Telephone Triage How To Survive Being On Call

Transcription

1 Telephone Triage How To Survive Being On Call Simulations

2 Telephone Calls From Direct Care Staff Training Objective: The RN will be able to identify the need for Telephone Triage training. Materials: Flipchart Markers Handout on telephone calls from direct care staff Teaching Strategies: Using brainstorming, list on flipchart calls RNs have received and designate as general, specific, diagnosis, frequent flyer and possible suggestions to clarify. Review list of calls from direct care staff on handout and suggest additional questions to ask along with a possible plan of action.

3 Handout Of Telephone Calls From Direct Care Staff Staff called because they want to give Tylenol to an individual. Staff reported that an individual has pain on side and think the individual is having a gall bladder attack. Staff report that an individual is complaining of a headache again, but, he always complains about something. Staff called that consumer has RX in place of Saline Nasal Spray after meals. Consumer receives 6 small portion meals a day due to passing food through nose. Seen by new ENT MD. New order for Saline Nasal Spray BID. RX never verified or changed. Staff report that consumer is unsteady and needs assistance walking down stairs. Favoring left hip. Body check shows no swelling or discoloration. Vital signs within normal limits. Staff report that a consumer came out of her bedroom and says she swallowed a piece of her remote. She coughed up the part and had some emesis. Staff called to report consumer had seizure activity for 5 minutes. Diastat 20 mg administered rectal and VNS swiped. Consumer had another seizure three minutes later, VNS swiped. Emesis once in A.M. Staff states he does not look well. 78 year old consumer had finished eating an uneventful dinner. After dinner, the staff noted that the consumer was slumped over in his chair and had emesis. Individual returns from ER with new prescription for Z-pack. Reference materials indicate potential interaction with current medications. Staff reports an individual has redness above upper lip, no signs or symptoms of infection. Staff called to report an individual has had difficult behaviors all day long. Currently he is sleeping in the living room. Staff are requesting directions. Individual diagnosed with UTI was started on Macrobid. Had emesis after lunch, temp Staff reports an individual fell and hit her head on a chair. There is a small raised area on the back of the head. Staff report an individual fell and twisted left ankle while getting off stationary bike. Individual is complaining of soreness in mouth. Three small raised areas on inner lower lip. Individual was bitten by peer on right arm near wrist.

4 Staff report an individual fell and sustained a laceration on upper lip. Individual is presenting with elevated pulse, respirations and elevated temp. Staff are requesting directions. Staff requesting directions about individual presenting with poor skin color, shivering, rapid respirations and pulse, no fever. Staff note an individual is lethargic, decreased responsiveness and frequent self abusive behavior during past week. Staff report an individual ate a box of sugar free chocolate in AM. Has had 5 to 7 bouts of loose stools throughout the day. No vomiting noted, vital signs are within normal limits. Staff state individual fell while playing basketball. Complaining of left ankle pain, unable to bear weight on left leg. Staff reports individual pulled right small toenail off and are requesting directions. Individual fell and sustained a ½ inch bump with abrasion to forehead, no other injuries noted, no loss of consciousness. Staff reported individual had temp of at 8:30 pm, Tylenol PRN given. Temp at 12:30 am of 100.8, Tylenol PRN given. Temp at 4:30 am of 102. Staff called to state an individual had blood come out of his butt. Staff reported an individual did not get her MOM after three days of no BM. Staff report individual states he was kicked and has blood in his urine.

5 How Do You Think (Naturally)? Teaching Objective: The student will understand how nurses utilize what appears to be hunches in decision making. Materials: Handout with picture of old man complaining of back pain and space to write down hunch and rationale. Flip Chart and Paper Markers Strategy: Show picture and say I have back pain in a perplexed voice. Ask students to write down a Hunch on what they think is wrong based on statement and give a rationale for decision. Go around room and put hunches with rationales on flip chart. Classify hunches as musculoskeletal, kidney related or other categories. Classify rationales as most common complaint, worst possible consideration, work in that clinical setting, had such a patient in past, have had or family member has had that problem. Continue with lesson and explanations.

6 How Do You Think (Naturally)? I have pain in my back! (in a perplexed voice) Write down your hunch on what you think is wrong and a rational for your choice. We will then put all hunches and rationales on a flipchart.

7 Triage Categories Teaching Objective: The learner will understand and be able to identify the triage categories of EMERGENT, URGENT and NON-URGENT. Materials: Handout on triage categories Teaching Strategy: The RN will identify different scenarios as emergent, urgent or non-urgent and determine a plan of action.

