Harbor:ED policy manual

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ALL POLICIES ARE IN ADDITION TO AND NOT IN PLACE OF HARBOR-UCLA AND DHS POLICIES

1.0 Abuse (Adult and Peds)

http://myladhs.lacounty.gov/polproc/Harbor%20Policies%20and%20Procedures/DEM%20Policy%20Manual/01.0%20Abuse.pdf

  • Peds
    • If <120 hours, contact Sheriff, DCFS, and SCAN Teams (8-5 M-F on-site at HUMC, otherwise USC or SART Center)
    • If >120 hours, contact SCAN team to determine appropriate evaluation and follow-up
  • Adult
    • Refer to SART center if <120 hours since assault
    • Contact Sheriff who will determine appropriate SART center and either transport or escort the patient
    • HIV prophylaxis is not routinely given, but can be offered in conjunction with ID recommendations
  • SART Center at Little Company of Mary San Pedro 562-497-0147

1 Abuse (Adult and Peds) POLICY: Assault/abuse should be evaluated and reported to Los Angeles Sheriff’s Department (LASD) in all cases of assault/abuse reported by the patient or patient's caregiver. If the suspected perpetrator is a family member/caregiver or lives in the home of the child, a report should also be made to the Department of Children and Family Services (DCFS).

ADULTS

  1. See Harbor-UCLA Policies 332A
  2. Perform MSE and provide appropriate medical care as necessary.
  3. Call Los Angeles County Sheriff’s Department (LASD) to report the incident. LASD will decide on the SART location, contact the appropriate jurisdictional law enforcement agency, and LASD or appropriate jurisdictional law enforcement agency will provide transport for the patient to the appropriate SART facility. The patient may choose to drive herself/himself, or other alternative transport, but law enforcement should follow them and needs to be present at the SART. You do not need to contact the accepting SART facility unless you have a specific question for them (see attachment 1 for contact information).
  4. Contact Social Work for supportive counseling and community resource referrals (see attachment 2 for a list of Rape Crisis Centers and hotlines).
  5. If the patient declines transportation to a SART facility for forensic examination and counseling, ED staff still need to report the incident to law enforcement. The patient should be offered prophylaxis against sexually transmitted illnesses as appropriate. HIV prophylaxis is not routinely offered but may done on a case to case basis after evaluation by the Infectious Diseases service.

PEDIATRICS:

  • See Harbor-UCLA Policy 332B

SUSPECTED ABUSE OR NEGLECT OF DEPENDENT ADULTS OR ELDERS

  • See Harbor-UCLA Policies 332D

3.0 Admissions and Consultations

  • 3.1 - Clinic Admissions
  • 3.2 - OOP
    • HUMC 308A
  • 3.3 - Eval by consultant from the WR

3.4 - Flow of patients between Psych & AED

21.3 Respiratory Isolation Patient Protocol[1]

All adult patients presenting to the DEM will be screened at the time of triage by a RN for risk factors, symptoms or complaints of respiratory/tuberculosis (TB) using the RIPT criteria in the EHR; five points or greater indicates the need for immediate initiation of the RIPT procedure.

  1. A mask will be placed on the patient and PA/Lateral chest x-ray will be ordered by the triage provider or nurse (with a DEM Attending on duty as ordering physician)
  2. The patient will be escorted to the radiology waiting area, and the triage nurse will hand off communication to the Area Charge Nurse (ACN).
  3. On completion of the chest x-ray, the ACN will follow-up with the R-3 or Attending Physician for interpretation of the chest x-ray. The decision to release the patient back to the waiting area or continue isolation in a designated isolation room will be made by the provider at that time.

<https://www.ncbi.nlm.nih.gov/pubmed/10736118>

<http://www.currytbcenter.ucsf.edu/sites/default/files/ic_book_2011.pdf>

4.0 - Misc

  • 4.1
    • HUMC 312
  • 4.2
  • 4.3
  • 4.4
  • 4.5
  • 4.6
  • 4.7

5 - Consent

  • 5.1
  • 5.2
  • 5.3
  • 5.4

6 - Deaths

  • 6.1
  • 6.2
  • 6.3

8 - Discharges

  • 8.1
  • 8.2
  • 8.3
  • Disability will not be given to emergency department patients by ED staff. Patients requesting disability will be referred to a long term care provider (at Harbor-UCLA Medical Center or in the community). Patients who have been followed in the Harbor-UCLA Medical Center Clinics may be referred to the Medical Records Department (daytime, Monday – Friday) to determine if the medical record contains sufficient documentation to complete the disability forms.
  • Short term time off (< one week) or limited duty (< one week) may be given by the emergency physician to a patient with an acute problem needing short term restricted activities. To give limited time off or restricted activity, the emergency physician is to write for the specific restricted activity and duration of time in the discharge-related documentation in the electronic medical record (eg. Off work 2 days; strict bed rest 2 days; no lifting >15# for 5 days). The patient is to be given a copy of their discharge paperwork at time of ED discharge.
  • In the setting of infectious diseases requiring a period of quarantine, CDC guidelines should be followed for prescription of time off work/school.

