Standards of Care in the ER

Anna Flaxis, BSN, RN · Oct 25, 2011

Yes, we have a written policy.

FancypantsRN · Oct 25, 2011

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.

Anna Flaxis, BSN, RN · Oct 25, 2011

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.

Esme12, ASN, BSN, RN · Oct 25, 2011

google is your friend and so is the ena......

http://www.ena.org/iqsip/nursingpractice/scopes/pages/default.aspx

http://www.med.unc.edu/emergmed/files/edpolicy.pdf

http://www.mssm.edu/static_files/mssm/files/departments/emergency%20medicine/manual/sub38.pdf this has pain/vitals standards.

http://www.premierinc.com/advisorlive/2005/program050405/ercaringstandards.pdf

http://www.adph.org/cep/assets/closed_pod_example_nyc_hospital.pdf

i am surprised that you have no policy for the assessment of pain as that is a focus of the jc, ahrq, and other quality measures. if you have no set policy, how do you document response to intervention and response time to treatment for quality and not get in trouble with the jc (joint commission)? which measures of the standards and adherence to the standards are just as important.

is your facility accredited? then they must have a policy to measure the quality of interventions and how frequently you need to reassess to measure compliance. if they really don't have one in this day and age with standards of care and minimizing delay of care i'd be looking for anothrer position because where else do they lack in quality.....and if anything ever happens and there is a bad outcome or delay intreatment the lack of a policy and standard of care will place you at a higher risk for being sued and thrown under the bus.

FancypantsRN · Oct 25, 2011

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

VICEDRN, BSN, RN · Oct 25, 2011

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

RN1980 · Oct 26, 2011

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.

Altra, BSN, RN · Oct 26, 2011

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?

Sanuk · Oct 26, 2011

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.

Rob72, ASN, RN · Oct 26, 2011

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

RN1980 · Oct 26, 2011

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.