Emergency Department Technician (EDT)

Your Role with Our TEAM

Developed by

Lori Baker, RN, BSN

Communication

• Verbal• Words used• Speech patterns• Tone of voice

• Non-Verbal• Posture• Eye-contact• Facial expressions• Physical space

Barriers to receiving a message…

• Stress• Psychiatric or emotional conditions• Age and developmental level• Cultural differences• Past experiences• Privacy and confidentiality issues• Distractions in the environment

Handling Conflict

• A stressful environment does NOT excuse rudeness or inappropriate behavior

COMMUNICATION REVIEW…

• Two types of communication• Verbal and Non-verbal

• Rolling eyes and huffing falls into which category• Non-verbal

• Name 3 barriers to receiving a message appropriately…• Stress, psychiatric or emotional conditions, age,

developmental delays, cultural differences, past medical experiences, privacy and confidentiality issues, distractions in the environment

Documentation

• MUST ALWAYS BE ACCURATE – • NO EXCEPTIONS

Documentation

• DO’S• Record time using the 24-hour method

(often called military time)• Record time precisely – if it is 0953,

don’t document 0950 – there are many times when EXACT time is needed when reviewing certain situations

• Use correct spelling and grammar – if the case goes to court you will be considered “not credible” if your spelling and grammar is atrocious

Documentation

• DO’S (cont’d)• Use only institution-approved

abbreviations• Charting must be to the point, in

sequence, and entered when there is a change in a patient’s condition or when care is given

• If using paper documentation write legibly, date and time all entries, sign each page with complete name and credentials

Documentation• DON’TS

• Document BEFORE care is given• Use documentation to argue a point, place

blame, criticize, or include personal opinions in the patient’s chart

• Document with and incident report has been filled out on a patient

• When paper-charting DON’T• White-out or erase• Destroy records• Scribble over – just draw one line and place

your initials over it• Leave blanks

Documentation…

• Per legal standards, the following must be part of every patient’s documentation…• Accurate dates and times• Patients physical condition, including results of a primary

and secondary survey• Patient’s medical history• Any treatment administered in the ED• Any reaction or lack of reaction from these treatments• Any changes in vital signs or physical condition• Any unusual circumstances or causes for delay in tests or

treatments, such as the failure to obtain consent

Documentation…

• Must have’s (cont’d)• Mental status of the patient, with any changes, should

be recorded on a regular basis, especially if the patient has sustained a head injury

• All airway maintenance procedures, as well as use of any supplemental oxygen devices

• If the patient sustains any spinal or possible spinal cord injury, the movement and sensation of all the extremities must be recorded as well as any changes in condition

• Any violent or unusual behaviors should be listed

Documentation…

• Again, it is NOT the responsibility of the EDT to do ANY INITIAL assessment, however, the EDT must follow-up on all assessments and properly document as well as inform the RN

DOCUMENTATION REVIEW…

• White-out is appropriate on consents ONLY but not notes• False

• If paper charting and a mistake is made, use a sharpie marker so the charting cannot be seen• False

• Make sure you use correct spelling whether paper charting or computerized charting• True

• You can use any abbreviations as long as you tell people what they mean• False

Legal Issues…

• Delegation and Responsibilities• While it is the RNs responsibility to

know what can and cannot be delegated to the EDT it is also YOUR RESPONSIBILITY to know when to say NO (with respect)

• Rule of thumb – if you have not been checked off on a task you are NOT to do it• Also, if you know it is NOT within your

scope of practice, DO NOT do it.

Legal Issues…• Examples of tasks for the EDT…

• Clean and stock exam rooms• Assemble crutches• Assemble equipment• Collect and transport specimens• Assist with admission and discharge of patients• Perform clerical tasks• Obtain vital signs• Document in patient records• Clean and bandage simple wounds• Splinting of extremities• Perform 12-lead EKG• Remove sutures• Perform CPR

NOT an all-inclusive list

Legal Issues…

• Professional Negligence entails 4 elements• Duty• Breach of Duty• Causation• Damages

Legal Issues…

• Intentional Torts• Abandonment• Assault• Battery• False imprisonment• Invasion of privacy• Libel• Slander

Legal Issues…

• Consents• (It is NOT the responsibility of the tech to get

consent for any patient, however, you need to be aware of them)

• Informed consent• Implied consent• Expressed consent• Consents for minors • Involuntary consent

Infection Control…

• Microorganisms• Bacteria• Viruses• Fungi• Protozoa

• Modes of transmission• Droplet or airborne• Direct contact• Ingestion• Animals or Insects

Infection Control…

• Standard Precautions/Universal Precautions• Guidelines used by the CDC for reducing the risk

of transmission of blood-borne pathogens in hospitals

• Used for ALL patients regardless of any known disease or condition

• Always use if there is ANY remote possibility you may come in contact with any bodily fluids