10 - Residents & Medical Students

10.1 Supervision of Medical Students

  • Medical Students
    • Medical students may perform histories, physical examinations, and procedures with appropriate supervision. All medical orders require co-signature by a licensed physician. Medical students are supervised at all times by the residents and faculty assigned to the DEM. All charts by medical students must be cosigned by a licensed physician and reviewed by the senior Emergency Medicine resident or faculty member.

10.2 Approval of DEM Housestaff in Performance of Invasive Procedures

POLICY:

DEM housestaff are initially allowed to perform specified procedures only under the direct supervision of DEM faculty or other housestaff who have already been approved in the performance of those procedures. Once residents have been approved for a certain procedure, they are allowed to perform the procedure independently, with indirect supervision of faculty.

The following is a list of the procedures that are covered by this policy, including the number of times each procedure must be performed under direct supervision before a resident can be approved in that procedure:

  • PROCEDURE MINIMUM NUMBER
    • Percutaneous central line:
      • Internal jugular 3
      • Subclavian 3
      • Femoral 3
    • Intraosseous line 1
    • Cutdown 1
    • Tracheal intubation 10
    • Thoracostomy 2

Procedure

  • The following procedure will be used to privilege DEM housestaff in the performance of specified procedures:
  1. When a resident performs a procedure he/she will fill out a procedure note in the electronic health record (and in a separate electronic log when at outside rotations), which identifies the patient, the procedure performed and the supervising physician.
  2. Intermittently, each resident will be provided with feedback regarding the number of procedures they have performed. This feedback will note the procedures they are currently credentialed to perform independently.
  3. This will be posted for reference on iPrivileges/Resident Competencies located on the Harbor-UCLA intranet homepage (Clinical --> Applications -> iPrivileges).

10.3 Transition of Care

All transitions of care for patients occur during rounds. Rounds occur 3 times a day between 8-hours shifts with overlap. Rounds are staggered so that there is not a complete change of providers at any given time. Most patients are seen and discharged or admitted during one shift. There are no more than 3 transitions in a 24 hour period. Patients who are signed out to an oncoming team are assigned a new provider on the electronic health record (EHR) and the providers communicate two identifiers (typically name and MRN#), current clinical condition, what has been done for the patient, any tests, tasks or consults that require follow-up, and a working diagnosis when appropriate. Rounds are supervised by an Emergency Medicine attending physician.


11 - Med Legal Section

  • Drugs found on patients (other than small amount of THC)
    • Call the Sheriffs to dispose of substance
      • No charges pressed if here for OD
      • If here for CC other than drug OD, may have charges pressed

11.1 Medical-Legal Specimens

Medical –legal specimens removed from patients in the DEM will be handed to law enforcement if available or taken to the Pathology Department. Each person handling the specimen will be expected to complete the chain of possession information.

PROCEDURE

  1. Containers or envelopes for legal specimens can be obtained from Pathology.
  2. Complete all information on front of the small envelope. Physician to place specimen into the envelope and seal.
  3. Employee who seals the small envelope must sign across the outside flap.
  4. RN to fill in all information on the top third of the large envelope as well as #1 under Chain of Possession of Specimen. Place small envelope into larger one, DO NOT SEAL.
  5. RN to hand envelope to law enforcement or take envelope along with Surgical Pathology Tissue Report Form (completed by Physician) to Pathology Department.


14 Medications

14.2 Prescription Refill for Patients from Harbor-UCLA Clinics

  • Medications will only be refilled for registered ED patients. Unregistered patients will be referred back to their primary care provider for refills.
  • For psychiatric medication refills, referral can be made to the Psychiatric ED or Exodus.


