Republic of the Philippines Province of Rizal City Government of Antipolo
Rizal Provincial Hospital System- Antipolo Annex Annex II Provincial Road, Brgy. Dalig, Antipolo City el !o. "#$%&' ()*+-*
EMERGENCY ROOM
+ A!DAR A!DARD D / + /P0RA1!G P + PR/C0D2R0
INRO!"CION
0mergency nursing is a specialty area of the nursing profession li3e no other. 0mergency nurses must possess both general and specific 3no4ledge about health care to provide 5uality patient care for people of all ages. 0mergency nurses must be ready to treat a 4ide variety of illnesses or in6ury situations, ranging from a sore throat to a heart attac3.
he 0R nurse as a member of the emergency response team has been responsible for triaging and caring for patients at the emergency department for care. his includes assessments, diagnosing, planning, therapeutic interventions, care delivery and evaluation. 0mergency nurses specialize in rapid assessment and treatment 4hen every second counts, particularly during the initial phase of acute illness and trauma. 0mergency nurses must tac3le diverse tas3s 4ith professionalism, efficiency and above all 7 caring.
his scope of service for the 0mergency Department aims to offer guide to 0R nurses so as to provide 5uality care to patients in the Rizal Provincial 8ospital ystem + Antipolo Anne9 11 0mergency Department.
GOA# O$ HE EMERGENCY !EPARMEN •
o provide 5uality emergency care in the most effective and efficient manner to
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all patients presenting to the RP8 7 Antipolo Anne9 11 0R. o provide an efficient transition into the hospital for the patients re5uiring
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admission. o provide accurate triage assessment of all direct admission patients 4ho pass
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through the department. o strive in improving the 5uality of emergency care provided by the revie4ing practice and adopting performance improvement pro6ects as a vehicle for
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change. o reflect contemporary practice in emergency care.
O%&ECI'ES O$ EMERGENCY !EPARMEN •
Primary ob6ective of 0mergency Department is to render immediate 5uality care
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to emergency patients. Contributory ob6ectives are: *. o have an understanding of survival procedures and emergency life saving measures. &. o provide the best clinical e9perience for nurses and other members of the health care team.
PRIORIIES O$ EMERGENCY MANAGEMEN
he ma6or goals of emergency medical treatment are: • • •
o preserve life. o prevent deterioration before definitive treatment can be given. o restore the patient for useful living. G"I!E#INES IN EMERGENCY !EPARMEN *. Attend to patient immediately for emergency measures.
&. /btain patient;s data records, vital signs and refer patient to the physician on duty. %. /R0> CAR0. ?. Assist the Doctor 4hile e9amining the patient and carry out orders promptly and accurately. . 1f patient;s condition needs admission, obtain informed consent. a. Give initial medications, 1@<;s s3in testing, for4ard laboratory re5uests, 9+ ray etc. b. !otify 4ard nurse before patient is brought to the 4ard. (. Record pertinent information regarding patient;s condition and management in the patient;s chart. *.Accompany patient to the 4ard and endorse properly to 4ard nurse. a. !ame and Diagnosis b. Complaints and Appearance. c. >edications and reatments given. d. Any special procedures. Note( 1f patient is for referral to the agencies for further management, be sure to
have referral slip and proper coordination and ma3e arrangement 4ith the ambulance driver. >a3e sure that the ambulance is properly e5uipped 4ith emergency 3it.
RESPONSI%I#IIES O$ ER !OCORS
*. 09amine patient and 4rite order for medications and treatment needed. &. 1f resuscitative measures failed to the patient 4ithout vital signs, pronounce patient as Dead on Arrival "D/A'.
%. 1f patient is for admission, 4rite and sign admitting order and notify 0R nurse on duty. ). 1f patient is for surgery, 4rite statistical orders on the patient chart for immediate 4or3+ups li3e CBC, urinalysis and any special procedures. -. 1f patient is for referral to the other health facilities prepare referral slip 4ith proper coordination to the Referring hospital. $. 1f patient is for observation advice 0R nurse and give instructions. !ote: /bservation of patient is good up to *& hours only. 1f patient 4ill stay for more than t4elve hours, admit patient and follo4 admitting procedure. ?. 1f patient is for discharge, instruct patient and relatives to comply 4ith the discharge re5uirement.
&O% !ESCRIPION O$ HE N"RSE ON !"Y
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a. b. c. d. e.
