Triage help....

Specialties Emergency

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Specializes in med/surg---long term---pvt duty.

This may have been asked elsewhere but there is soooo much info on this forum I had a hard time finding it...

I am a new ER nurse...just completed my 1st 2 days in the department...and have sooo many questions I don't know where to start LOL

In my small ER...the same nurse triages and often goes though the "back door" and turns around and takes care of that same patient. I have asked about triaging and have not received very much info from my peers...you just ask them questions on the form...

I'm looking for info on how to get the most info while doing the triage assessment...How do you "pull" the info from the patient, what questions do you ask to get the druggie to tell ya when he took his last hit so you don't give him something during treatment that will cause more problems or from the little old person who tells you they have "no history" and you look at their meds and they have "everything"--heart, diabetes, seizures, etc.

I don't want to miss something that can be a very important part of the treatment needed.

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don't ask broad questions -be specific.

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Yes, be specific. Many people are too distressed to think straight.

To cover all the bases I'd follow the SAMPLE format:

S: Symptoms

A: Allergies

M:Medications (prescribed, herbal, illicit drugs)

P: Past medical history (conditions, surgeries, hospitalizations, etc.)

L: Last oral intake (also ask last time took meds/drugs, etc.)

E: Events leading up to ER visit ( why are they here? what were they doing when symptoms started?)

And with the "druggies"- you may just have to assure them that you are not the police. You are asking to treat them and they will not get in trouble.

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Specializes in Emergency & Trauma/Adult ICU.

I could have written a very similar post when I was a brand-spanking-new-grad ER nurse. :)

I was SO impressed with my preceptor & other nurses who could immediately zero in on those points which differentiated intercostal muscle spasm from true cardiac chest pain. I once started to do a cumbersome (but thorough!) neuro assessment on a seizure patient ... until my preceptor rolled her eyes and asked the patient, "Do you drink everyday? When was your last drink?" :imbar

You've been in the ER all of 2 days. Give this some time - it WILL get better!

Having said those things ... listen to how the physicians in your dept. evaluate a patient. Examine how those questions fit in with your knowledge of the pathophysiology of the patient's chief complaint. Ask questions - draw on the knowledge of your preceptor, nurse educator & others. Take note of the information you get in report from medics & how they convey it to you - what did they emphasize and what is its importance? What s/s did they note were absent and what is the significance of those?

One point - while every ER & hospital has its own quirks to documentation and you will have to comply with those quirks or face getting reams of "love notes" in your mailbox, don't lose focus on THE PATIENT to dot every i and cross every t when triaging a new patient. Vital signs & just enough information to effectively convey the patient's chief complaint are all that's required to get treatment going. Details like the name of "that little white pill I take at bedtime" can be worked into the conversation later.

Good luck to you - welcome to the ER! :specs:

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Specializes in Emergency Dept, ICU.

The ENA also offers a triage course. Based more on the 5 levels of triaging but it seems as though it would be helpful for a new nurse too.

One piece of advice I could give you would be, if they look sick as sh*t and by that I mean REALLY GOING DOWN THE DRAIN, don't waste time up at triage. Bring them straight back to a room so you can get help and then do the triage WHILE you are putting in iv's getting an EKG and and MD.

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Specializes in med/surg---long term---pvt duty.

Thanks for the tips...:)

"One piece of advice I could give you would be, if they look sick as sh*t and by that I mean REALLY GOING DOWN THE DRAIN, don't waste time up at triage. Bring them straight back to a room so you can get help and then do the triage WHILE you are putting in iv's getting an EKG and and MD."

That's one reason why the ER Manager wanted me in the ER..because of my knack for "I may not know what's wrong with them but I do know when some thing's not right and to get someone who does know what to do"...she said I had "great guts"...I took it as a compliment!! :D

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Specializes in Nephrology, Cardiology, ER, ICU.

Triaging effectively is all about the "across the room assessment" and like the above poster stated "the guts" of things. It takes time...don't worry you'll get it! Good luck.

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Specializes in ER/EHR Trainer.

In my busy ER a nurse may not sit in the position of triage until they have been there one full year....this includes experienced nurses. The feeling is that triage is a skill that is gained by working the ER with all types of patients and seeing others half a$$ed notes as you work there(and what you would add).

Our charting is computerized, includes meds, med hx, allergies, vitals w/ht and wt, doctor name, drink smoke drug usage?, tet pneu flu vaccine? exposure to communicable disease? Pain # pqrst

Then the narrative...why are you here today? How do they look/walk? If they have a fever and cough-how are lungs? Edema to lower legs? Detailed description...if the patient is very sick...this is the time to get it, if bad things happen later you may have nothing else. Also if someone comes in with the I have had a cough x1 month "what was worse about today?"

We also use a 5 tier acuity level-1 cva, stemi 2 sob, cp, pain 8/10

Hope this helps.

Maisy

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Specializes in ED staff.

Give yourself some time in the ER, then you won't even have to ask this question, you'll already know the answer. Remember the ABC's first and foremost. DO they have a competent airway? Are they breathing and do they have any circulation. If there is a no answer to any of those questions, they go straight back.

Many of the questions you are asking will be answered in time. How do you get an addict to tell you when he last used you ask... most people who are addicted to illegal substances won't even admit that they use them. Sometimes they do but it's not very often. Many times we have to do a urine drug screen just find out if the patient was using anything. I don't tell them to pee in the cup so we can test your urine to see if you've been using, I just act like it's routine. When you have the results then you can confront the patient.

But...... what to you do if your drug addict is a 68 year old granma who is addicted to Darvocet N 100? She's out of it, she needs more but she's not going to tell you any of that. She may say something like " this feels just like that virus I had last year and they gave me darvocet, I think that's what it's called. It's the only thing that's ever really helped with my pain."

I know you want answers to your questions but as you can see, it takes time to develop the skills that you need to be able to get people to tell you what you need to know, sometimes they tell me stuff I NEVER, EVER wanted to know. As a matter of fact one of my main problems in triage is getting the patient to shut up!! Rather, getting the patient to stay on task, which is answering my questions.

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Specializes in med/surg---long term---pvt duty.

"they tell me stuff I NEVER, EVER wanted to know. As a matter of fact one of my main problems in triage is getting the patient to shut up!!"

:D I've had that happen already....sometimes it's like "That was WAY too much information or that was a mental picture that I REALLY didn't want!!!" :rolleyes:

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