emergency department policy and procedure manual
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emergency department policy and procedure manualClose this message to accept cookies or find out how to manage your cookie settings. Section 2Cambridge University PressEmergency Nursing Principles and Practice, 6th edn. St, Louis, MO: Mosby, 2010. 2. Paige JB. Solve the policy and procedure puzzle: bring together numerous departments to create one inclusive patient care model. San Diego, CA: Governance Institute, 2009. 4. Hudson K. Policy and procedure management: a job that’s never done. History of the Joint Commission. (accessed January 2014 ). 7. Hudson K. From research to practice on the Magnet pathway. Continuous Quality Improvement in Health Care: Theory, Implementation, and Applications. Gaithersburg, MD: Aspen, 1999. 9. Institute of Medicine of the National Academies. Washington, DC: IOM, 2010. 10. Zavotsky KE. Developing an ED training program: how to “grow your own” ED nurses. Statement of Conditions: Compliance Document, 2004. (accessed January 2014). 13. Joint Commission on Accreditation of Healthcare Organizations. Gaithersburg, MD: Aspen, 1990. They will be marked new for up to 6 months after being added. Deaths DNR PATIENTS POLICY FOR CERTIFICATION OF DEATHS THE DEATH CHART: STEPS TO PROPER COMPLETION XIII. Nursing ASSESSMENT AND TREATMENT OF THE PATIENT WITH ACUTE PAIN CHAPERONES FOR EXAMINATIONS IN THE EMERGENCY DEPARTMENT Updated Sept. 27, 2006. Physician Administration ASSESSMENT AND DOCUMENTATION OF DIRECT ADMISSIONS CO-SIGNING ORDERS FREEDOM HOUSE RECOVERY CENTER MEDICAL DETOXIFICATION OUTSIDE THE HOSPITAL NURSE PRACTIONER SUPERVISION IN THE EMERGENCY DEPARTMENT SCHEDULE MAKING - NURSE PRACTITIONERS IN ED SICK CALLS BY NURSE PRACTITIONERS IN ED XV. Consultation and Consent Services XVII. Disposition ED HOLDING PATIENT CRITERIA LOCATED WITHIN CDU (6 WEST) UTILIZING CDU FOR HOLDING OF ED PATIENTS XVIII. Disaster Management ENHANCED DECONTAMINATION PROCEDURE STANDARD DECONTAMINATION PROCEDURE RADIATION INCIDENT MANAGEMENT PLAN Updated Sept. 27, 2006 Carolina Air Care Manuals 12.http://bluecrown-fx.com/files/delphi-fuel-injection-pump-manual.xml
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Hospital and University Human Resources Manuals This manual is designed as a guide for medical, nursing and administrative staff of the Emergency Department of the University of North Carolina Hospitals. Information contained in this manual has been compiled by the Emergency Department Nursing and Medical Administration and approved by the Chairman, Department of Emergency Medicine.We therefore depend upon good relationships with the University, the UNC Health Systems, community physicians, and citizens in our communities for a successful practice. To function as an integral and responsible member of the University of North Carolina, Division of Health Affairs, School of Medicine, and the University of North Carolina Hospitals. To provide patient care, service to the physicians, for the community, region, and state. To teach the principles and practice of medicine and emergency medicine to health professionals, students, and house officers of all specialties, including emergency medicine residents. To provide direction to the Emergency Medical Services of Orange County and the State. To become an influence in local, state, and national emergency medicine academic and political activities. To produce research in clinical care, basic science, and health care systems, both in emergency medicine and in interdisciplinary fields.The Pediatric Trauma Team will be called for patients less than 16 years of age and the Adult Trauma Team for patients 16 years of age and other. To notify and mobilize the Trauma Team based on physiologic and Anatomic criteria of the injured patient as reported by prehospital or emergency personnel. Trauma activation should be initiated based upon the trauma tier system criteria listed below: I. CRITERIA FOR TRAUMA SYSTEM ACTIVATION To ensure that injured patients receive appropriate medical care, the following criteria shall guide health care professionals in rendering trauma care.http://ecogestval.com/userfiles/file/delphi-evap-tester-manual.xml Crushing, amputation or degloving injuries distal to elbow or knee. Criteria for Trauma Green (NO ALERT ACTIVIATION COMPUTER VIA COMPUTER IS NECESSARY) Hemodynamically stable GCS 15 RTS 12 Falls greater then 20 feet with a GCS 15 or RTS 12 Patient traveling at a speed greater then 40 mph with a GCS 15 or RTS 12 No obvious deformities Classified as green tag by EMS or Transferring agent II. RESPONSIBILITY FOR ACTIVIATION OF A TRAUMA ALERT Activation Prior to Patient Arrival to the ED The Charge Nurse will activate the trauma paging