8 Triage Categories Directions: Identify the following scenarios as EMERGENT, URGENT, NON-URGENT and determine a plan of action. 1. Change in established seizure pattern 2. Severe dyspnea, stridor 3. Mild headache with no other complaints 4. Sinus congestion without a red face 5. Conjunctivitis with eye pain 6. Sudden onset cold, pale extremity 7. Sudden loss of vision 8. Sudden onset severe abdominal pain 9. Cough, fever, weakness 10. Uncomplicated rash 11. Limited short-term vomiting or diarrhea 12. Onset of mild abdominal pain 13. Sudden paralysis, loss of consciousness 14. New onset seizure 15. Uncontrolled high blood pressure 16. Blunt extremity trauma with pain 17. Cough, afebrile, no chest pain 18. Severe crushing chest pain 19. Mild sore throat without other symptoms 20. Very bad headache which is new

9 Clinical Decision Making Role Playing Teaching Objective: The RN will use a template for clinical decision making to assess the caller based on the patient interview. Materials Needed: Two players Template for clinical decision making Cards with different diagnosis Telephone Triage Books (optional) Telephone (optional) Teaching Strategy: Players sit back to back. One player to be caller with cards that have signs and symptoms of illness and will be calling RN by telephone for advice. Second player is RN and uses template for clinical decision making to assess the caller during a telephone conversation.

10 Telephone Scenarios Give only chief complaint. Other signs and symptom should be confirmed if asked by RN. Scenario 1 Scenario 2 Scenario 3 Scenario 4 Congestive Heart Failure Chief Complaint: Congestion for two weeks Signs & Symptoms: SOB upon exertion Dry unproductive cough at night Fatigue Trouble sleeping Heart rate is fast Restless Esophagitis Chief Complaint: Burning sensation behind sternum Signs & Symptoms: Pain with regurgitation of acidic or bitter fluid Aggravated by lying down Happens when bending over Food sticks in throat, need to wash down with fluid Pain when drinking citrus or hot fluids Aggravated by coffee Cough up blood Helps by drinking water or milk, taking antacids Peptic Ulcer Chief Complaint: Heartburn Signs & Symptoms: Pain in mid epigastric area Pain radiates to back Worse when stomach is empty Hurts especially 2 hours after meals and middle of night Belching frequently Nausea and vomiting after evening meal Ulcerative Colitis Chief Complaint: Abdominal Pain Signs & Symptoms: Bloody diarrhea Weight loss Fever Nausea and vomiting Loss of appetite Remissions and exacerbations

11 Scenario 5 Scenario 6 Scenario 7 Scenario 8 Scenario 9 Hepatitis Chief Complaint: Just do not feel well Signs & Symptoms: Flu like illness Headache, fatigue, fever, general malaise Dark urine Tenderness on right side Sclera yellowish tint Gall Bladder Infection/Gallstones Chief Complaint: Pain in upper right quadrant of abdomen Signs & Symptoms: Fever Nausea Vomiting Pain sometimes radiates to back Over age 40 Overweight Ruptured Spleen Chief Complaint: Abdominal pain Signs & Symptoms: Persistent abdominal pain Abdominal rigidity Rebound tenderness Doesn t look so good Fell off bicycle Vaginal Infection Chief complaint: Burning upon urination Signs & Symptoms: Irritating, thick vaginal discharge White patchy cheese-like particles on to vaginal wall Itching Vulva and vaginal areas red and edematous Tinea Pedis Chief Complaint: Souls of both feet red and cracked Signs & Symptoms: Feet itch and burn all the time Very painful at times Chronic condition

12 Scenario 10 Scenario 11 Scenario 12 Scenario 13 Contact Dermatitis Chief Complaint: Hands are red and rough Signs & Symptoms: Itching, burning, redness Vesicles Weeping and crusting of vesicles Looks like eczema Cracked and peeling skin Started using new hand soap Hypothyroidism Chief Complaint: Tired all the time Signs & Symptoms: Weight gain Temp and pulse below normal Skin thick and dry Hair falling out BP low Feet cold all the time Muscle ache and weakness Memory is poor Constipation Tuberculosis Chief complaint; Flu like symptoms Signs & Symptoms: Fatigue Night sweats Anorexia Weight loss Chills Low grade fever Productive cough with lots of mucous and some blood Meningitis Chief Complaint: Severe Headache Signs & Symptoms: High fever Nausea and vomiting Neck, shoulder and back stiffness Petechia on trunk and legs Resistant to neck flexion With thigh on abdomen, cannot extend lower leg When neck flexed, knees and hips flex

13 Scenario 14 Scenario 15 Scenario 16 Scenario 17 Myocardial Infarction Chief Complaint: Pain in back between shoulder blades Signs & Symptoms: Indigestion Belching Can not catch breath Sweaty Does not look good Restless Increased pulse that is irregular Increased respiration that are shallow Nauseated Bowel Obstruction Chief Complaint: Abdominal Pain Signs & Symptoms: Loss of appetite Weight loss Abdomen distended and rigid Liquid, watery stools Brown emesis with fecal smell Fracture Chief Complaint: Ankle Pain Signs & Symptoms: Fell and twisted ankle Ankle is red, swollen and painful to touch Crepitus Ectopic Pregnancy/Tubal Rupture Chief Complaint: Abdominal Tenderness Signs & Symptoms: Female Abnormal menses Dull pain on right or left side Pain on side radiates to back, shoulder, neck Nausea and vomiting Pallor Slight cyanosis around lips