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ED Immediate Orders – Adult/Pediatric - Emergency Department [61]

ED Immediate Orders – Adult/Pediatric - Emergency Department [61] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 61

Delegation Protocol Title:
ED Immediate Orders - Adult/Pediatric - Emergency Department

Delegation Protocol Applies To:
UWHC Emergency Department (ED) patients: All adult and pediatric patients not yet evaluated by an ED
provider.

Target Patient Population:
Adult and pediatric patients who require immediate medical intervention based on documented
symptom/condition and/or whose care can be initiated immediately upon arrival to facilitate throughput.

Delegation Protocol Champions:
Andrew Lee, MD – Department of Medicine – Emergency Medicine
Josh Ross, MD – Department of Medicine – Emergency Medicine

Delegation Protocol Reviewers:
Tami Morin, MS, RN – UWHC Emergency Services
Anne LeGare, MS, RN – Emergency Services

Responsible Department:
Emergency Department

Purpose Statement:
To delegate authority from ED providers to Registered Nurses (RNs) to place initial care orders for the
management of patient symptoms. In addition, authority is delegated from ED providers to ED technicians to
order and perform EKGs in patients meeting specific criteria as outlined below.

Who May Carry Out This Delegation Protocol:
Registered Nurses in the Emergency Department (for the management of patient symptoms)
ED Technicians in the Emergency Department (for immediate EKG orders)

Guidelines for Implementation:
ED NURSING IMMEDIATE CARE ORDERS Patient registers in the Emergency Department
1. RN documents patient’s symptoms.
2. RN initiates the “ED- Immediate Order-Adult”, or “ED-Immediate Orders- Pediatric- Patients Less Than 18
Years of Age” order sets, respectively, if documented symptoms and conditions are covered in order sets.
3. RN will follow specific ordering instructions per symptoms/conditions that apply to patient’s
symptom/condition being treated.
4. Venous access will be ordered if needed to carry out orders to treat specific symptoms/conditions.
5. RN signs orders with order mode of “Cosign Required Protocol/Policy” to communicate back to the
designated ‘administrative’ physician what orders have been placed. The designated administrative
physician will review orders. Orders can be implemented before co-signature occurs.
ED TECHNICIAN IMMEDIATE CARE ORDERS
1. Patient is screened by ED Tech using standard screening document
2. Need for EKG is established based on the following 3 criteria:
2.1. Patient is > 30 years of age and c/o chest pain or chest pain equivalent
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2.1.1. Chest pain = pain, pressure, compression, tightness, heaviness, cramping, burning or aching.
2.1.2. Chest pain equivalent = arm, neck and/ or jaw pain without explanation
2.2. Any patient > 70 years of age with medical complaint(s)
2.3. Any patient > 30 years of age AND with any symptom below
2.3.1. Dyspnea - Unexplained difficulty breathing or shortness of breath
2.3.2. Nausea, vomiting or severe epigastric pain, excluding pelvic pain
2.3.3. Weakness and/ or fatigue
2.3.4. Confusion, unexplained change in level of consciousness
2.3.5. Palpitations
3. ED Tech gives completed screening document to ED Clerk to enter the EKG order into Health Link. ED Clerk
signs EKG order with an order mode of “Cosign Required Protocol/Policy” to communicate to the designated
‘administrative’ physician that the order has been placed. The designated administrative physician will
review the order and act upon it and/or forward to treating provider.
4. Orders can be implemented before co-signature occurs.
5. ED Tech performs EKG
6. Patient’s name is flagged on the patient board as having an EKG performed.

Order Mode: Cosign Required, Protocol/Policy

References:
1. UWHC Emergency Department Pediatric Guidelines –Fever in Neonates UWHC Pain Management Policy
8.76
2. UWHC ED Protocols Policy 60.11
3. UWHC Vascular Access (Venous and Arterial) Policy 8.18
4. UWHC Adult Insulin Infusion Algorithm- UWHC Diabetes Management
5. Retezar R, Bessman E, Ding R, Zege SL, McCarthy ML. The effect of triage diagnostic standing orders on
emergency department treatment time. Ann Emerg Med. 2011;57:89-99.
6. Seguin D. A nurse-initiated pain management advanced triage protocol for ED patients with an extremity
injury at a level I trauma center. J Emerg Nurs. 2004;30:330-335.

Collateral Documents:
1. ED – Immediate Orders – Delegation Protocol – Adult [4222]
2. ED – Immediate Orders – Delegation Protocol – Pediatric – Patients Less Than 18 Years of Age [4274]

Approved By:
UWHC ED Performance Improvement: October 2011; March 2014; *July 2015
UWHC ED Clinical Operations: November 2011; *March 2014; *July 2015
UW Health Nursing Practice Council: November 2011; April 2014; *August 2015
UWHC Pharmacy & Therapeutics Committee: December 2011; April 2014; *August 2015
UWHC Medical Board: January 2012; May 2014; *August 2015

Effective Date: September 2015

Scheduled for Review: September 2018

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org