling act on the ER staff nurse. The ONLY time I note skin assessment is if there is reason. For instance, my patient comes in with altered mental status I will note the decub on his buttocks as he could be septic. But it he comes in with respiratory distress and gets himself a tube, then no I did not get past The "B" in my ABC's, his skin tear is besides the point. The ER should be a focused assessment and take care of the emergency at hand, not the besides the point diagnosis. When do the ER nurses perform these detailed assessments? In between intubating room 1, getting the MI in room 2 to the cath lab in