ED management : the monthly update on emergency department management
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A "full capacity" protocol requires that admitted patients being held in the ED are moved upstairs when the ED is at full capacity. Length of stay for admitted patients is reduced. Morale of ED nurses is improved. Inpatients receive better care when moved upstairs.
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Children are at high risk for errors in the ED, and the mistakes often are due to weight-based dosing errors. Reduce the number of drugs, concentrations, formulations, and suppliers used. Have ED prescriptions reviewed by a pharmacist. Have two nurses or physicians verify dosages for high-risk drugs such as sedating agents.
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You need a policy to ensure that important orders are carried out for admitted patients being held in the ED. ED physicians should not succumb to pressure to write inpatient orders. Transitional orders can be used for stable inpatients during their stay in the ED. By using transitional orders, inpatients being held in the ED can be sent upstairs more quickly.
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To comply with standards of the Joint Commission on Accreditation of Healthcare Organizations, you must provide the same level of care to inpatients held in your ED as they would receive in critical care units. Train the entire staff in telemetry monitoring. Give patients the same level of services from radiology, laboratory, and pharmacy as they would receive upstairs. Have ED nurse work occasional shifts in critical care units.