Emergency Department Technician (EDT)

1. Emergency Department Technician (EDT) Your Role with Our TEAM Developed by Lori Baker, RN, BSN

2. Communication • Verbal • Words used • Speech patterns • Tone of voice • Non-Verbal • Posture • Eye-contact • Facial expressions • Physical space

3. Barriers to receiving a message… • Stress • Psychiatric or emotional conditions • Age and developmental level • Cultural differences • Past experiences • Privacy and confidentiality issues • Distractions in the environment

4. Handling Conflict • A stressful environment does NOT excuse rudeness or inappropriate behavior

5. COMMUNICATION REVIEW… • Two types of communication • Verbal and Non-verbal • Rolling eyes and huffing falls into which category • Non-verbal • Name 3 barriers to receiving a message appropriately… • Stress, psychiatric or emotional conditions, age, developmental delays, cultural differences, past medical experiences, privacy and confidentiality issues, distractions in the environment

6. Documentation • MUST ALWAYS BE ACCURATE – • NO EXCEPTIONS

7. Documentation • DO’S • Record time using the 24-hour method (often called military time) • Record time precisely – if it is 0953, don’t document 0950 – there are many times when EXACT time is needed when reviewing certain situations • Use correct spelling and grammar – if the case goes to court you will be considered “not credible” if your spelling and grammar is atrocious

8. Documentation • DO’S (cont’d) • Use only institution-approved abbreviations • Charting must be to the point, in sequence, and entered when there is a change in a patient’s condition or when care is given • If using paper documentation write legibly, date and time all entries, sign each page with complete name and credentials

9. Documentation • DON’TS • Document BEFORE care is given • Use documentation to argue a point, place blame, criticize, or include personal opinions in the patient’s chart • Document with and incident report has been filled out on a patient • When paper-charting DON’T • White-out or erase • Destroy records • Scribble over – just draw one line and place your initials over it • Leave blanks

10. Documentation… • Per legal standards, the following must be part of every patient’s documentation… • Accurate dates and times • Patients physical condition, including results of a primary and secondary survey • Patient’s medical history • Any treatment administered in the ED • Any reaction or lack of reaction from these treatments • Any changes in vital signs or physical condition • Any unusual circumstances or causes for delay in tests or treatments, such as the failure to obtain consent

11. Documentation… • Must have’s (cont’d) • Mental status of the patient, with any changes, should be recorded on a regular basis, especially if the patient has sustained a head injury • All airway maintenance procedures, as well as use of any supplemental oxygen devices • If the patient sustains any spinal or possible spinal cord injury, the movement and sensation of all the extremities must be recorded as well as any changes in condition • Any violent or unusual behaviors should be listed

12. Documentation… • Again, it is NOT the responsibility of the EDT to do ANY INITIAL assessment, however, the EDT must follow-up on all assessments and properly document as well as inform the RN

13. DOCUMENTATION REVIEW… • White-out is appropriate on consents ONLY but not notes • False • If paper charting and a mistake is made, use a sharpie marker so the charting cannot be seen • False • Make sure you use correct spelling whether paper charting or computerized charting • True • You can use any abbreviations as long as you tell people what they mean • False

14. Legal Issues… • Delegation and Responsibilities • While it is the RNs responsibility to know what can and cannot be delegated to the EDT it is also YOUR RESPONSIBILITY to know when to say NO (with respect) • Rule of thumb – if you have not been checked off on a task you are NOT to do it • Also, if you know it is NOT within your scope of practice, DO NOT do it.

15. Legal Issues… • Examples of tasks for the EDT… • Clean and stock exam rooms • Assemble crutches • Assemble equipment • Collect and transport specimens • Assist with admission and discharge of patients • Perform clerical tasks • Obtain vital signs • Document in patient records • Clean and bandage simple wounds • Splinting of extremities • Perform 12-lead EKG • Remove sutures • Perform CPR NOT an all-inclusive list

16. Legal Issues… • Professional Negligence entails 4 elements • Duty • Breach of Duty • Causation • Damages

17. Legal Issues… • Intentional Torts • Abandonment • Assault • Battery • False imprisonment • Invasion of privacy • Libel • Slander

18. Legal Issues… • Consents • (It is NOT the responsibility of the tech to get consent for any patient, however, you need to be aware of them) • Informed consent • Implied consent • Expressed consent • Consents for minors • Involuntary consent

19. Infection Control… • Microorganisms • Bacteria • Viruses • Fungi • Protozoa • Modes of transmission • Droplet or airborne • Direct contact • Ingestion • Animals or Insects

20. Infection Control… • Standard Precautions/Universal Precautions • Guidelines used by the CDC for reducing the risk of transmission of blood-borne pathogens in hospitals • Used for ALL patients regardless of any known disease or condition • Always use if there is ANY remote possibility you may come in contact with any bodily fluids

