College Health Nursing – Pearls of Triage, Treatment and Stats

1. College Health Nursing – Pearls of Triage, Treatment and Stats Chris Rooney BSN, RN BC Health Services Millersville University of Pennsylvania

2. College Health Nursing • Scope of practice - • Direct Nursing Care • Collaborative Role • Health Educator • Research/Consultant • Advocacy • Combining Triage with College Health Nursing

3. Factors to consider • Staffing • Staff – provider type • Time – hours of service , time of day • Method of contact • Walk in • Phone interaction • Chief Complaint - Assessment • Appointment/walk-in • Need for ancillary services - immediate lab/x-ray • Other considerations • Transportation • Distance to acute care/ER

4. Baseline considerations • 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

5. Literature Review of Protocols • None specific to college health • 2007 JCN -Clinical decision making • 2008 IJN - Knowing the patient • JCN – Context vs protocols • 2008 JTIICC – Triage Tools • 2009 IJCN - Expertise

6. PEARLS of Triage and Treatment • Nursing judgment/clinical decision making - within the scope of practice of Registered Nurse if based on assessment findings and nursing guidelines • Vital Signs imperative • Policy/Guidelines – follow documentation form • Guideline resources abundant but not specific to college health

7. Other sources of Algorithms 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 BriggsLippincott 3rd 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)

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

9. Best Practices/Telephone Triage 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.

10. 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.

11. Gathering Statistics • 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

12. Pearls • 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 Protocols Chris Rooney BSN RN BC chris.rooney@millersville.edu