system with a goal of 15 minutes prior to patient arrival. If there is significant forewarning (greater than 15 minutes) the charge nurse shall notify the ED Attending regarding the number of patients, type of injury and estimated time of arrival. The ED Attending shall notify the in house surgery residents.ED Attending will be in charge until Trauma Surgery Resident (PGY4 or higher) arrives. Trauma Attending will respond within 20 minutes of activation. Physicians are expected to sign Trauma Flow Sheet for accountability. Primary Nurse will record all other team members. The trauma Surgery Service team will receive a page by the alert system but will not respond to a yellow alert until called by the ED Attending.PROCEDURE The House Nursing Supervisor reports bed status to the Emergency Department physicians each day at the beginning of the afternoon shift. Periodic reassessments will continue about every four hours during the period of critical bed status. During the period of critical bed status, requests for emergency transfers will be determined case by case, in accordance with federal law (Emergency Medical Treatment and Active Labor Act-EMTALA). The attending emergency physician will discuss potential transfers with both the House Nursing Supervisor and the responsible faculty member on call before denying transfers. The unavailability of a bed and the inability to accommodate the transfer in any way shall be fully documented.http://fscl.ru/content/boss-gt3-manual-free-downloadThe below policy requirements are to be followed consistent with federal law on accepting transfers. Trauma transfers from other emergency departments can only be diverted with the approval of the trauma attending on call and the chief of staff. Acceptance or denial of transfers, of other types of patients from other emergency departments, are determined by the attending emergency physician. Such decisions are based upon the best information available from multiple sources including the patient s medical needs; OR, ICU, and floor bed capability and nursing resources; and the bed capacity and nursing resources in the ED. Transfers from inpatient beds at other hospitals to UNC inpatient beds can only be accepted or denied by the attending responsible for that service. Judith E. Tintinalli, MD, MS Professor and Chair Department of Emergency Medicine June 25, 2001 July 2, 2001 Approved by UNC Hospitals Medical Executive Committee Replaces Department of Emergency Medicine Policy originally written October, 1989; revised December, 1990; December, 1991; November, 2000 Reviewed and revised as necessary: Dec Updated Sept. 27, 2006 Medical Students present directly to the attending. Any cases supervised by a Resident must be examined by the Resident before approving the work-up. Documentation Standards The ED record documentation standards for all patients with moderate or high complexity problems are as follows: 1. Time of exam 2. ROS as appropriate 3. History and Physical Examination 4. Results of laboratory values that require medical action. Rote transcription of labs in WebCIS is not encouraged. The phrase webcis reviewed is preferred to transcription of lab values. This should reduce unnecessary work and errors. 5. Results of radiologic studies and EKG. 6. Procedure notes 7. Re-evaluation notes when appropriate. 8. Notes indicating time of consultations. 9. Condition on discharge. 10. Activity excuse notes. 11. Follow up instructions. 12.https://www.mapefumigaciones.es/images/97-maxima-manual-transmission.pdf An attending note documenting the appropriate level of involvement with the case. James L. Larson MD Medical Director UNC Hospitals Emergency Department May 10, Updated Sept. 27, 2006 PROCEDURE 1. Admission disputes between services need to be resolved within 2 hours. Designation of the admitting service will be delegated to the emergency medicine attending physician if a resolution is not made within 2 hours after the potential admitting services have been notified. 2. It is the responsibility of the accepting service to arrange an inpatient bed prior to transfer of an inpatient from another institution. Patients brought by ambulance will be assessed by the emergency department charge nurse and by the emergency medicine attending. The physician will verify the patient s stability, authorize transport to the inpatient bed, and will notify the appropriate admitting resident. Patients will be registered in the emergency department if they are unstable or if the bed arranged is inappropriate for the patient s condition.PROCEDURE: Prospective telephone referrals from outside physicians, hospitals, or agencies should all be directed to the charge nurse or emergency medicine attending physician. Complex calls should be directed to