1n Patient Care Plan to meet the total nursing needs of the patient. 0valuate the effectiveness of patient care. Promote the improvement of patient care. Give direct nursing care to the patient Responsible for the accurate assessments and documenting treatments and care
rendered 4hether it may be independent, interdependent or dependent. f. Responsible for e9ecution of doctor;s order.
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1n 2nit >anagement
a. Plan for the environment conducive to the physical and spiritual 4ell+being of the patient. b. Participate in the formulation, interpreting and implementing ob6ectives and c. d. e. f. g. h.
policies of nursing care. Promote good nurse+patient relationship. Promote the improvement of nursing service in the unit. each and guide all ne4 nursing personnel in the unit. Assist in the orientation program of the ne4 nursing personnel in the unit. Demonstrate ne4 procedures and use of the ne4 e5uipment in the unit. 1mpart health teaching in personal hygiene to the patient and member of the family.
!"IES AN! RESPONSI%I#IIES O$ HE ER N"RSE ON !"Y
he continuity of nursing care is maintained throughout a &)+hour period by the three +hour shifts. he 0R !urse is responsible for the individualized patient care, placing patient in rooms and liaising 4ith case management. taff !urse: $+& hift I)
En*orsement Receive endorsement from *+$ shift Receive the unit , chec3 supplies and instruments available for the 0R •
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II)
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Department Receive and chec3 patients in the 0R beds as 4ell as the incoming
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patients during shift transition. Chec3 the available room per department for admission of patient foe the
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shift. Chec3 0R ogboo3 and verify if records from previous shift 4ere returned
to the record section. Patient Care Give oral and 1@ medication as ordered. •
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III)
Prepare and administer intravenous therapy as ordered. Assist in treatment and special procedure to be done for the patient. Prepare the patient 4ith medicine secured from supplies if indigent. 09plain the diagnostic procedures li3e +Ray, 0CG, 2ltrasound that the
patient 4ill be sub6ect to. +ar* Policies Ans4er telephone calls. >a3e sure that only one to t4o companion comes 4ith the patient in the • •
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ard. >a3e sure that the patient or relative is informed about any procedure prior to e9ecution.
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Proper !oc,mentation Chec3 the admission documents, referral re5uest and prescription before •
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patient 4ere discharged or transferred. Document all medical treatment and nursing intervention given to the
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patient. Document or report any unto4ard incident during the shift in a clean piece of paper. 1ndicate the date and time of incident, people involved, actual scenario, 4ith the signature over printed name of the !urse on Duty and
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address it to the upervisor on duty. Ho,seeepin. an* Maintenance upervise and guide the 1nstitutional or3er assigned in the area 4ithin •
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the shift. Report out of order e5uipment and instruments to the Charge !urse on
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duty. he Charge !urse should re5uest supplies from the Central upply Room for 0R use.
Sta// N,rse( 0-12 S3i/t I)
En*orsement
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Receive endorsement from $+& shift Receive the unit , chec3 supplies and instruments available for the 0R
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Department Receive and chec3 patients in the 0R beds as 4ell as the incoming
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patients during shift transition. Chec3 the available room per department for admission of patient foe the
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shift. Chec3 0R ogboo3 and verify if records from previous shift 4ere returned
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to the record section. II)
Patient Care • • • • •
Give oral and 1@ medication as ordered. Prepare and administer intravenous therapy as ordered. Assist in treatment and special procedure to be done for the patient. Prepare the patient 4ith medicine secured from supplies if indigent. 09plain the diagnostic procedures li3e +Ray, 0CG, 2ltrasound that the patient 4ill be sub6ect to.
III)
+ar* Policies • •
Ans4er telephone calls. >a3e sure that only one to t4o companions come 4ith the patient in the ard.
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>a3e sure that the patient or relative is informed about any procedure prior to e9ecution.
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Proper !oc,mentation •
Chec3 the admission documents, referral re5uest and prescription before
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patient 4ere discharged or transferred. Document all medical treatment and nursing intervention given to the
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patient. Document or report any unto4ard incident during the shift in a clean piece of paper. 1ndicate the date and time of incident, people involved, actual scenario, 4ith the signature over printed name of the !urse on Duty and address it to the upervisor on duty.
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Ho,seeepin. an* Maintenance •
upervise and guide the 1nstitutional or3er assigned in the area 4ithin
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the shift. >aintain the cleanliness of the 0R Department. 09tend help in cleaning through dusting and scrubbing off the e5uipment
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used li3e urinals, bedpans, surgical instruments, suction machines and the •
li3es. Report out of order e5uipment and instruments to the Charge !urse on duty.