15.1 Visitors in the ED

http://myladhs.lacounty.gov/polproc/Harbor%20Policies%20and%20Procedures/DEM%20Policy%20Manual/15.1%20Visitors%20in%20the%20ED.pdf

  • Due to the unique setting of the Emergency Department, the decision to permit visitation is at the discretion of the Emergency Department staff. Visitation may be restricted in an emergency situation and/or any active or potential hospital safety situation.
  • In accordance with Harbor-UCLA Policy 109A, each patient has the right to designate visitors of his/her choosing with the following exceptions:
    • Staff safety needs to be maintained at all times;
    • Staff needs to be able to perform their duties with minimal interference from visitors;
    • When no visitors are allowed;
    • The patient has notified the healthcare provider that he/she no longer wants a particular person to visit;
    • No more than one visitor at the bedside unless approved by DEM staff; or
    • Visitors must remain inside the patient’s room. Visitors will not be allowed to stand in the hallways.

In some instances, it may be beneficial to allow a family member or support person to be present while a procedure is being performed at the discretion of ED staff. This usually relates to a parent/guardian of a child, caregiver, or support person who can enhance the patient cooperation interaction experience.

  • Family presence at the bedside or in the room is encouraged for a variety of medical or surgical procedures, including resuscitation, while avoiding any disruption in care being provided.
    • A chair should be provided for all family members who are present during a procedure/resuscitation for their own safety.
    • Prior to a family member entering the resuscitation area, a staff member will notify the team that the family has arrived/present.
    • Offer the family simple comforts such as a phone, tissues, water, restroom access, and clergy.
    • As much as possible, a staff member (MD, NP, RN, LCSW) will accompany and explain to the family members the following:
      • What they are about to see.
      • They can leave the room at any time.
      • They may be asked to leave the room at any time for a variety of reasons
      • While we understand that they may become emotional and we support. their feelings, they must not interfere with medical treatment.
  • In the event of patient death:
    • Department of Social Services or nursing should provide the family with a copy of the Harbor UCLA Medical Center Bereavement Packet with information on funeral homes, community support groups, and information concerning the disposition of the body.
    • For pediatric deaths, nursing may offer the family a lock of hair, a hand or foot print when possible.
    • Provide the family with the telephone number to the ED for any questions they may have after returning home.

16 Prehospital Care

16.1 Paramedic Clinical Training Policy

  • Paramedic/trainees, during the course of their education, will abide by the clinical practice policies for the Department of Emergency Medicine (DEM).
  • Paramedics/trainees shall be directly supervised by a physician or a registered nurse working in the clinical area. Paramedic/trainees must adhere to local EMT-P Scope of Practice, per Ref. 803 Los Angeles County Prehospital Care Manual, while performing clinical duties in the emergency department.
  • Paramedics/trainees may administer medication only when directly supervised by a physician, registered nurse, or paramedic instructor. Paramedics/trainees may administer only those medications found in the Los Angeles EMT-P Scope of Practice per Los Angeles County Prehospital Care Manual Ref. 803. It is the responsibility of the paramedics/trainees to be knowledgeable of all information concerning each medication prior to administration.
  • Any specific medical questions directed at a paramedic/trainee shall be referred to the patient’s physician or registered nurse.
  • In the event of an incident involving a paramedic/trainee in the clinical setting, reporting of the incident should be in accordance with Harbor-UCLA policy 612A. The paramedic/trainee shall report the incident to the Charge Nurse, who will notify the prehospital care coordinator (PCC). The PCC will report the incident to the paramedic/trainee’s training institute and to their provider agency.

16.4 Guidelines for Prouncement in the Field

  • Pronouncement may only be performed by an attending physician in the Department of Emergency Medicine or a senior resident (3rd or 4th year resident) that has completed the Base Hospital Physician Course and Radio Internship.
  • The physician will determine if futility is met and comply with LA County Prehospital Care Manual Ref No. 814 Determination/Pronouncement of Death in the Field when pronouncing a patient in the field.
  • The MICN or Base Physician providing the online medical direction will complete the base documentation form with all of the pertinent information, including the name of the pronouncing physician and time of death

