ED organization

1. Emergency Department Organization,
Equipment and Drugs,
Communication and Documentation
BY. AME M. (BSc, MSc)

4. Objectives
 Discussing about the overview of ED organizatioin including:-
 EM human resources,
 Emergency drugs
 Equipments
 Discuss about the types of communication, barriers and
strategies to improve communication.
 Discuss about documentation, characteristics of good recording
and advantages of clinical documentation.

5. Outlines
 ED organization
 Major determinant spaces in ED
 Classification of treatment areas
 EM equipments & drugs
 Communication
 Clinical documentation

6. Emergency hospital in Poland

9. Emergency Department Organization
 ‘The emergency department(ED):
 is the dedicated area in a hospital that is organized and administered to
provide a high standard of emergency care to those in the community who
perceive the need for or are in need of acute or urgent care including
hospital admission’ (ACEM, 2001:2).
 is a core unit of a hospital and the experience of patients attending the ED
significantly influences the patient journey and the public image of the
hospital (ACEM, 2007).
 Therefore, it is important for all emergency staff to leave a positive first
impression with the patient and their family and friends.
 Emergency care is a recognized nursing specialty.

10. Design and Function of the ED
 The major functions of the ED is to:
 Receive
 Triage
 Resuscitate
 Stabilize
 Diagnose and initially treat, and
 Promptly transfer patients.

11. Design and Function of the ED
 The major functional areas of the department may be divided
broadly into:
 Entrance/reception/triage/waiting.
 Resuscitation area.
 Acute treatment area.
 Consultation area.
 Staff/amenities area.
 Administration area.

12. ED Organ…
 In addition to clinical areas, emergency
departments require facilities for the following
essential functions:-
 Teaching
 Research
 Administration
 Staff amenities

13. ED Human resources
 Emergency physicians
 Emergency Residents
 Medical and Surgical Residents
 Emergency Nurse practitioners
 BSc nurses
 Security guards
 Cleaners
 Porters/patient assistants
 Oxygen technician

14. ED Organ….
MAJOR SPACE DETERMINANTS
 Space determinants revolve around the major
functional areas of the department.
 Ambulance and ambulatory entrances
 Reception/Triage/Waiting area
 Resuscitation area
 Acute Treatment Area (of non-ambulant patients)
 Consultation Area

15. ED Organ….
MAJOR SPACE DETERMINANTS
 Staff Workstations –staff working area which
may contain desk top computers.
 Administrative Area
 Procedure Room(s)
 Pharmacy/Drug Preparation/Store
 Isolation Room(s)
 Decontamination Areas

16. ED Organ…
MAJOR SPACE DETERMINANTS
 Tutorial Room/Teaching Areas
 Storage of Different Machine
 Clean and Dirty Utility
 Shower/Bathroom/Toilets
 Staff Rooms – staff resting room.
 Cleaner's Room
 Emergency Services Lounge
 Diagnostic Areas Medical Imaging Unit/Laboratory Area
 ED Short Stay/Observation Area – Ward A, B, C.
 Circulation Space

17. ED Organ…
 Majority of EDs are comprised of the
following functional areas:-
 Entrance/Reception/Triage Area
 Resuscitation Area
 Acute Treatment Area
 Consultation Area
 Staff/Amenities
 Administration Area

18. Physiological Monitors
 Each Acute Treatment area bed should have access to a
physiological monitor.
 Physiological monitoring equipment ideally should be
central in resuscitation and acute areas.
 Monitors should have printing and monitoring
functions:-
 Cardiac monitor – to diagnosis and monitor vital functions
 ECG machine
 Defibrillator
 NIBP/BP Apparatus
 Pulse oxymetery
 Thermometer

19. 1. Reception
 The Entrance/Reception/Triage area is the
focus of initial presentation of the patient in
the hospital.
 The Administration area should be accessible
to the clinical areas but should not impair the
clinical function of the department.

20. Adult and children entrance reception area

21. 2.Triage
 Patients may present self-referred or via emergency
services (ambulance, police etc.).
 All patients should be triaged through a single
point/entry point.
 The aim of triage is to "sort" patients in order to;
 provide optimum care consistent with their medical need
and
 ensure the efficient utilization of the available resources
 There is a close operational relationship between Triage
and reception.
Patient to the triage – for Stable patients
Triage to the patient –if the patient is Unstable

23. 3. Treatment Area
 Patients may be directed to:-
 Resuscitation Area
 Acute Treatment Area
 Procedure room
 Consultation area
 Medical Imaging
 Waiting Area

24. a) Resuscitation Room
 If the early severity index is greater than 5,
dispose the patient into resuscitation room by
leveling orange or red.
 The Resuscitation area should be easily
accessible from the ambulance entrance and
separate from patient circulation areas and must
be easily accessible from the staff station:-

25. Resuscitation …
 The Resuscitation area should have a full range of
physiological monitoring and resuscitation equipment.
 Transcutaneous pacemaker
 Infusion pumps
 Fluid warming devices including infusers and warming
cupboards
 Portable ventilator with invasive & non-invasive functions
 White boards
 Defibrillators
 Cardiac monitors
 ECG machine
 Suction machine with suction catheter

26. Roles of resuscitation team

27. EM post resuscitation wards

28. b) Tutorial Room
 This room provides facilities for formal undergraduate &
postgraduate education & meetings.
 It should be in a quiet non-clinical area, near the Staff
room & offices.
 Provision should be made to have the following available:
 DVD
 Television
 Slide projector
 Overhead projector
 Projection screen
 Whiteboard

29. b) Tutorial room …
 Digital projector
 X-Ray viewing facilities/digital imaging
system
 Telephone
 Examination couch
 Storage cupboard, large enough to store
simulation mannequins (dolls) and training
materials.