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S,pplies an* E4,ipment • •
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Chec3 available instrument for procedures Refill containers 4ith supplies li3e dried or 4et cotton balls soa3ed 4ith saline alcohol or betadine. Clean instruments and gloves for autoclaving. ist supplies, instruments and e5uipment needed for the follo4ing day that needs to be endorsed to the incoming *+$ shift for re5uisition of the charge nurse in the $+& shift.
Sta// N,rse( 12-5 S3i/t I)
En*orsement
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Receive endorsement from &+* shift Receive the unit , chec3 supplies and instruments available for the 0R
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Department Receive and chec3 patients in the 0R beds as 4ell as the incoming
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patients during shift transition. Chec3 the available room per department for admission of patient foe the
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shift. Chec3 0R ogboo3 and verify if records from previous shift 4ere returned
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to the record section. II)
Patient Care • • • • •
Give oral and 1@ medication as ordered. Prepare and administer intravenous therapy as ordered. Assist in treatment and special procedure to be done for the patient. Prepare the patient 4ith medicine secured from supplies if indigent. 09plain the diagnostic procedures li3e +Ray, 0CG, 2ltrasound that the patient 4ill be sub6ect to.
III)
+ar* Policies
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Ans4er telephone calls. >a3e sure that only one to t4o companions come 4ith the patient in the
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ard. >a3e sure that the patient or relative is informed about any procedure
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prior to e9ecution.
I')
Proper !oc,mentation •
Chec3 the admission documents, referral re5uest and prescription before patient 4ere discharged or transferred.
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Document all medical treatment and nursing intervention given to the
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patient. Document or report any unto4ard incident during the shift in a clean piece of paper. 1ndicate the date and time of incident, people involved, actual scenario, 4ith the signature over printed name of the !urse on Duty and address it to the upervisor on duty.
')
Ho,seeepin. an* Maintenance •
upervise and guide the 1nstitutional or3er assigned in the area 4ithin
•
the shift. >aintain the cleanliness of the 0R Department. 09tend help in cleaning through dusting and scrubbing off the e5uipment
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used li3e urinals, bedpans, surgical instruments, suction machines and the •
li3es. Report out of order e5uipment and instruments to the Charge !urse on duty.
'I)
S,pplies an* E4,ipment • •
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Chec3 available instrument for procedures Refill containers 4ith supplies li3e dried or 4et cotton balls soa3ed 4ith saline alcohol or betadine. Clean instruments and gloves for autoclaving. ist supplies, instruments and e5uipment needed for the follo4ing day that needs to be endorsed to the incoming $+& shift for re5uisition of the charge nurse on duty.
RE$ERRA# O$ PAIEN O OHER HOSPIA#
Patients 4ith condition re5uiring tertiary care need to be transferred to a tertiary hospital for further management, referral form is given to the patient addressed to the
agency they are being endorsed to or their hospital of choice. Communicable Disease cases and Psychiatric cases are transferred to a specialty hospital that caters such conditions.
PROC"REMEN ME!ICINE
Prescription should be given as soon as possible to the patient or their significant others 4hen medications are not available at the hospital;s pharmacy. Relatives are instructed to buy outside the hospital pharmacy 4henever supplies are not available. 0mergency Room "0R' supplies used in critical cases should be replaced as soon as possible. 1n case that the patient cannot afford to replace the 0R supplies used, the !/D should inform the charge nurse for the immediate replacement of the medication used.
PO#ICIES REGAR!ING EMERGENCY S"PP#IES
*. 0R cabinet must be maintained filled ade5uately 4ith supplies and emergency 3it for urgent cases. 1t is the responsibility of the 0R nurse to determine and monitor the ade5uacy of e5uipment, instruments and supplies for the use of the 0mergency Department. &. !o instrument or articles should be brought outside the unit e9cept if it is sub6ect to sterilization. %. Borro4ing instruments or articles for personal use and for use outside the unit is not allo4ed. ). 1f an instrument, catheter or drainage tube is attached to the patient upon transfer to the 4ard, the nurse in charge must replace as soon as possible for use. -. he outgoing and incoming nurse on duty must have endorsement of all e5uipment and articles.
!ISPOSIION O$ %RO6EN ARIC#ES
*. 1f in case of brea3age of anything in the unit, a letter of e9planation must be 4ritten and for4arded to the proper authority. &. here should be a replacement at once of any brea3age and losses in the unit. %. Condemning of article that cannot be use should be brought to the central supply office for replacement.
PAIEN PRESENAION
Patient A.e Ran.e
he 0mergency Department provides health care for emergency presentations of all triage categories of patients ranging from ne4born to aged.
