Emergency Triage (eBook)

Manchester Triage Group

Kevin Mackway-Jones, Janet Marsden, Jill Windle (Herausgeber)

eBook Download: PDF | EPUB

2013 | 3rd Edition (Version 3.8, 2023)
John Wiley & Sons (Verlag)
978-1-118-29905-0 (ISBN)

Infos

The Manchester Triage System (MTS) is the most widely used triage system in the UK, Europe and Australia, with tens of millions of patients being processed through hospital emergency departments, It is also used in hospitals throughout Brazil,

Emergency Triage is the core text for the MTS, which utilises a risk averse system of prioritisation for patients in all unscheduled care settings,  As such, it is an essential text for all emergency department staff using the MTS, in particular triage nurses, The book is both a training tool and a reference for daily use in the Emergency Department and prehospital settings, 

This edition features revised protocols that reflect new approaches to prioritisation, with accompanying revised flowcharts -  the core part of the book,

Table of Contents

Presentation flow charts index

1: Introduction

2: The decision-making process and triage

3: The triage method

4: Pain assessment as part of the triage process

5: Patient management, triage and the triage nurse

6: Auditing the triage process

7: Telephone triage

8: Beyond prioritisation to other applications

Kevin Mackway-Jones, Professor of Emergency Medicine, Manchester Royal Infirmary, Manchester, UK
Janet Marsden, Professor of Ophthalmology and Emergency Care, Manchester Metropolitan University, Manchester, UK
Jill Windle, Lecturer Practitioner in Emergency Nursing, Salford Royal Hospital, Salford, UK

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The Manchester Triage System (MTS) is the most widely used triage system in the UK, Europe and Australia, with tens of millions of patients being processed through hospital emergency departments. It is also used in hospitals throughout Brazil. Emergency Triage is the core text for the MTS, which utilises a risk averse system of prioritisation for patients in all unscheduled care settings. As such, it is an essential text for all emergency department staff using the MTS, in particular triage nurses. The book is both a training tool and a reference for daily use in the Emergency Department and prehospital settings. This edition features revised protocols that reflect new approaches to prioritisation, with accompanying revised flowcharts - the core part of the book. Table of Contents Presentation flow charts index 1: Introduction 2: The decision-making process and triage 3: The triage method 4: Pain assessment as part of the triage process 5: Patient management, triage and the triage nurse 6: Auditing the triage process 7: Telephone triage 8: Beyond prioritisation to other applicationsThis Edition was updated in 2023 to Version 3.8.

Inhalt

Editors vi

Members of the original Manchester Triage Group vii

International Reference Group viii

Preface to the third edition ix

Preface to the first edition xi

1 Introduction 1

2 The decision-making process and triage 6

3 The triage method 11

4 Pain assessment as part of the triage process 25

5 Patient management, triage and the triage practitioner 35

6 Auditing the triage process 42

7 Telephone triage 47

8 Beyond prioritisation 54

Presentational flow chart index 62

Presentational flow charts 64

Discriminator dictionary 174

Index 185

General discriminators 190

Textauszug

Chapter 4
Pain assessment as part of the triage process

Introduction

Pain is a key issue for patients attending Emergency Departments. Pain assessment has improved since the first edition of this text, however pain assessment must remain at the forefront of the triage method so that pain continues to be assessed and managed appropriately. Pain is an important issue for a number of reasons.

• The majority of patients attending Emergency Departments have some degree of pain
• The degree of pain influences the urgency
• The adequacy of pain management is a key criterion for patient satisfaction
• Patients in pain can become agitated and aggressive
• Patients in pain are a source of distress and stress to both staff and other patients
• Patients have an expectation that their pain will be dealt with

There are many advantages in assessing pain as part of the triage process. First, it ensures that a patient's pain is managed at the earliest opportunity – the provision of appropriate analgesia and consequent reduction in pain may lead to the possibility of re-categorisation to a lower priority. Patient anxiety is reduced and communication is improved. Without pain assessment the provision of appropriate analgesia at triage is not possible.

Pain assessment at triage

Pain assessment is an integral part of the Manchester triage methodology. This is a deliberate and explicit recognition of the importance of pain and it is recognised that the result is that patients are categorised into a higher priority than was traditionally the case.

If a patient's pain is to be assessed formally at triage, and the outcome of that assessment is to help determine the urgency with which that patient is to be seen, then all triage practitioners must be competent in assessing pain, and the pain assessment must be valid and reproducible. It is unrealistic to expect that only the patient's subjective assessment will be taken into consideration during this process. By the same token it is inappropriate that the triage practitioners make their own subjective assessment of the patient's pain in isolation.

Pain assessment in the Emergency Department

This can be difficult because patients may be under pressure to say that their pain is severe so as to justify their attendance, and some patients, particularly children, may deny that they have pain to avoid having treatment or being admitted to hospital. Some practitioners' assessment and management of pain may be influenced by ‘traditional’ pathways of care. For example, patients who have fractures are offered immediate analgesia, but patients with abdominal pain may not be offered analgesia until the surgeons have seen them.

There may be concerns by staff that a patient will score pain higher if it is thought that this will result in a quicker treatment, but the objective assessment of pain will ameliorate this.

