Welcome to CHFT ED Induction
Lay out in ED cross-site for normal, triage, majors, resus, minors for adults and children. Hospital specialty support includes acute medicine, frailty/care of elderly, gastro/gen surgery, and more. Guidelines, discharge advice in EMBEDS. Personal Safety tips, EPR in ED using Firstnet, team briefings, selecting patients to be seen in EPR. Stay informed and safe during your redeployment.
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Presentation Transcript
Welcome to CHFT ED Induction FOR REDEPLOYED STAFF DURING COVID-19 PANDEMIC
Lay out in ED cross-site Normal (Green) ED (Triage, Majors, Resus) Resp (Red) ED (Triage, Majors, Resus) Minors Adults & children in all 3 areas
In hospital Specialty support HRI Acute Medicine Frailty/ Care of Elderly, Gastro Gen Surgery, T&O, Vascular (oncalls shared with BRI) Oncology No acute Paeds Experienced APNP to support bleep 102 CRH Acute Medicine Cardiology, Respiratory, Stroke Paeds Obs & Gynae ENT, Eye Neurosurgery Online Ref to Leeds Plastics BRI Burns Pinders (both adults & paeds) Use SiD online ref with photos see EMBEDS Cardio-Thoracic Surgery, Spinal Surgery - Leeds
ED guidelines & discharge advice leaflets All in EMBEDS - https://www.embeds.co.uk/ Free access from any where brows it, know it, use it
Personal Safety Know your Donning & Doffing of PPE correctly Wash hands frequently Ask an ED Cons when & where to use Level 3 PPE (guidance keep evolving)
EPR in ED - Firstnet Very similar to Power Chart Watch the Video on EMBEDS Learn how to use it https://www.embeds.co.uk/2020/04/07/first-net/
Team briefings & safe working Daily Safety huddles Senior (Cons/ ST4 or above EM MG) sign-off 1. Atraumatic chest pain in patients aged 30 years and over 2. Fever in children under 1 year of age 3. Patients making an unscheduled return to the ED with the same condition within 72 hours of discharge 4. Abdominal pain in patients aged 70 years and over Review & Sign ECGs, POCT ABG/VBG, Sysmex & iSTAT as soon as possible. If abnormal immediately escalate to senior & act
Selecting pt next to be seen - EPR Use Time to be see column on Emergency Department tab This is based on triage priority & length of time in ED If not clear Ask NiC or ED Cons which pt next to be seen Once signed to a pt Read Triage Notes, Nursing Notes & Ambulance Records
Early decision making Discuss with ED senior (MG or Consultant) early if you find it difficult Things to consider Can an admission be avoided discharge with support? DNACPR & ceiling of treatment Early specialty referrals to ensure pt flow & decongest ED Any problems escalate to ED Consultant early
Initial documentation - EPR 1) Clinical Notes Hx Ex, Clinical decision (DD/ problem list), Mx plan 2) Diagnosis on Depart use possible/differential if not confirmed 3) Safeguarding questionnaire on Depart Don t leave for NiC to complete If Yes to any -> D/w ED Senior Complete all above 3 during initial documentation for every pt
Communicate your plan/ change of plan Inform the nurse looking after pt Inform NiC Put in bubble as a reminder Do referrals early as possible & update NiC
Completion with a pt EPR on Depart Code all activities within ED Complete discharge information convey information to GP - eg Check urine MC&S results in 3 days for ?UTIs Repeat CXR in 6weeks for ?LRTI who are well enough to go home Breach document actual time pt left
Special Circs Children in ED Up to 18thBirthday considered children Use Paeds ED Triage tool Paeds safeguarding questionnaire Use Paeds mental health assessment tool on AdHOC Admissions up to 16thbirthday under Paeds; 16Yrs 17Yrs under Adult specialties Always document who is with the child Document who history is taken from (child or carer) Listen to Parents concerns All kids in Majors should have minimum of 2 sets of PAWS B4 discharge Abdominal pain (except ? testicular torsion) should be referred to Paeds (APNP in HRI)
Airway Stridor Drooling Assessing Circulation Work of Breathing Efficacy of Breathing Heart Rate Rate Colour Capillary Refill Time (Central v Peripheral) Use of Accessory Muscles SpO2 Chest Expansion Intercostal Recession/ Tracheal Tug Temperature of skin (Central v Peripheral) Breath sounds Percussion Nasal Flaring/ Head Bobbing Tone of skin Conscious Level Noise of Breathing Urine Output Ability to speak/eat and drink Blood Pressure
ENT Examination Avoid as far possible If essential need PPE with Visor Ask parent to take a photo of throat & show you
Special Circs Mental Health Assess risk ReACT proforma on EPR, Remove all possible ligatures Ensure fit for MH assessment immediate physical needs must be attended TOXBASE for overdose management Involve MHLT (RAID Team) early Ligature cutters available with the ED co-ordinator on each site For children (up to 18th birthday) Complete Paeds MH Assessment on AdHOC Ref CAMHS Ref RAID out of hours for 16yrs & 17yrs
Special Circs - Safeguarding Check Alerts on EPR Left hand corner of Blue Bar Under Pt name & Allergy Must complete SG questionnaire use the correct form Paeds for <18Yr If Yes to any question -> D/w ED Senior Think of Hidden Child in Adults with alcohol & drugs, MH issues, overdose & DSH, domestic violence If you have any concerns always ask a Senior or the NiC for advice. Contact Social Care to obtain & share information Document all concerns & discussions Complete Paeds Liaison Form, MARAC ref form (for Domestic Violence), Adult safeguarding form etc
Special Circs Intoxication & ABD Don t put every thing on Alcohol & Drugs think of other possibilities Eg Reduced LoC is not due to alcohol/ drugs until proven otherwise Acute behavioural disturbance Ref EMBEDS High risk of cardiovascular collapse Minimum restrain Sedation Identify & treat underlying cause quickly Refer to The Base or Branching Out for Alcohol or Substance Misuse
Special Circs Procedures in ED Document procedures - on AdHOC > ED procedures eg conscious sedation, fem nerve block, reduction of #s dislocations Femoral Nerve block Local Mix - 10ml 2% lidocaine + 10ml 0.25% chirocaine (<50kg adjust to weight) Use Ultrasound guided + nerve block needle Code correctly on Depart eg Ultrasound, Nerve block, Sedation, manipulation, POP etc
Special Circs - Trauma Scoop to transfer patients to CT Secure patient to scoop using spider straps Have a working Neurosurgical login for HRI and CRH activated you can have both on the same login and change your site via the online helpdesk available on leedsneurosurgery.com website Document Trauma team assessments using Trauma Form on Adhoc Adhoc Forms>Trauma
Any Questions? THANKS Please contact Dr Chamika Mapatuna Consultant in EM chamika.mapatuna@cht.nhs.uk