the emergency physician. Calls from outside agencies or physicians should be directed to the emergency physician at UNC Hospitals. Bed status is maintained by the House Nursing Supervisor who will notify the ED Attending several times each day about bed availability. The Charge Nurse enters transfer information into the SMS system. ED Referrals from Orange County, Trauma Referrals, Referrals from other Emergency Departments All requests for emergency department patient evaluations from physicians or agencies in Orange County, or for scene trauma calls or acute trauma transfers, or from other Emergency Departments in the State, are accepted directly by the triage nurse or emergency physician. Referrals from Inpatient Units to UNC Requests for in-hospital transfers should all be directed to the Emergency Medicine Attending, who will then locate the attending on-call for the appropriate in-patient service. Only the inpatient attending can accept inpatients. Transfer Denials Only Attendings can deny transfers. The chief of trauma surgery is the only individual who can authorize adult or pediatric trauma transfer denials. A log of transfer denials due to insufficient ED hospital resources will be maintained by the ED Attending and submitted monthly to Hospital Administration.Procedure: Maintaining the Transfer Diversion Log. The transfer diversion log will be maintained in a looseleaf folder at the A side attending desk. Each faculty member should indicate diversion status as OPEN or CLOSED at the beginning of each shift, that is at 7AM, 4:30 PM, and 1:30 AM. The date and time should be entered. When status is DIVERSION, the date and time of diversion and the responsible individual (house nursing supervisor, trauma attending) should be entered in the log. The Chief of Staff must be notified and that should also be entered in the log. DIVERSION will normally last for the entire shift. Status should be rechecked at the beginning of each shift as indicated above. Requests by individual faculty in departments other than Trauma for diversion. When faculty from other Departments request diversion for cases in their specialty, that is to be documented in the Diversion Log, with the name of the specialty attending also documented. The Chief of Staff must be notified of such requests for diversion as well. Documenting any refusals of transfers. Communicating OPEN or CLOSED status to the Emergency Department. A side faculty must also write OPEN or CLOSED for each shift on the large wax board in the Emergency Department. Communicating with Hospital Administration. The ED Administrator will forward a copy of the diversion log to Sandra Evans, RN, MBA, on the first of each month. Judith Tintinalli, MD, MS, Chair James Manning, MD, Vice Chair 19 Updated Sept. 27, 2006. PROCEDURE: If a patient does not respond to a callback to triage or to the department, then Emergency Department staff will document no answer and the time on the computerized documentation system (T-system). Attempts will be made to callback the patient for a total of three times, approximately ten minutes apart, with each attempt documented as above. After three attempts, the patient will be documented as having left without being seen and discharged in the computer system (Siemens) by selecting the left without receiving medical advice option. 20 Updated Sept. 27, 2006 It is the responsibility of the private physician, or other services within the UNC system, to communicate with the emergency physician or the ED charge nurse regarding pre-arrival information. PROCEDURE: Pre-arrival information can be entered into the SMS system by the charge nurse, triage nurse, or senior attending emergency physician. Physician to physician calls will be entered directly by the senior emergency physician into the SMS triage referral system. UNC Hospitals ISD system is responsible for maintenance of all SMS sites. There is no method to maintain a permanent record of pre-arrival information, as this is all located in temporary files. The triage nurse or charge nurse must actively query the triage referral screen in order to determine if pre-arrival information has been entered on the patient. System errors which can result in loss or failure to capture pre-arrival information include: 1) patient arrives in the ED before the private physician or UNC service calls the ED; 2) nurse or attending physician is occupied with critical patient tasks and enters information after the patient has arrived; 3) private physician or UNC service does not communicate with the ED regarding pre-arrival information; 4) triage or charge nurse may fail to query the pre-arrival screen. Judith E. Tintinalli, MD, MS Professor and Chair James L. Larson, MD Professor and Clinical Director 21 Updated