21. Infection Control… • Bodily fluids include • Blood • Urine • Stool • Sputum • Vaginal or penile secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Peritoneal fluid • Amniotic fluid

22. Infection Control… • Personal Protective Equipment (PPE) • Situational • Equipment • Disposable gloves • Disposable gowns • Disposable masks • Eye protection • Disposable containers

23. Role of the EDT in Triage… • Functions of PCT at Triage • Vital signs on patients • Assist patients to and from registration, to the assigned room, x-ray, or other treatment area • Assist with re-assessing patients in the lobby • Patient advocate to the family/visitors

24. Triage… • Does the person who performs triage have to be a nurse? • Yes, it is the policy • Non-nursing personnel do not have the authority to make advanced protocol and triage decisions • THE RN IS ULTIMATELY RESPONSIBLE FOR ALL TRIAGE DECISIONS. • Please do not take it upon yourself to do any task beyond your scope of practice. Consult the RN first.

25. Triage… • Decisions • The TRIAGE NURSE makes the decision who goes to which room first • The time of patient arrival is not the purpose of triage • acuity • symptoms • VS stability • Pain Scale >7

26. Triage… • Triage Staff • Can “set the tone” for the ED staff, patients, and families as well • Remember to “SMILE” • Introduce yourself • Explain what you are doing • Validate findings • Explain prioritization’s

27. Triage… • Triage Staff, cont. • Explain wait times • Explain rechecking them • Direct to next process • Direct to return to triage if condition changes • Offer comfort measures, i.e. wheelchair, stretcher, blanket, ice bag, splint, sling, etc.

28. Triage… • Triage Staff, cont. • Remember to convey that calm, caring approach during the process to allay the patient and family anxiety and lead to a more comprehensive and successful visit for the patient and family.

29. Triage… • KEEPING EVERYONE INFORMED • Communication is the KEY • Informing patients of delay is of the utmost importance • Can’t predict length of stay or how long it will take • Offer comfort measures • Discuss other reasons for information:

30. Triage… • Legal Considerations • An emergency evaluation must be performed on any individual with an emergency medical condition or a woman in active labor • If the individual’s condition is unstable, then an attempt to stabilize the individual must be done • Level of transportation to treatment area/s must be appropriate

31. Triage… • JCAHO Standards • Domestic abuse victims are identified by criteria developed by the hospital • Each patient needs to be reassessed at intervals designated by the institution • Each patient’s physical, psychological, and social status is assessed • Need for discharge planning assessment is determined

32. Triage… • JCAHO • Staff members integrate the information from various assessments of the patient to identify and assign priorities to his/her care needs • A Registered Nurse assesses the patient’s need for nursing care in all settings where nursing care is provided

33. Triage… • Special Considerations • Violence in the Emergency Department • Disruptive Clients • Disruptive Family members/visitors • Potential of Psychiatric patients to become agitated and violent • Beware of the emotionally distraught clients or family members especially when advised to loss of a loved one • Any other situations?

34. Triage… • Communicable Diseases • Chickenpox or Shingles • Remove from waiting area to an isolated area, such as a room, out of the way place in the hallway, etc. • Identify some other communicable diseases?

35. Triage… • Immuno-suppressed Patients • Chemo-therapy patients, AIDS, transplant patients, high dose of steroids • Mask them and remove to an area away from the public and other flu’s, colds, viruses, etc. • Reverse type isolation treatment for these patients

36. Triage… • Pediatric Patients • Remember safety issues with these little ones • Remember the parent may be suffering more than the child • Beware of the child’s activity and bed heights, side rails, playing in the trash cans, etc. • List other concerns with pediatric patients?

37. Triage… • Triage from a Motor Vehicle • Use the buddy system • Use C-spine precautions if indicated • Use good body mechanics • List other ideas for getting a patient out of the vehicles?

38. Triage… • Hazardous Waste • Remember to use safety precautions • Beware of the fact that bio-hazards or contamination to materials is a major concern • Look for MSDS sheets or call the 1-800 number for copies of the MSDS sheets, etc. • Discuss other concerns:

39. Triage… • Psychiatric Patients • Beware of their behavior • Speak softly and slowly in short sentences or phrases • Never turn your back to them • Stay near an exit when interacting with a psychiatric patient • Other Pearls from experiences?

40. Triage… • Obstetric Patients • Place in wheelchair to go to L&D • If presenting part is visible or lots of rectal pressure keep patient in ED for quick evaluation to determine if eminent delivery is about to occur • Never send a patient to L&D alone, an employee must accompanying a woman in labor to the unit • If presenting with obstetric complaints and under 18 weeks gestation, we see them in the ED.

41. Further Information for the EDT • Specimen collection • Cardiac monitoring • Administrative P&P • Advanced Triage Protocols (ATPs) • Disaster Management • These are on separate power points.

42. QUESTIONS???????