Standards of Care in the ER

Yes, we have a written policy.

Thanks stargazer.... I am interested to know this bc we do not have a policy. I volunteered to write one and was turned down on my offer, they do not want one. It got me wondering if ER's in general were reluctant to have a policy, or if it's just mine.

I've only worked in one ER, so I don't really know what ERs do generally, just the one I work at. We are required to re-vital stable patients every two hours and reassess hourly. Unstable patients or those undergoing conscious sedation require more frequent vitals and assessments. Patients in the lobby are to be re-vitaled and assessed hourly.

I'm not sure why they would be reluctant to have a written policy in place. My cynical self tends to associate it with staffing. If the written policy would increase the amount of time each RN spends at each patient's bedside, then the nurse to patient ratio would have to decrease, which would mean hiring more staff.

I could be way off base, though. I have no idea what staffing levels at your facility are like.

Esme I think I sent you a PM. Or at least I tried to :)

q4 hours on hall patients and patients waiting in triage. q 4 hours on all patients in monitored beds (say a syncope or seizure) and

q2 hours for all critical care/trauma patients.

personally, i think only a nutcase sticks with these guidelines.

I obviously chart responses to any medications such as vitals for all patients that received narcotics, bp meds, fluids, anti-pyretics, etc.

Every patient in our dept also gets a set of discharge vitals. must be taken within 15 prior to departure

all routine pts get vs recorded q 1hr, urgent pts get vs q 30min, every emergent vs q15min. we are lucky enought that our monitors atomatically update our computer charting system with vs, so we just apply the cuff, leads and probes set the timer and go. every pt get d/c vs.

all routine pts get vs recorded q 1hr, urgent pts get vs q 30min, every emergent vs q15min. we are lucky enought that our monitors atomatically update our computer charting system with vs, so we just apply the cuff, leads and probes set the timer and go. every pt get d/c vs.

The extremity sprain who gets an xray and some p.o. pain meds needs hourly vitals?

Isn't it interesting how practices vary? We do q2 on stable workups (belly pain, etc), at least q1hr on chest pain and the like, q15-30 on most cp and neuro/trauma, and q4 on holding pts. Discharge vitals need to be within the hour, but at least 20 minutes after any narcs.

I have actually had a manager tell me, "We will not be establishing SOPs, because we would be held to them...":rolleyes:

The extremity sprain who gets an xray and some p.o. pain meds needs hourly vitals?

yep, it used to be a big pain in the ass for everyone, but like i stated before all our rooms are stocked with new nihon kohden monitors and they record the vs in our computer charting automatically. however on non urgent pts we are only required to get a temp on admit and d/c, unless they are febrile. the vs policy use to be real laxed but we got a new medical director thats anal about getting vs.

We have vitals policies but they would be physically impossible to abide by and get anything else done. So we vital per nursing judgement.