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Discussion

triage help

I work in a correctional setting where the patient's become too familiar to me as they continue to return. A report was given to me regarding a young male who was lying in bed complaining his heart hurt. This patient arrived the night prior and was fully assessed and intake by an RN during 3:00 p.m. to 11:00 p.m shift. He had no acute or chronic issues. Noted from prior incarceration was a heart murmur for which he had a full work up and was negative. The patient was not on any meds and he reported his only illegal substance was smoking cannabis. Given his age, and history I used nursing judgement and did not feel he needed immediate evaluation at that time and would be evaluated by the nurse who visits the housing units daily for patient complaints. I exercised my judgement and advised out secretary he would be evaluated in his housing area and if he became worse or things changed the officer would be calling medical again. I was reprimanded for my judgement because the patient was evaluated later by the triage RN in the unit who reported patient was diaphoretic although when he was brought up to medical and questioned and evaluated by the provider this was denied by the patient and was not observed by the provider. The patient's dx was anxiety related which is what my impression of the situation was at the time. Chest pain is a common complaint which patient's state to be able to get out of their housing areas and when they report to medical the story changes. I though I used proper nursing judgement based on the information I received and yet I was reprimanded.

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    I don't know what's common in a correctional setting, but I would not be comfortable "triaging" a patient I didn't actually assess face to face.

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    Are you a student (asking because you posted in the nursing student forum)?

    I'm not familiar with correctional policies. In the hospital setting, any complaint of chest pain necessitates a full work up including full assessment, EKG and labs. I totally see how complaints of chest pain could be used to get an inmate out of their cellblock, probably in the same way someone could use it to get seen faster in the ER. But for the times when it isn't a fake complaint, it can get bad fast. It sounds like you just made a decision that this patient didn't need evaluation by a physician based solely on medical history and what was reported to you about his complaints. Did you see him in person at all? If not, it makes sense to me that you could have been reprimanded. Anxiety can cause cardiac symptoms that warrant medical intervention, let alone a condition that is cardiac in origin.

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    I did not see complaints of chest pain until the very end, after you got reprimanded. All I saw was him complaining of a headache. However, if this patient had a significant murmur, I would imagine you would have checked his vital signs as murmurs can be problematic for both stroke and heart attacks.

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    While I am not familiar with how the chain of command works in correction facilities, it worries me that you mention that heart pain/chest pain is often used to get off the unit. If this influenced your decision not to have this addressed immediately, then at some time or another you will get burned with this. You will never be faulted or reprimanded if you practice from the standpoint that chest pain should always be assumed to be cardiac or pulmonary in etiology, until definitively ruled out.

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    • Admin

    Thread moved to Correctional Nursing forum.

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    Nursing judgement is, complaints of chest pain requires complete medical evaluation. Send them out.

    No skin off your nose.. CY your A.

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    Every complaint of chest pain should be checked out. You got lucky this time that that nothing serious happend. I'm sure the officers would have called if it got more serious but you never know. I'd advise against dismissing concerns just because a prior assessment was negative. You need to have your eyeballs on every inmate with a serious complaint, even if 99 out of a 100 don't turn out to be serious.

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