1. Zimmermann, Polly Gerber MS, MBA, RN, CEN


The Emergency Nurses Association focuses on reducing error and easing triage.


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A record number of emergency nurses, leaders, educators, and researchers convened in Boston, from February 22 to 25, at the Leadership Conference of the Emergency Nurses Association (ENA) to focus on best practices and ways to provide high-quality emergency care to America's 110 million ED patients a year. Special emphasis was placed on overcrowded EDs, patient safety, and "ease of practice" (finding ways to make emergency nurses' jobs less difficult).


Risk reduction. Daniel Sullivan and Alida M. Zamboni of the Sullivan Group discussed the results of a performance-based audit, conducted over several years, of more than 400 EDs. They focused on a systems approach to decreasing medical error and risk and improving patient safety. They advocate


* developing departmental standards for monitoring vital signs and physician notification. They found that 10% to 25% of patients discharged from the ED had abnormal vital signs that weren't remeasured prior to discharge.


* holding a joint nurse-physician meeting at discharge for high-risk, critical complaints. Physicians are often unaware of important vital sign measurements or patient statements documented after they last reviewed the chart. In one example, a nurse's report that the patient stated his chest pain had migrated to his lower back led to correctly diagnosing a dissecting aortic aneurysm.


* having bedside tools available to assist practitioners, including tools to help them conduct a systematic analysis of risk factors for life-threatening conditions.


* measuring blood pressure in both arms to assess for aortic aneurysm in all patients older than 50 years who complain of chest pain.


* ensuring that there is documentation of follow-up assessment of a patient's condition after treatment for headache, fever in a pediatric patient, or pain in an older adult.


* using comprehensive, preprinted discharge instructions, including a designated time for follow-up.



Triage. One of the most popular sessions was presented by Shelley Cohen of Health Resources Unlimited on how to manage the risks associated with the triage process. She stressed that it's important for triage nurses to accurately capture a patient's description of her or his problem (by using direct quotes) and to follow policies for reassessing patients awaiting treatment.


Maureen Mudron, William D. Rogers, and Sandra J. Sands, national experts on emergency care law, stressed the importance of having a standard process for distinguishing between triage and the medical screening examination, and of clarifying that "not having an empty bed" isn't the same as "having no capacity." The current expectation is that if that facility or patient unit has ever been "that busy" before, it can be that busy again, even if clients are placed in the hall.


The Joint Commission. Cathy Fox relayed advice drawn from more than 13 surveys by the Joint Commission. Her suggestions included using


* "critical lab" stickers. Nurses document critical laboratory or X-ray results they receive by phone on a large sticker placed on the chart.


* medicated symbol signs. Patients who receive narcotics or other pain or sedating medications are at risk for falls. When patients leave the unit for diagnostic testing, all staff interacting with them must be made aware that they're taking such medications. A large laminated sign placed on the iv pole can accomplish that.


* the "5P" transfer sheet. Before a patient is transferred, information is faxed to the unit receiving the patient; it contains a standardized checklist with Patient name, Past medical history, Pain status, Plan of care (with pertinent results), and Purpose (with any required infection control precautions).



Additional information is available at the ENA's Web site:


Polly Gerber Zimmermann, MS, MBA, RN, CEN


coordinator of Emergency