Sept. 27, 2006 22 MENTAL HEALTH EVALUATION IN THE EMERGENCY DEPARTMENT November 3, 2000 POLICY: To prioritize and efficiently manage patients presenting to the emergency department with mental health problems, and to insure the provision of appropriate medical evaluation for all patients with mental health problems. For purposes of this policy, patients with mental health problems are those with a chief complaint of a psychiatric nature and with no acute medical problems identified at triage. These patients are triaged directly to the psychiatry crisis service in the ED. They will be triaged to Rooms 16 and 17 in the ED or other appropriate acute care bed within direct visual range of nursing staff. The purpose of a Medical Screening Exam is to determine if an emergency medical condition exists and to provide appropriate stabilizing treatment. PROCEDURE: Patients will be provided information regarding the need for their medical condition to be evaluated. Patients will be advised to inform the triage nurse if their condition changes or if they plan to leave without being seen. If a patient expresses the desire to leave, they will be advised of the risks of not having a medical screening exam done and will be asked to sign a Withdrawal of Consent for Medical Screening Exam form. If a patient refuses to sign, the triage nurse will document the patient s refusal, sign and date the form. The form will be retained as a permanent part of the medical record. University of North Carolina Hospitals 23 Updated Sept. 27, 2006 24 OBLIGATION TO PERFORM A MEDICAL SCREENING EXAMINATION UNC Hospitals obligation under federal law is to provide patients a medical screening examination and indicated stabilizing treatment. The purpose of a medical screening examination is to determine if an emergency medical condition exists and to provide appropriate stabilizing treatment. You will be evaluated and triaged as soon as possible based on the severity of your condition. If you decide to leave the UNC Hospitals Emergency Department, or other locations within UNC Hospitals where emergency care is provided, before receiving a medical screening examination by a physician, you are asked to notify the triage nurse prior to leaving. Leaving before receiving further medical examination would be against medical advice and may result in a worsening of your condition and could pose a threat to your life, health and medical safety. 24 Updated Sept. 27, 2006 25 PEDIATRIC RED (LEVEL ONE) TRAUMA RESPONSE COVERAGE September 13, 2005 The Pediatric Surgery Service can not reliably provide attending coverage for pediatric red alert traumas within the required 20 minute time frame during off hours given the geographic constraints of covering WakeMed in Raleigh. The following changes in pediatric red trauma coverage have been developed to assure trauma attending presence within 20 minutes. In addition, red trauma criteria will be reviewed to reduce the number of unnecessary pediatric alerts. The purpose of this arrangement is to provide an initial resuscitation consultation to maintain compliance rather than obviate involvement or assumption of responsibility by Pediatric Surgery. Coverage of Pediatric Red Traumas 1. Pediatric Surgery will be the primary responder for all pediatric red alert traumas between 7:00am and 5:00pm weekdays. Should this be necessary, the Pediatric Surgery attending will personally call the Adult Trauma attending to communicate the need. If this response is anticipated to be longer than 40 minutes from the time of alert, the Pediatric Surgery attending will alert the Pediatric Surgery back-up attending so that they can respond. As a state institution, we have the obligation to provide that opportunity on a 24 hour basis. Procedure 1. Individuals who are charged with DWI and receive a breath analyzer test in Orange and Chatham counties will be advised that they can come to the emergency department at UNC Hospitals to have a blood ethanol level drawn, and that they will receive the standard emergency department and laboratory charges for the procedure 2. The individual reports to the Triage Desk with a form signed by the responsible police jurisdiction. PROCEDURE: Requests for diagnostic or interventional studies without emergency medical indication are not performed in the Emergency Department. Examples of such requests include but are not limited to requests by lawyers for blood ethanol levels for clients, requests by a parent for a routine toxicology screens on a child, and requests for routine HIV testing. Judith E. Tintinalli, MD, MS Department Chair Sandy Pabers, RN, CNS II Nurse Manager 27 Updated Sept. 27, 2006 28 SEXUAL ASSAULT EVALUATION Department of Emergency Medicine Policy: Sexual Assault Evaluation is accomplished