Triage Protocols

Nalon1 RN/EMT-P, BSN, RN · Jun 9, 2016

x-rays for obvious deformities, UA for GU/GI/renal stone, and Ibuprofen/Tylenol for fever are about the only things we order from triage itself.

Editorial Team / Moderator · Jun 9, 2016

My last ED had complaint-based protocols for both adults and peds. Labs and x-rays were typical, some meds (Zofran, nebs, etc.), but things like CT or ultrasound usually came after the patients were seen (the obvious exceptions being when those things were needed emergently, like with r/o CVA pts).

My question to the OP: wouldn't your ED typically provide some education/launch information for new protocols so that you know if they're actually approved and active? When we implemented ours, there was plenty of information/reinforcement when it happened.

Bobjohnny · Jun 9, 2016

We currently do not have any ED protocols. The only facility wide protocols that we have are to d/c a foley post-op, and send a stool for c-diff if the patient has loose BM. We switched medical directors about 18months ago and the new one has yet to sign them. We have repeatedly harassed him about signing new ones, but he continues to fiddle fart around.

Thankfully most of our Docs will allow us to do our triage, ask them for an order based on it and then we order it when they give us the verbal go ahead. Also a bunch of our midlevels will toss in orders when they're not busy in fast track, which is about 85% of the time since our fast track only has enough physical space for four patients.

cayenne06, MSN, CNM · Jun 10, 2016

My question to the OP: wouldn't your ED typically provide some education/launch information for new protocols so that you know if they're actually approved and active? When we implemented ours, there was plenty of information/reinforcement when it happened.

I am LDRP when I work as an RN, not ED, but I agree... whenever there are protocol changes at my hospital, there is a definite officiality to it. A random email would never, ever pass muster. It has to be an "official" document, in proper format, signed off by the appropriate higher ups. And you have to sign off on reading it and any accompanying educational materials.

In LDRP, our standing orders for labor admits are pretty much just focused on monitoring parameters, PDAs, IVF, etc. But ED is a whole different world.

floridaRN38 · Jun 16, 2016

In triage we have the usual standing orders for labs,UAs, X-rays and it all goes under the Cheif MDs name when we order it. As for medications and US or CTs. That is a big no for us. Only Med I can give in triage is tylenol for a fever

Editorial Team / Moderator · Jun 16, 2016

I think there is a state in which the nurse practice act prohibits triage protocols... New York, maybe? So much for getting a jump on orders in those ERs.

DeenieRN · Jun 26, 2016

In our ED we have "ATIs" I think it stands for active triage interventions or something along those lines. We've had over a year of education along with the integration of them. They are complaint based (theres maybe 5-6 categories), usually include just labs and xrays, and tylenol for fever and aspirin for chest pain, no CTs or ults. Most nurses will avoid the meds though, even if it is only tylenol. I like that my chest pain pts I can triage and order labs including cardiac enzymes, CXR, EKG all at once, often all of those have been done by the time the doc walks in.

applesxoranges, BSN, RN · Jun 26, 2016

Well, most facilities I work with we do not order medications except a duoneb or tylenol or motrin for fevers in kids. We can order a chest xray or extremities xrays. We can order lab work and depending on what it is, we have lists like bmp, cbc, amylase, lipase, etc.

Kristenlaurenw · Jun 26, 2016

Like other posters, I don't order meds other than Tylenol or motrin. We do UAs, xrays, cardiac monitor, oxygen, ekgs, labs, IV placement. In an anaphylatic emergency, we go ahead and give epi.

EDRNCCmom, MSN, RN · Jun 27, 2016

In the ED I work in there are multiple triage protocols .... Chest pain, Abdominal pain, Sepsis, lady partsl Bleed, UTI, X-rays for injured extremities, stroke to name a few! Medication protocols - Tylenol or Motrin for fevers, Zofran, and LET. Our doctors rely on protocols being placed. Just today I had a patient that didn't really fit under any certain protocol but I wanted an EKG and labs due to past medical history. I was digging through the stack of charts of patients to be seen and one of the doctors told me to order whatever protocol I wanted just to get the ball rolling. Our docs get very irritated if they go evaluate a patient and a protocol was not initiated which should have been. When we get super busy, the clinical managers go through and place additional orders on patients under protocol - such as ultrasound to rule out DVT or CT scan for a head injury. It definitely makes a difference to patients with nurse based protocols- they feel as if their concerns are being addressed as we are able to start things quicker. It's not unusual for a doctor to go assess the patient and all of the labs and tests that were ordered per protocol are already back. I believe that nurse initiated protocols have helped decrease our throughput times.

turnforthenurse, MSN, NP · Jun 30, 2016

Our protocols are pretty basic. XRs for any obvious deformities/chest pain/SOB, CT w/o for AMS or suspected CVA and then of course the appropriate labs that come with those protocols, along with IV insertion. We can give Tylenol and Motrin per protocol and also Zofran and NS if the patient meets the criteria. We can also order Duonebs. That's about it.