Presentin. Con*itions
A. urgical Cases Cases 4hich re5uire usual and operative procedures are catered. hese include burns, cuts, fall, fractures and vehicular accident 4hich happened fe4 minutes prior to consultation. 8ernia that re5uires emergency operation is accommodated, ho4ever elective cases are referred /PD. B. Pediatric Cases and vomiting that 4ould re5uire hydration are treated 4ithin the 8ydration Partition of the 0mergency Room. C. >edical Cases Patients under medical cases presenting to the 0R 4ill be assessed and given immediate care if necessary. hey 4ill be managed based on the presentation of the illness by the Resident on Duty. Patients 4ith condition re5uiring tertiary care 4ill be advised and assisted to transfer to a tertiary hospital for further management. D. /bstetric and Gynecologic Cases /bstetric and Gynecologic patients presenting to the 0R 4ill be triaged, assessed and should be given initial treatment before referring to the Resident on Duty. Patients 4ho are in labor, 4ith vaginal bleeding and the li3es are assessed, given immediate care then referred.
0. >edico+egal Cases his includes vehicular accident, mauling, stab 4ounds, gunshot 4ound, suicidal attempt or in6ection of poison that happened fe4 minutes or hours prior to consultation. <. Dead on Arrival "D/A' Relatives are advised to send patient for autopsy and death certificate shall be issued by the >edico+egal /fficer 4ho performed the e9amination. 1n case that the
patient has no relatives available, it should be reported to the guard for proper coordination to the police officer.
MINOR PROCE!"RES A ER INCISION AN! !RAINAGE
urgical procedure of an inflamed and superlative 4ound must fre5uently carried out because of infection. he cavity is usually irrigated and 4ound pac3ed and allo4ed to heal by granulation. he causative organism is often Staphylococcus. Nursing Intervention for Patients undergoing I and D
*. 1nform patient about the procedure and indicate ho4 he can be helpful. &. /btain an informed consent. %. Gather instruments needed in the operation: calpel 4ith balde Curved forcep 0ye sheet Drain yringe 4ith needle terile gauze ocal anesthetic terile gloves • • • • • • • •
). Position patient 4ith operative site e9posed. -. Paint the site 4ith antiseptic solution before surgeons apply the drape. $. After the procedure, pressure dressing is applied to seal the 4ound. ?. 0valuate patient;s response to procedure.
E7CISION
Removal of tissue, organ or tumor from the body. Nursing Intervention for Patient undergoing Excision
*. 1nform patient about the procedure &. ecure consent from the patient. %. Chec3 the order of the surgeon. Determine the e5uipment needed for the procedure.
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calpel 4ith blade !eedle holder Cutting needle il3 cutting suture Allis forceps >etz scissors issue forceps terile gloves Gauze pad Cotton 4ith betadine idocaine yringe 4ith needle
). Position patient 4ith operative site e9posed. -. Paint the site 4ith antiseptic solution before surgeons apply the drape. $. After the procedure, pressure dressing is applied to seal the 4ound. ?. 0valuate patient;s response to procedure.
S""RING Nursing Intervention for Patients undergoing Suturing
*. 1nform patient about the procedure. &. ecure consent form the patient. %. Prepare the instruments needed for the procedure: Cutting needle !eedle holder uture sil3 terile )E 9 )E gauze pad • • • •
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Cotton 4ith betadine ocal anesthetic yringe 4ith needle terile gloves
). Position the patient e9posing the affected area. -. Arrange the instruments in the mayo table. $. After donning the gloves to the surgeon, assist in obtaining local anesthetic. ?. After suturing, a clean dressing is then put in place. . 0valuate patient;s response to the procedure.
REMO'A# O$ $OREIGN %O!Y
Removal of foreign body li3e needle, fish hoo3, bone, 4ood or glass and the li3es 4hich penetrates the s3in and underlying tissue. Nursing Intervention for Patient undergoing Removal of Foreign Body
*. Position the patient e9posing the affected area. &. 1nstruct the patient not to remove the foreign body since uns3illed manipulation produces s4elling or infection 4hich ma3es removal difficult.
%. he physician places mar3er near the foreign body before any attempt of surgical removal is made. ). Re5uest for 9+ray as ordered to confirm the success of the surgery. -. 0nsure 9+ray e9amination is done before the procedure. $. During the procedure, instruct patient to rela9 to prevent trauma and decrease movement that may affect the affected surgical area. ?. Dressing is then applied after the removal of foreign body. . 1nstruction in cleaning and home management is given to the patient.