Infection Control…

• Bodily fluids include• Blood• Urine• Stool• Sputum• Vaginal or penile secretions• Cerebrospinal fluid• Synovial fluid• Pleural fluid• Peritoneal fluid• Amniotic fluid

Infection Control…

• Personal Protective Equipment (PPE)• Situational• Equipment

• Disposable gloves• Disposable gowns• Disposable masks• Eye protection• Disposable containers

Role of the EDT in Triage…

• Functions of PCT at Triage• Vital signs on patients• Assist patients to and from

registration, to the assigned room, x-ray, or other treatment area

• Assist with re-assessing patients in the lobby

• Patient advocate to the family/visitors

Triage…• Does the person who performs triage have

to be a nurse?• Yes, it is the policy• Non-nursing personnel do not have the

authority to make advanced protocol and triage decisions

• THE RN IS ULTIMATELY RESPONSIBLE FOR ALL TRIAGE DECISIONS.

• Please do not take it upon yourself to do any task beyond your scope of practice. Consult the RN first.

Triage…

• Decisions• The TRIAGE NURSE makes the

decision who goes to which room first• The time of patient arrival is not the

purpose of triage• acuity• symptoms• VS stability• Pain Scale >7

Triage…

• Triage Staff• Can “set the tone” for the ED staff,

patients, and families as well• Remember to “SMILE”• Introduce yourself• Explain what you are doing• Validate findings• Explain prioritization’s

Triage…• Triage Staff, cont.

• Explain wait times• Explain rechecking them• Direct to next process• Direct to return to triage if condition

changes• Offer comfort measures, i.e.

wheelchair, stretcher, blanket, ice bag, splint, sling, etc.

Triage…

• Triage Staff, cont.• Remember to convey that calm, caring

approach during the process to allay the patient and family anxiety and lead to a more comprehensive and successful visit for the patient and family.

Triage…• KEEPING EVERYONE INFORMED

• Communication is the KEY• Informing patients of delay is of the

utmost importance• Can’t predict length of stay or how long

it will take• Offer comfort measures• Discuss other reasons for information:

Triage…• Legal Considerations

• An emergency evaluation must be performed on any individual with an emergency medical condition or a woman in active labor

• If the individual’s condition is unstable, then an attempt to stabilize the individual must be done

• Level of transportation to treatment area/s must be appropriate

Triage…

• JCAHO Standards• Domestic abuse victims are identified

by criteria developed by the hospital• Each patient needs to be reassessed at

intervals designated by the institution• Each patient’s physical, psychological,

and social status is assessed• Need for discharge planning

assessment is determined

Triage…• JCAHO

• Staff members integrate the information from various assessments of the patient to identify and assign priorities to his/her care needs

• A Registered Nurse assesses the patient’s need for nursing care in all settings where nursing care is provided

Triage…• Special Considerations

• Violence in the Emergency Department• Disruptive Clients• Disruptive Family

members/visitors• Potential of Psychiatric patients to

become agitated and violent• Beware of the emotionally

distraught clients or family members especially when advised to loss of a loved one

• Any other situations?

Triage…

• Communicable Diseases• Chickenpox or Shingles• Remove from waiting area to an

isolated area, such as a room, out of the way place in the hallway, etc.

• Identify some other communicable diseases?

Triage…

• Immuno-suppressed Patients• Chemo-therapy patients, AIDS,

transplant patients, high dose of steroids

• Mask them and remove to an area away from the public and other flu’s, colds, viruses, etc.

• Reverse type isolation treatment for these patients

Triage…• Pediatric Patients

• Remember safety issues with these little ones

• Remember the parent may be suffering more than the child

• Beware of the child’s activity and bed heights, side rails, playing in the trash cans, etc.

• List other concerns with pediatric patients?

Triage…

• Triage from a Motor Vehicle• Use the buddy system• Use C-spine precautions if indicated• Use good body mechanics• List other ideas for getting a patient out

of the vehicles?

Triage…

• Hazardous Waste• Remember to use safety precautions• Beware of the fact that bio-hazards or

contamination to materials is a major concern

• Look for MSDS sheets or call the 1-800 number for copies of the MSDS sheets, etc.

• Discuss other concerns:

Triage…

• Psychiatric Patients• Beware of their behavior• Speak softly and slowly in short

sentences or phrases• Never turn your back to them• Stay near an exit when interacting with

a psychiatric patient• Other Pearls from experiences?

Triage…• Obstetric Patients

• Place in wheelchair to go to L&D• If presenting part is visible or lots of

rectal pressure keep patient in ED for quick evaluation to determine if eminent delivery is about to occur

• Never send a patient to L&D alone, an employee must accompanying a woman in labor to the unit

• If presenting with obstetric complaints and under 18 weeks gestation, we see them in the ED.

Further Information for the EDT

• Specimen collection• Cardiac monitoring• Administrative P&P• Advanced Triage Protocols (ATPs)• Disaster Management

• These are on separate power points.

QUESTIONS???????