by the SANE team. Physicians assist in the medical aspect of sexual assault care. GENERAL STATEMENTS (1) The North Carolina Board of Nursing does not differentiate the role of a nurse as it pertains to gender. (2) The North Carolina Nurse Practice Act does not differentiate the role of the nurse as it pertains to gender in the delivery of nursing care. (3) The University of North Carolina Hospitals does not differentiate or limit the role of the nurse as it pertains to gender in the delivery of nursing care. (4) The University of North Carolina Hospitals Legal Department knows of no existing policy addressing gender in pelvic or sexual assault examinations and forensic evidence collection. (5) The delivery of nursing care should be patient-based and should reflect the patient s needs and desires whenever possible. Explanation should be given in terms the patient understands. (2) All patients should be informed as to personnel to be present during the examinations and as to their roles. (3) In sexual assault cases, the patient should be informed of the availability of a rape counselor. At the patient s request, a rape counselor may be present throughout the examination. (4) This Emergency Department policy and procedure will be reviewed periodically and updated as needed to reflect current nursing practice. Revised: February, Updated Sept. 27, 2006 30 EMERGENCY DEPARTMENT STANDING ORDERS The Clinical Operations Group of the Department of Emergency Medicine has developed standing orders for implementation by the nursing staff prior to the patient being evaluated by an emergency physician. These are guidelines for actions to be taken by nursing staff based upon the patient s chief complaint. These do not replace clinical judgment and should be used in conjunction with a patient s clinical presentation. Vital Sign Guidelines: Vitals signs may vary for each patient. Listed below are some general guidelines for each vital sign (for adult patients). If a patient falls outside of these, the patient should be placed on a monitor and a physician contacted immediately. Temperature 31 TREATMENT OF PATIENTS WITH EMERGENCY MEDICAL CONDITIONS POLICY It is the policy of the University of North Carolina Hospitals, that all patients presenting for examination or treatment, including women in labor, shall be given an appropriate medical screening examination by a physician to determine if an emergency medical condition exists. If the physician determines that an emergency medical condition exists, or that a woman is in labor having contractions, the patient shall be treated; the patient may be transferred or discharged only in compliance with the procedures detailed below. Whenever a person who is within 250 yards of the Hospitals buildings needs medical care, but is not inside a hospital building, 911 should be called promptly to provide the person with appropriate level of life support and to transport the person to the Hospitals Emergency Department. If a person comes to a hospital based clinic off the Hospitals main campus, the health care providers at that clinic should perform a medical screening exam to determine if an emergency medical condition exists. If it does, then they should provide care within their capabilities in an attempt to stabilize the patient, and call 911 if it appears the patient cannot be stabilized. With respedt to a pregnant woman who is having contractions, it means: that there is inadequate time to effect a safe transfer to another hospital before delivery; or, that transfer may pose a threat to the health or safety of the woman or the unborn child. The terms stable or stabilized are defined in paragraph 7 below. PROCEDURE Medical Screening Examination 31 Updated Sept. 27, 2006 32 1. All patients presenting to the University of North Carolina Hospitals for examination or treatment, including minors without a parent and women in labor, shall be given an appropriate medical screening examination by a physician to determine if an emergency medical condition exists. The medical screening examination may include laboratory tests, radiology studies, or consultations, as appropriate. 