16.5 Paramedic Radio Candidate (Internship) Protocol

  • In order to be eligible to begin internship, the MICN or Base Physician candidate must demonstrate completion of the LA County MICN certification examination or Harbor-UCLA Base Physician Course respectively.
  • Currently certified MICNs, not sponsored by Harbor, requesting to intern on Harbor’s paramedic radios will: 1) Provide proof of current Advanced Cardiac Life Support Provider Course completion and 2) Provide proof of current Los Angeles County MICN certification.
  • Preceptors will directly observe the candidate in the process of taking paramedic runs.
  • The direction of the run will be the responsibility of the preceptor.
  • Direction of a paramedic run by a MICN or Base Physician candidate without the observation of a preceptor may be considered grounds for failure.
  • Preceptors will have a minimum of 6 months experience as a MICN at Harbor, or be a senior DEM resident or a DEM attending that has completed the Base Physician Course and Internship.
  • MICNs must comply with LA County Prehospital Care Manual Ref 1010 Mobile Intensive Care Nurse (MICN) Certification and complete the internship in accordance with this policy.
  • Satisfactory completion of radio internship will require that the Base Hospital Medical Director (BHMD), PCC and Asst. PCC (if applicable) are in agreement that the MICN or Base Physician candidate has performed in a safe and competent manner in the area of assessment, treatment, verbal communication, or record keeping skills.
  • Failure of internship will require that the BHMD, PCC, and Asst. PCC (if applicable) are in agreement that the MICN or Base Physician candidate has failed to perform in a safe and competent manner in assessment, treatment, verbal communication, or record keeping skills.
  • In the event of failure of an MICN candidate, the MICN candidate may petition the BHMD and PCC to retake the radio internship. The petition should occur within 6 months of taking the LA County MICN certification, or Harbor-UCLA authorization exam.
  • In the event of failure of a DEM physician candidate, the physician will be remediated until competency is achieved.

17 Notification & Reporting

17.1 Family and Next-of-Kin

  • All attempts will be made to notify family or legal guardians whenever possible and as soon as possible when a minor presents or is brought to the emergency room. However, these attempts will not delay emergent care when an emergency medical condition exists. Additionally, the family or next-of-kin of adult patients will be notified at the patient’s request.
  • In the event of a critical patient or patient death Social Services will be contacted to assist with family notification.
  • All attempts to notify family and next of kin should be documented on the patient’s health record.

17.2 Animal Bites

  • All animal bites to people, including bites by domestic animals, are legally reportable in Los Angeles County, except for rodent and rabbit bites. Animal bites will be reported to the Los Angeles County Veterinary Public Health-Rabies Control Program by the DEM staff upon completion of emergency treatment. Exceptions include animal bites sustained in Pasadena, Long Beach, or Vernon, which should be reported to their respective animal control agencies.
  • Reporting may be done via the Los Angeles County Veterinary Public Health-Rabies Control Program Animal Bite Reporting Form or via the Los Angeles Veterinary Public Health-Rabies Control Program online portal.
  • Pertinent information should be documented in the electronic medical record and electronically submitted to Los Angeles County Veterinary Public Health

18 Diagnostic Tests

18.1 HIV testing in the ED

In compliance with Harbor-UCLA Policy 318, when HIV testing is performed in the ED:

  • Patients must be informed that they are being tested for HIV, with an opportunity to decline, or “opt out” of the test.
  • HIV tests ordered in the ED on patients who might be discharged should always be rapid HIV test, so that the results come back while the patient is in the ED. The ELISA test should be reserved for admitted patients.
  • The ordering physician (or a designee) should follow up on the result of a rapid HIV test before the patient leaves the ED. If the patient leaves prior to completion of care, the patent should be placed on the lab follow-up track to ensure notification of results.
  • For a positive HIV result in adults, the HIV fellow should be contacted. For pediatric patients, the pediatric ID service should be consulted. These consults should occur before the patient leaves ED, to arrange for follow up, to assist with recommendations regarding disclosure of the preliminary positive result, and also to ascertain the likelihood of this result being a true positive (if thrush, leukopenia, seborrheic dermatitis, etc. are present, the HIV service would like to see the patient in the ED). If the fellow cannot be reached, the Director of the HIV Clinics at HUCLA may be contacted.
  • The patient should be informed of a positive result before leaving the ED, and be counseled that the test (rapid HIV test or ELISAs) yields a preliminary result. A positive test doesn’t always indicate HIV infection, but should be taken seriously with arrangements made for early follow up of the confirmatory test.
  • A confirmatory test (the Western Blot) should be sent on all patients with a positive rapid HIV or ELISA. The results takes about a week come back and will be followed up by the HIV service.
  • Patients should be scheduled to go to Harbor-UCLA Medical Center’s HIV clinic in about one week, to discuss test results (the Western Blot should be back by then). The fellow can help arrange for an appointment.

18.3 Follow-up of Abnormal Test Results – Adult ED and Pediatric ED

In conjunction with Harbor-UCLA Policy 393B, the following mechanisms have been established for notifying and recalling Emergency Department (ED) patients with abnormal/critical test results who are deemed to need further evaluation or care.

