45 years old female patient, known case of DM (diabetes mellitus) type 1, presented to Emergency Department brought by family, confused, sweating, shivering and her blood sugar was low 3 mmol. Patient took her dose of insulin but did not take her enough breakfast. When the patient arrive was confused, BRS checked in triage was 2.5 mmol and she was unable to drink. Patient shifted direct to resuscitation room, Oxygen 6 liter applied, and cardiac monitor connected shows BP:133/80 mmHg, HR: 89 b/min, Spo2:94% in room air, Temp: 36.5C. IV line inserted, Inj. Dextrose 50% 50ml IV given, then IVF Dextrose 10% started as infusion. RBS was rechecked after 5 minutes it shows 9.8mmol/L. Patient regain her consciousness level; she was responding to commands. Food was provided for her. Blood sugar was regularly monitored to prevent recurrent of hypoglycemia. RBS was remained within normal level for around 3 hours observation, after that patient was discharge home with health education.
- Patient kept in category 2 (Emergent level) as per ESI triage: patient is had LOC at home and was confused, lethargic and sweating.
- Patients need many resources (investigation, fluids, ECG…)
Different policies and guidelines of triage system within MOH hospitals.
| Royal Hospital Triage Policy |
Khoula Hospital Triage Policy |
| The Institution utilizes a unique triaging framework as based on the existing ESI (Emergency Severity Index).
There are 5 levels:
Level I-Immediate.
Level II-Emergent.
Level III-Urgent.
Level IV- Less urgent.
Level V-Non urgent.
§ They do not depend on time waiting.
§ Patients’ priorities according to their condition and how many resources needed.
§ Not use color.
Policy:
1.All patients will be assigned and acuity level upon arrival to the emergency department, with expectation of direct admission, unless medical evaluation is necessary prior to transfer to inpatient unit.
2.Reassessment of level I and II patients is the responsibility of the resus/major treatment nurse.
3. Reassessment of level III and IV patients is responsibility of the triage nurse until the patient is moved into a treatment area and the major treatment nurse assume care.
4. All patients will have full set of vital signs in a timely fashion.
5. All abnormal vital signs will be brought to the attention of the physician and will be repeated and addressed prior to discharged from ED.
6.All temperature will be documented in centigrade.
7.All patient with chest pain or have risk of cardiac disease. Should have immediate ECG and seen by physician.
8.Initiat triage will be done by experience nurse then to be seen by physician.
9.Patients waiting after triage should be re-triaged if any change in clinical condition or waiting time exceeds the expected in triage.
10.Known diabetic patients should have glucochek in triage. |
The Institution utilizes ONSET (Oman National System for Emergency Triage).
There are 5 Levels: Time.
Level 1-Resuscitation Immediate
Level 2-Very Urgent. 10 Mint
Level 3-Urgent. 30 Mint
Level 4- Less urgent. 90 Mint
Level 5-Non urgent. 240 Mint
§ They use time when prioritize patient.
§ Use Resuscitation instead of Immediate.
§ Time to see physician and standard were added to the original ESI.
§ Time to triage nurse.
§ They use standard for every level.
§ ONSET added triaging instructions for trauma patients whereas RH do not have.
Policy:
1.Triage Nurse Qualifications
§ Must be a register nurse (RN).
§ Completion of post-basic diploma in emergency nursing or on-job training.
§ Completion of national triage course.
§ Certificate BLS, ACLS and PALS.
§ Minimum of two years of experience as an ED nurse after completion post basic qualification.
2.Triage system selection
3.Component of the triage system
ü The purpose and role of the triage
ü Triage and ED operation
ü Use of ONSET
ü Re-triage
ü Concurrent patients’ arrival
ü Triage of ambulance patient
ü Triage of expected patient
4.Infection control
5.Mass casualty (disaster triage)
6.Continu quality improvement (CQI).
7.Public awareness.
8.Legal Issues
ü Redirection low acuity triage patient.
ü Patient left without seen (LWBS)
ü Documentation
ü Language.
|
References:
Ministry of Health: Saudi Kingdom (2019).
Guidelines and Protocols of Diabetes Emergencies. Retrieved from
https://www.moh.gov.sa/Documents/Diabetes- Emergencies.pdf.
Directorate General of Specialized Medical Care, MOH (2019). Policy of Oman national system for emergency triage (ONSET) in hospitals.
Royal Hospital, Ministry of health: Oman (2020). Triage prioritizing of care guidelines.