2. The medical screening examination shall be performed without regard to the patient s ability to pay, and without regard to the diagnosis, financial status, race, color, national origin, disability, sex, or age. Discharge or Transfer 7. If the physician determines that an emergency medical condition does exist, the patient may be discharged or transferred from UNC Hospitals when the patient has been stabilized. As to a pregnant woman having contractions, stabilized means that the woman has delivered the child, including the placenta. As to a pregnant woman having contractions, stabilized for transfer means that the woman has delivered the child, including the placenta. Requests in writing, including the reasons, for transfer to another medical facility a) after being informed of UNC Hospital s obligation to provide care without Fegard to ability to pay and obligation to stabilize the patient prior to transfer, and b) after also being informed of the risks and benefits of transfer, or - b. A physician has signed a written certification, including the risks, benefits and reasons fpr transfer, that the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual, and, in the case of labor, to the unborn child from effecting the transfer. A patient under psychiatric commitment who is not stabilized may be transferred to another facility when a physician has documented in the medical record the risks and benefits of transfer. Patients, except those under involuntary commitment, must consent to a transfer. 9. The transfer must be effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. For physician-initiated transfers for medical benefits, a re-evaluation of the patient must be performed shortly prior to the actual transfer, and the findings documented in the medical record. If the patient has been stabilized or is unchanged, proceed with the transfer. The receiving medical facility must have available space and qualified personnel for the treatment of the patient, and prior to transfer, must have agreed to accept the transfer of the patient and agreed to provide appropriate medical treatment. The receiving medical facility s agreement to accept the transfer shall be documented, including the date and time of the agreement to accept the transfer and the name of the person accepting the transfer. 33 Updated Sept. 27, 2006 View more Page 1 of 11 Patients with emergency medical conditions were Each year in the United States, burn injuries result in more than 500,000 hospital Such rules and regulations may be a part of these bylaws except History, Physicals and Routine Health Care UNC-CH School of Nursing Faculty Practice Carolina Nursing Associates Review education and basic Virginia Beach Department of Human Services MHSA Division 409 Birdneck Circle Virginia Beach, VA 23451 For detailed procedures and information see the Family Violence Policy and Procedures; Suspected Child The consumer is: Patients shall be attended by their own private Medical Revised 2015. Society of General Practitioners You about to embark on a four-week excursion into an area of pediatrics which will be slightly different from any other area you have so far Revision January 2015 Which HCPCS codes are used for reporting hospital None of the following questions or answers He is ultimately responsible for the professional conduct To use this website, you must agree to our Privacy Policy, including cookie policy. The 13-digit and 10-digit formats both work. Please try again.Please try again.Please try again. The sample materials can serve as a foundation from which managers may develop and build upon their own forms, policies, and procedures for their own emergency departments. Features include: Strategies for managing a more cost-effective emergency department Emergency care pathways and protocols Quality improvement policies and guidelines Patient assessment and triage Risk management and legal issues And more. Emergency Department Manual has been updated to include: Important legal information including: Revisions to the Emergency Medical Treatment and Labor Act (EMTALA) regulations adopted in 2009 HIPAA Communications with Family and Friends Essential Guidance from the Centers for Disease Control: CDC Guidelines for Disinfection and Sterilization CDC Standard Precaution Guidelines Plus new information on: EMS and Terrorism Injury Data from the Emergency Department Emergency Medical Services Management of Swine Origin Influenza Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Register a free business account To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Updates to the manuals are done by Corporate Governance and Risk Management Branch as electronic amendments. A register of amendments accompanies the electronic version of each manual. To request written permission, ask a question about this site, or report a broken link, please contact the IHOP Coordinator. The information is believed, but not guaranteed, to be correct. Guidance reflects our expert opinion and is not necessarily applicable to all institutions. It is intended to be a reference for clinicians caring for patients and is not intended to replace providers’ clinical judgment. For comments or suggestions please contact Jeff Holmes, M.D. The teaching module will take users through the setup, technique, and findings in early pregnancy. For more information, please contact Liz Andrada.