  • Laboratory Studies:
    • Critical Laboratory Values – When the laboratory calls the ED with critical lab values the following procedures will be followed:
    • For patients in the ED, the clerk who receives the call from the lab will transfer the call to the RN caring for the patient. The RN will verbally report the critical lab value to the appropriate care provider. This verbal report process includes a read back by the provider for confirmation, and nursing documentation of the verbal report in the electronic medical record. In all cases, the provider and nurse caring for the patient will be apprised of the test results.
    • For patients still in the waiting room, the clerk who receives the call from the lab will refer the call to the triage provider, who will assure that the patient is brought into the ED for further evaluation as soon as appropriate and possible.
    • For patients who have been discharged from the ED, or who have left the ED or waiting room before completion of their evaluation, the clerk who receives the call from the lab will refer the call to the triage provider. The provider will attempt to contact the patient (by phone or telegram) and ask him/her to return to the ED for evaluation if appropriate. Documentation of communications regarding critical lab results and plan of action will be placed in the electronic medical record.
  • Lab Follow-up
    • Any patients with outstanding lab results at the point of discharge will be placed on the lab follow-up track for review and patient contact once the labs are resulted.
    • Clinic Referrals – When patients are referred to Harbor-UCLA Medical Center clinics or to community clinics with access to the hospital information system, follow-up on laboratory results can be performed by their empaneled provider. The ED provider should message the empaneled provider in the EHR (and “save to chart”) to ensure follow-up.
    • Sexually Transmitted Disease Information – Patients with outstanding tests for sexually transmitted infections (STI) should be placed on the lab follow-up track. Once reviewed, the patient will be contacted with results and prescriptions will be given if further treatment is warranted.
  • Radiographic Studies:
    • Plain film (x-ray) radiographic studies performed on ED patients are always interpreted by the emergency provider prior to the patient being discharged from the ED. This initial interpretation is documented in the electronic medical record. All radiographic studies are also interpreted by the radiologist.
    • For all radiographic studies, when there is a critical result or the radiologist's interpretation differs significantly from the emergency physician's interpretation, radiology will immediately notify the Adult ED attending or DEM senior resident for adult patients, and the PED attending or resident for pediatric patients, per the Department of Radiology policy. If the patient has left the ED, the ED Attending or Senior Resident will review the patient's record. If appropriate, the physician will call or send the patient/child’s parents a telegram informing them of the need to return to the ED for re-evaluation. The physician’s actions are recorded in the patient's medical record.
  • Microbiology Studies:
    • Positive blood or stool cultures are reported by laboratory to the AED senior resident for adult patients, and to the senior PED resident or pediatric nurse practitioner in the PED. The provider is responsible for review of the electronic medical record, and for calling the patient back to the ED for re-evaluation and treatment as needed. The provider is also responsible for documentation of their medical decision making about these test results in the electronic medical record


21 Triage and Medical Screening Examination

==21.1 Medical Screening Examination Policy

  • A medical screening exam (MSE) will be provided to any child or adult who comes to the Emergency Department (ED) per the Policy No. 374A Medical Screening Exam. The MSE will be performed within the capability of the Department of Emergency Medicine. The examination will be the same appropriate screening examination that would be performed on any individual with similar signs and symptoms, regardless of the individual’s ability to pay for medical care.
  • A medical record will be established for every patient who registers to be seen in the ED. If a patient leaves the hospital before receiving a MSE, a hospital medical record will be established for the patient with documentation of the results of the visit.
  • The MSE is a continuous process reflecting ongoing monitoring in accordance with the individual’s needs. Monitoring will continue until the individual is stabilized or appropriately transferred. Reevaluation of the patient must occur prior to discharge or transfer.
  • The categories of persons qualified to perform a ED MSE include licensed independent practitioners (physicians and nurse practitioners).