Pain assessment tools

Many Emergency Departments now use a formal pain assessment tool, but many such tools suffer from the fact that they were developed for use with postoperative and chronically ill patients.

There are three main types of pain assessment tools:

• Verbal descriptor scales
• Visual analogue scales
• Pain behaviour tools

Verbal descriptor scales

These scales consist of a number of word descriptors, usually three or five, which are numerically ranked. The most common descriptors are as follows:

• None
• Slight
• Moderate
• Severe
• Agonising

and the numerical value increases with the severity of the pain. The verbal descriptor scale is short and relatively easy for the patient to use and has been employed in the Emergency Department environment (Table 4.1).

Table 4.1  

Advantages

Disadvantages

It provides a score which is easy for any practitioner to analyse

The use of a single word from a limited list may not reflect the pain that the patient is experiencing

It probably produces reliable data

It is not suitable for patients who do not speak English

It can be modified for use in children

It is the patient's subjective assessment

Visual analogue scales

These scales usually consist of a straight line representing varying levels of pain with verbal anchors at each end.

NO	PAIN AS BAD AS

PAIN	IT COULD BE

Patients can mark anywhere on the line. Verbal descriptors can also be added beneath the line in addition to the word anchors. The line can also be broken down to facilitate scoring for evaluation or comparative purposes.

Table 4.2  

Advantages

Disadvantages

Easy and fast to use and score These scales may be more sensitive than verbal descriptors If used correctly they are reproducible and reliable

Some patients choose to mark the line near one of the verbal anchors Certain patients find these scales too abstract to use, in particular those in severe pain, those with lower educational abilities or those with impaired motor coordination. The elderly can have some difficulty in using these scales

Pain behaviour tools

These tools have been developed relying on the principle that patients who are in pain exhibit certain behaviours and physiological changes. These tools can measure the following:

• Verbal response
• Body language
• Facial expression
• Behavioural changes
• Conscious level
• Physiological changes

A number of different tools exist, each based on combining a number of the above factors, but have some disadvantages in use (Table 4.3).

Table 4.3  

Advantages

Disadvantages

Can be used in patients with communication problems

Complex scales; comparison and scoring are difficult The patient's subjective assessment is not included Difficult to ensure that pain alone underlies the observed changes Time consuming, taking 5–15 minutes to use

The ideal pain assessment tool

An ideal tool for use in the Emergency Department should be simple and quick to use, should have been validated and must give reliable, reproducible results. These results should take account of both patient and observer data.

The pain ruler

No single pain assessment tool is better than another, although some would seem to be more suited to particular clinical areas than others. The pain ruler is a well-established pain assessment tool which would seem to lend itself for use in the Emergency Department setting more than some others. In particular, the advantages are as follows:

• It measures the intensity of pain and the effects on normal function
• It combines the use of verbal descriptors and a visual analogue scale
• It is fast and easy to use
• It is easily weighted to allow pain assessment to be part of the triage process
• By helping in the normal function assessment, the triage practitioner can become involved in the pain assessment process
• It promotes dialogue, which in turn encourages patients that their pain is being taken seriously
• It produces a score facilitating ongoing assessment
• The outcome of the assessment is quick and easy to document
• It can easily be adapted for use in children

A pain ruler offers scores of 0–10 but this is grouped into no pain, mild pain, moderate pain and severe pain, which is congruent with other pain scoring tools. These descriptions are used in the presentational flow charts. A pain ruler is shown in Figure 4.1.

Figure 4.1 Pain ruler

This can be supplemented by a faces scale for use in small children as shown in Figure 4.2.

Figure 4.2 Faces scale pain ruler for use in smaller children

Pain assessment at triage

Pain assessment is a skilled process in any environment and the assessment carried out during triage is no exception. There are particular constraints in this setting reflecting the emergency nature of the patients and the lack of assessment time. Nevertheless, an accurate assessment of the patient's pain into one of the categories shown in the flow chart is essential if proper and timely care is to be given. The triage practitioner must take into account a number of factors that influence the patients' perception of their pain.

Age

Children may imagine the worst possible outcome of their pain. They use catastrophic thinking which increases their anxiety and fear and may therefore enhance their perception of pain. The practitioner must be able to recognise the signs of pain in pre-verbal children and the pain ruler can be adapted for this.

Many elderly people suffer...

Produkt-Details

• Erscheint lt. Verlag: 21.10.2013
• Reihe/Serie: Advanced Life Support Group
• Reihe/Serie: Advanced Life Support Group
• Reihe/Serie: Advanced Life Support Group
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Themenwelt: Medizin / Pharmazie ► Pflege ► Fachpflege
• Schlagworte: Acute, Critical & Emergency Care • Department • easytounderstand • Emergency • Emergency Medicine & Trauma • essential text • information necessary • Intensiv- u. Notfallpflege • Krankenpflege • Medical • Medical Science • Medizin • millions • MTS • Notfallmedizin u. Traumatologie • nurses • nursing • patients • Prioritisation • SAFE • Staff • System • TENS • Treatment • Triage • triage system • UK • User • year
• ISBN-10: 1-118-29905-1 / 1118299051
• ISBN-13: 978-1-118-29905-0 / 9781118299050