Blog & Articles

According to ENA, retrospective chart review is a critical element of ongoing triage competency validation. The RSQ® Solutions – Triage Assessment tool is built upon triage best practices and provides a mechanism through which your organization can implement and execute a scalable and sustainable chart review process.

Using this tool, nursing management can easily assess triage competency on an ongoing basis; it allows them to:

• Determine the accuracy of triage levels assigned by an individual nurse or by the entire department.
• Measure overall improvement in a department’s triage accuracy.

Because every patient entering the emergency department needs to be triaged, it is imperative to ensure that every triage nurse maintains accurate clinical decision-making skills that support optimization of patient flow. While the Emergency Nurses Association (ENA) has historically recommended ongoing triage competency validation to ensure safe practice in the ED, the organization updated itsTriage Qualifications and Competency Position Statementin 2017 to place greater emphasis on the use of retrospective chart review as a means to ensure accurate clinical decision-making in triage.

In addition to the ENA recommendation, here are five more reasons retrospective chart review is an effective part of a triage competency validation process:

[10 MIN READ]

Have you ever wondered as an Labor and Delivery RN how many hours during your shift you spend staring at fetal heart tracings?

I’ll bet you have never tried to tally such a figure, but I’d venture to guess it encompasses not only a large portion of your daily practice, but an enormous part of your career as well.

During a 12-hour shift of managing labor induction, you could easily spend approximately 5-6 hours or more actually staring at the monitor. That’s 50% of your shift! This translates into the possibility that half of your intrapartum career is immersed in FHR tracings!

This enormity speaks volumes to expectations of your ability to understand and manage the fetal tracing. Your knowledge base should be solidly comprehensive and your ability to articulate standardized definitions rapid. If litigation were ever to knock at your door, would you be able to defend your actions surrounding your interpretation and analysis of the FHR tracing?

Failure to recognize, failure to act, and failure to communicate have been cited as three litigious areas of concern regarding FHR monitoring. Let’s take a look at six common “pitfalls” that can get you into trouble regarding tracing analysis.

Many would contend that we currently live in a polarized society in the United States. Whether the issue is the environment, healthcare, taxes, religion, economic theory, immigration, globalization or politics, interaction between competing philosophies is often characterized by animosity, accusations, verbal abuse, and even physical harm. Make no mistake — this has been going on since the Garden of Eden (Ask Cain; better yet, ask Abel!). The impact on society is rarely, if ever, beneficial.

Surgical Site infections (SSIs) occur in 2% to 5% of surgery patients. This category of infection comprises approximately 22% of all healthcare-associated infections and has a 3% mortality. Patients with SSIs require significant care and average 7 to 10 days of increased length of hospital stay. The cost of providing care for a single SSI ranges from $3,000 to $29,000. The total cost of care for SSIs is estimated at $10 billion dollars per year. There are of course additional expenditures for outpatient care, readmissions, and care of long-term disabilities.

Catheter-associated urinary tract infections are the fourth most common HAI. They comprise over 12% of all acquired infections in acute care hospitals. 93,300 of these UTIs are estimated to be acquired in hospitals each year, with an estimated death toll of 13,000 patients.

The CDC defines a Central Line-Associated Bloodstream Infection as: “A laboratory-confirmed bloodstream infection (LCBI) where central line (CL) or umbilical catheter (UC) was in place for more than 2 calendar days on the date of event, with day of device placement being Day 1 and the line was in place on the date of event or the day before.” In other words, the patient must have had the device in place for at least 2 days and the diagnosis must be made while the device is still indwelling or was indwelling on the day before.

The Centers for Disease Control and Prevention defines healthcare-associated infections (HAIs) as: “Infections that patients acquire during the course of receiving healthcare treatment for other conditions.”

Healthcare-associated infections are very common, and the cost associated with them is enormous. It is estimated that 1 out of every 25 hospitalized patients is treated for an HAI, with costs ranging between $28 billion and $33 billion per year.

When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with chest-related complaints, not all of which involve the heart:

The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country.