Chris Rooney BSN, RN BCHealth Services

Millersville University of Pennsylvania

Scope of practice - •Direct Nursing Care•Collaborative Role•Health Educator•Research/Consultant•Advocacy

Combining Triage with College Health Nursing

StaffingStaff – provider typeTime – hours of service , time of day

Method of contactWalk inPhone interaction

Chief Complaint - AssessmentAppointment/walk-inNeed for ancillary services - immediate lab/x-ray

Other considerationsTransportationDistance to acute care/ER

State Board of Nursing Law Standard of Care

◦ National Council of State Boards of Nursing. https://www.ncsbn.org/312.htm

◦ Article 2, chapter 2

Medical Direction – what is your medical director comfortable with?◦ Protocols/documentation◦ Expertise of staff

Literature Review of Protocols

None specific to college health

2007 JCN -Clinical decision making

2008 IJN - Knowing the patient

2009JCN – Context vs protocols

2008 JTIICC – Triage Tools

2009 IJCN - Expertise

Vital Signs imperative

Policy/Guidelines – follow documentation form

Guideline resources abundant but not specific to college health

Nursing judgment/clinical decision making - within the scope of practice of Registered Nurse if based on assessment findings and nursing guidelines

Institute for Clinical Systems Improvement www.icsi.org Flow charts and algorithms for triage

Rapid Assessment A Flowchart Guide to Evaluating Signs and Symptoms Lippincott 2004 $45

Adult Telephone Protocols: Office Version (Spiral-bound)~ David A Thompson $85 (Amer. Acad. Of Peds)

Telephone Triage Protocols for Nurses Julie K Briggs Lippincott3rd Edition $50

Emergency Severity Index, Version 4: Implementation Handbook Chapter 2. Triage Acuity Systems http://www/ahrg.gov/research/esi/esi2.htm(Adaptable ED acuity systems with Practice Cases)

Assessment needs to include cultural/ethnic Assessment needs to include cultural/ethnic variations Example: Muslims may believe that variations Example: Muslims may believe that sickness is a test from God, seen as a purification sickness is a test from God, seen as a purification from sins and require a cure from Godfrom sins and require a cure from GodStudents’ limitations in ambulation and Students’ limitations in ambulation and communication and differentiation between acute communication and differentiation between acute and chronic neurological conditions are the main and chronic neurological conditions are the main challenges in the triage of students with special challenges in the triage of students with special needs and disabilities.needs and disabilities.Language Barriers – Use of interpreters – Time – Language Barriers – Use of interpreters – Time – use internet translators Google’s Language use internet translators Google’s Language tools AltaVista Translator TTY/Deaftools AltaVista Translator TTY/Deaf

Document calls and the triage decision in the medical chart, indicating the protocol used and the advice provided. Use the caller’s own words to describe the reason for the call.

Develop triage algorithms to assist the RN, NP/PA/Physician in appropriate documentation of telephone conversations.

Develop a written policy defining the role and limitations of non-clinical or unlicensed staff, as well as specific symptoms requiring immediate attention.

Review all telephone triage decisions for appropriateness of actions taken.

Review all scheduling encounters for appropriateness and timeliness of appointments.

Allow only qualified staff to provide telephone advice.

Examples of nurse initiated interventions to expedite care at triage may include:

Administration of analgesia; antipyretics; oral rehydration; oxygen therapy

Diagnostic testing: Rapid Strep or Flu, Blood glucose measurement; Urinalysis

First aid (BLS, splinting, RICE, eye irrigation) wound management

Self Care – OTC’s, Discharge instructions, education

F/u care recommendations – when, why, with whom

All nurse-initiated interventions should be in accordance with organizational guidelines and policies.

General lack of evidence based research in terms of Nursing Triage and Treatment outside of emergency rooms.

Non existent in College Health No financial reimbursement for nurse visit Variety of scope of service across campuses Centrality to mission and goals of Health Services

What information How to gather What to do with it

Nurses – Assessment and triage of students in college health settings is within the scope of registered nursing practice.

Develop simple easy to use algorithms and base documentation on their use.

Alter in the event of significant medical occurrence – Pandemic – create tools

Maintain cultural competency Quantify and evaluate effectiveness Need to research and publish evidence

based data in College Health Nursing Triage Encourage collaboration with Nursing Staff

in creating Triage ProtocolsChris Rooney BSN RN BCchris.rooney@millersville.edu