Triage in the ED

chris_at_lucas_RN, RN · Nov 15, 2003

What I have seen is that part of the paperwork admitting the patient to the floor is the nursing assessment. The plan of care seems to be something done on the computer.

Triage and plan of care are not the same, of that I am certain.

Triage is the initial assessment of patients to determine who has the more need for immediate attention and who can wait a bit.

So I guess if you are saying that "triage" is a part of initial assessment, maybe when you have more than one patient who needs attention, then yes, except I thought this was actually "prioritizing" and "delegating."

Maybe I'm off in left field. It'll be interesting to see what others post.....

Trauma Columnist · Nov 15, 2003

Well - I'm the stupid one here. We don't "develop a plan of care" for patients in the ER. It is an outpatient setting - doesn't require a nursing plan of care. Care plans don't begin until/unless patient is admitted. I'm an ER charge nurse in 650 bed level one truama center. Maybe I misunderstood???

neneRN, BSN, RN · Nov 15, 2003

RNs are the only ones allowed to triage in my facility; as far as developing a plan of care, in the ER this translates into determining who needs immediate care and who can wait as well as deciding which area of the ER is appropriate placement for the pt. Only RNs work in triage area, however with ambulance pts that come straight to the back, LPNs often fill out the actual triage sheet, but then must have it cosigned by an RN.

MrsWampthang, BSN, RN · Nov 15, 2003

( Triage in the ED Post #1

We have been discussing EMTALA and triage and the nurse practice act (Texas) and so forth. The State Board of Nursing states that an RN must make the initial assessment and develop a plan of care for the patient. Does this mean that a RN is required to perform triage? I believe that triage is an initial assessment to develop the plan of care (what order the patients will be seen). I wonder if some experienced ED nurses are out there who could answer this question for me. Any help will be greatly appreciated. ) *couldn't get the quote button to work.

Anyway, in our ER, sometimes we start by doing an across the room assessment; in other words, seeing a patient walk in the door and know that that patient has something "bad" going on. Then our plan of care is: wheelchair ride straight back! From there, it depends on what their problem is, as to what care path we follow. Chest pains get immediate EKG, IV, NTG, and O2 etc. Diabetics get IV, one touch etc.

If I am triaging one patient and another one comes up that I feel is more critical then I have been known to ask the current patient to excuse me and I go take care of the more critical patient.

I'm not sure that is what you mean by plan of care, but I guess that would be considered our "plan of care." We do have to have RNs that have taken a triage class man the triage desk, so new employees fresh out of orientation aren't thrust into this area.

Hope this answers your question.

Pam;)

TexNurse · Nov 16, 2003

In our ER, an RN is the 1st person to greet a patient and ask for the medical need. You do a quick assessment, triage in order of priority. We also do a paper care plan- something that was added last year because of 'JACHO'- If an RN is not doing triage, then who is determining medical need? prioritizing? May be called something else, but looks like it is all the same......

Sarah, RNBScN · Nov 17, 2003

ER Triage forms do you ... Post #1

Hello,

I am doing a triage course at present and was wondering if anyone would be able to send me via email/scanner what their facility uses as a triage form. I will in return send you what our facility uses. If you do not have a scanner, snail mail would be acceptable as well and I would pm you my address.

I would like to obtain as many as possible and hope that by sharing different forms would address any issues/needs, etc...

Please let me know if any of you would be interested.

Many thanks,

Sarah

athomas91 · Nov 17, 2003

we also perform a "quick look assessment" - basically an abc - if they pass this - we triage pt's in order of arrival and then give them a triage level on an eight-tier triage system - this determines who gets into the ed first...

i do however disagree on "care plans being for admitted pt's"

a care plan is formed for every patient - ex: a cp pt - you automatically start an iv,labs,ekg,monitor,cxr, etc....

and resp distress - you automatically determine the cause (copd/chf) and treat accordingly - these are care plans and whether you know it or not - you do it for every patient

our ed has protocols to cover our rn's when (one) of our doc's acts #hitty.......basically it give us the right to start iv's, labs, xrays, bloodwork, tylenol/motrin, 02, nebs...... many times our patients are completely worked up before a doc gets in there - really cuts down on the turnaround time lab-wise!!

Horton · Nov 17, 2003

I appreciate everyone's responses. I do see that triage and plan of care are different, but the state board tells me that an RN should be performing the triage. I can find no specific written rule stating that RN's are required to perform the triage assessment. I guess what I am asking is if it is a written rule in Texas or anywhere else that we must be using RN's for triage. This is my first time posting on allnurses.com and I am glad to know this resource is available. Thanks for your input.

Jim RN, BSN

erjulie · Dec 8, 2003

Triage must be performed by an RN, and in our facility, one that has taken our triage course, which is a review of the 5-tier triage method. ENA is promoting this method. I believe it's the State that sets the rules about who triages and who doesn't, but for sure it has to be a licensed, registered nurse. For a long time, we skated with either techs or admitting personnel greeting the patients, but that is no longer acceptable. When the RN is busy with another triage pt., she or the charge nurse is responsible for assessing (looking at) the next patient. It is almost impossible to manage this in a busy ER that cannot "up-staff" due to demand...but it's worth it when the lawyers come knockin'...

TinyNurse, RN · Apr 30, 2004

Yes in ohio or at least where i work an RN must triage a patient.

RNMedic1977 · May 4, 2004

In California only an RN can do an ASSESSMENT, LVN's (LPN's) cannot perform assessments, Triage involves doing an assessment, therefore only an RN can do Triage.

Hope this info helps.....