21.2 Guidelines for Triage and Medical Screening Examination (MSE)

  • Triage priority is based on the router nurse’s perceived urgency of a patient’s need for medical evaluation and/or treatment following initial assessment. Patient acuity is determined at the time of triage in accordance with the Emergency Severity Index (ESI). Please refer to the AHRQ Implementation Handbook for details.
  • Ambulance patients are generally placed directly into ED treatment bays, but may be referred to the Triage/MSE Area for formal assessment and prioritization relative to other ED waiting room patients if assessment by a licensed physician determines that the patients are non-critical and stable for triage.
  • A MSE will be performed and documented on all patients who register for evaluation in compliance with Harbor-UCLA Policy 374A. After triage, low-acuity patients who have been determined to not have an emergent medical condition (EMC) after initial evaluation may qualify to be seen in the Urgent Care Clinic (UCC), GYN Urgent Care Clinic, or referral to another specialty clinic. At no time will ED staff imply that patients must be seen in the UCC.
  • For patients with severe pain, the nurse and/or independent practitioner will document how the patient’s pain was addressed prior to sending the patient to the UCC for further evaluation.
  • Patients with the following vital signs should not be referred out of the Emergency Department:
    • Blood Pressure < 90/50 or > 240/140
    • Heart Rate < 40 or >120
    • Temperature < 95˚F or >103.9˚F
    • Respiratory Rate < 8 or ≥ 28
    • Pulse Oximetry < 90% on room air or the patient’s dose of home oxygen
    • Glucose < 60 or > 400 (Only measure if indicated/not necessary on all patients)


21.4 Care of Potential Myocardial Ischemia Patient in Triage

  • All adult patients presenting to the DEM triage area with a chief complaint suggestive of myocardial ischemia will be screened rapidly by the Router RN to determine the need for immediate intervention using the following criteria:
  1. Age >35 AND chest, arm, neck, jaw pain that is described as pressure, heaviness, or discomfort.
  2. Age >45 AND Shortness of Breath, weakness, or arm numbness, CONCERNING FOR A CARDIAC ETIOLOGY and without other explanation
  3. Age > 65 AND Nausea, lightheadedness, “indigestion”, or “dizziness" CONCERNING FOR A CARDIAC ETIOLOGY and without other explanation
  4. Clinical concern for myocardial ischemia exists despite absence of 1-3
  • If the patient meets the above criteria the Router RN will assign “cardiac” triage priority which automatically orders an EKG.
  • the patient will be placed in RME1 for immediate EKG
  1. Once the ECG has been completed, the triage nurse will notify the RME provider who will review the ECG

Approved June 2015, Chappell 2/22/16

21.5 Medications in Triage: Standardized Procedure

  • Administration of medications in triage (MIT) is to provide timely treatment for patients arriving to the ED with pain, fever, dyspepsia, or nausea and vomiting at the time of triage/assessment and reassessment. Available medications include Acetaminophen, Ibuprofen, Maalox, or Ondansetron.
    • PAIN: All patients who arrive to the ED Triage area will have their level of pain assessed and documented in the EMR. The pain scales used are FLACC, Numeric, and Faces, depending upon the age of the patient.
    • FEVER: All patients who present to the ED Triage area will have their temperatures taken and documented in the electronic medical record. All patients who present with a temperature > 100.4º F (38º C) [can be axillary, rectal, or oral temperature] shall be offered acetaminophen or ibuprofen. If a previous antipyretic has been given (either at home or in triage), an alternate antipyretic will be given if temperature >100.4º F (38º C). Rectal temperatures must be obtained for all of the following pediatric patients: Infants less than 2 months old, Children less than 2 years old with the exception of children presenting with minor trauma, & Active seizure patients up to 3 years old
  • Assessment of the patient’s symptoms (pain, fever, gastritis symptoms, nausea and/or vomiting) should be reassessed within 1 hours of the medication given in triage.
    • Patients who after reassessment of pain (within one hour of receiving the 1st dose of acetaminophen or ibuprofen) continue to complain of pain and desire further analgesic treatment will then be offered acetaminophen or ibuprofen alternating from the previous medication administration.
    • Patients who continue to complain of pain and/or fever may have a repeat dose of acetaminophen 4 hours after the initial dose, and/or a repeat dose of ibuprofen 6 hours after the initial dose.
    • Patients who continue to complain of dyspepsia may have a repeat dose of aluminum hydroxide and magnesium hydroxide antacid (Mag-Al Plus) 6 hours after the initial dose.
  • A nurse practitioner or physician provider will be notified of any patient that:
    • The triage nurse assesses to require more analgesia than oral acetaminophen or ibuprofen or aluminum hydroxide and magnesium hydroxide antacid (Mag-Al Plus) can provide

Consent

  • PD Blood ETOH draws: patient must be registered, police sign written consent form
    • ED staff will draw samples if the patient submits to the test, but will NOT attempt to obtain blood if physical force is required (by staff or law enforcement) to obtain the test
    • persons under arrest are only deemed to have given implied consent if they are unconscious or cannot refuse a test for other reasons

Approved November 2015, Chappell 2/22/16

See Also

References

  1. Approved June 2015, Chappell 2/22/16