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/depts/uwhealth/ambulatory-education/ambulatory-emergency/resources/Emergency-Event-Checklist.pdf

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Departments & Programs,UW Health,Ambulatory Education,Ambulatory Emergency,Resources

Emergency Event Checklist

Emergency Event Checklist - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Emergency, Resources


Ambulatory Emergency Response Checklist
_____ RN or appropriate clinical staff call report to the receiving facility
_____ Send copies of Snapshot, Emergency Response Form, EKG (if applicable) and other pertinent information with
EMS staff or code team.
_____ Send patient belongings with EMS staff, code team or patient’s family
_____ PSN submitted by 1st person on scene within 24 hours
_____ Per Policy 5.1.15 Maintaining and Securing the Emergency Response Carts, Defibrillators, and (AED)

o Restock Emergency Cart
o Exchange medication tray
o Exchange used oxygen tank with full tank
o Obtain new plastic lock

_____ Obtain appropriate signatures on Emergency Response Form if applicable (see form for details)
_____ Health Link Documentation: UW Health Patient
o RN to document in Health Link
 Schedule patient on RN schedule
 Start Allied Health Visit encounter
 Reason for Visit: Emergency Medical Response
 Use smart phrase .EMERGENCYMEDICALRESPONSE to document the event
 Use Charge code: HB 20967 (if applicable)
_____ Scan or send Emergency Response Form to HIM (see form for details)
o Follow current process if you bill for medications used
_____ If patient cannot be identified or is not in UW Health System
o Emergency Response Form is copied and sent with EMS Personnel
o PSN is completed and Emergency Response Form is scanned and attached to PSN
_____ RN Manager or RN Supervisor/coordinator to debrief as appropriate