30. Patient assistant room

31. Staff LRC

32. Staff duty room

33. ECG Room

34. Staff dining room

35. EMERGENCY DRUGS IN
RESUSCITATION AREA
Crash cart

38. Standard Equipment
 The following standard equipment are necessary for
emergency resuscitation room/area:
 Suction machine
 Oxygen cylinders and oxygen flow meters (at least 4)
 Sphygmomanometer, stethoscope
 Ambu bag with face mask (at least 4)
 Patient face mask, nasal prongs and catheter
 Urine bags, urine catheters, NG tubes, gloves
 Thermometer, mobile pulse oximeter
 Drip stand
 Suction tray

39. Standard Equipment …
 Safety boxes for sharp objects
 Cardiac monitoring with cables and electrodes(mobile)
 Perfusers
 ECG machines
 Torches, batteries
 Glucometer, dextrostix and ketosticks
 Ophthalmoscope
 Ottoscope
 Battery charger and rechargeable batteries
 Intubation trolley

40. Standard Equipment …
 Intercostal drains, bottles, connections and clamps
 Tracheotomy set, central catheters (if necessary)
 Burr hole tray (if necessary)
 Chest aspiration set
 Cut down set
 Lumbar puncture set
 Defibrillator
 Mobile X-ray machine
 FAST machine(bed side U/S)
 ABG analyzer(may not be available)
 BIPAP and CPAP machines

41. Suction Tray
 Suction tray should have the following components:
1. Suction catheters (mouth, endotracheal)
2. Bowel of sterile water or normal saline
3. Gauze swabs
4. Guedel air ways (different size)

42. Intubation Set with Trolley
 Intubation Set Trolley have the following
necessary equipment:
 Laryngoscopes with proper handle, blade and
functional light bulb (miller and mackintosh)
 Stylet for introducing ETT
 ETT (different size)
 Syringes
 Magill forceps
 Guider air ways (different size)
 Ambu bag, face mask (different size) and ambu
valve connected to oxygen catheter at one end.

43. Intubation Set with Trolley
 Intubation Set Trolley have the following
necessary equipment:
 Scissors
 Bandages and tape to secure ETT, syringes
 Drugs (ketamine, propofol, thiopental, etomidate,
atropine. suxamethonium, vecuronium, lidocaine,
hydrocortisone, albuterol, diazepam etc.)
 ETCO2 detector
 Surgical & clean gloves

44. Some of The Common Emergency Drugs
 Adenosine
 Adrenaline/Epinephrine
 Amiodarone
 Anticoagulant- heparin
 ASA - for unstable Angina
 Atropine
 Charcoal
 Dopamine
 Dobutamine
 Furosemide
 Hydrocortisone
 Insulin
 IV fluids
 KCL
 Lidocaine
 Metoprolol
 Morphine/Pethidine
 Noradrenalin
 Quinine
 Salbutamol/Aminophylline

45. Some Of The Common Emergency Drugs
 Calcium gluconate
 Dextrose 40%, 50%
 Diazepam/midazolam
 Digoxin
 Hydralazine
 Ketamine
 Labetalol/Sotalolol
 Mannitol
 Naloxone
 Nitroglycerine
 Oxygen
 Propofol
 Sodium bicarbonate
 Thiopental
 Thiamine
 Verapamil
 Water for injections

46. COMMUNICATION
AND
DOCUMENTATION

47. COMMUNICATION
 Communication is a dynamic, continuous,
and multidimensional process for sharing
information.
 Reporting and recording are the major
communication techniques used by health care
providers.

48. Communication is a two-way process
Message
Sender Receiver

49. Communication …
 Should be accurate, timely and effective
 Includes reports, records and orders
 Could be oral or written
 Effective communication is known to improve
patient safety, teamwork and operational
efficiency.

50. 1. Verbal Communications
 Good communication means that the person
receiving the message understands exactly what
the person who sent the message meant.
 Effective communication requires feedback.
 The receiver needs to communicate to the sender that
the message has been received and understood.

51. 2. Nonverbal Communication
 All behaviors that express messages without
the use of words
 Body movement
 Physical appearance
 Touch
 Body language
 Should be consistent with spoken word
 Cultural considerations

52. Communication con…
 External and internal distractions can hinder
effective communications.
 try to keep noise to a minimum
 don’t allow yourself to think about personal matters.
 Verbal communications are an essential part
of high quality emergency care.

53. Guidelines for Effective
Communication with Patients
 Identify yourself by name and profession
 Ask the pt’s name and use it
 Make and keep eye contact
 Use language the patient can understand
 Speak slowly, clearly, and distinctly
 Tell the truth
 Allow time for the pt to respond
 Limit the number of people talking with the pt.
 Be aware of your body language
 Act and speak in a calm, confident manner
 Treat all pts as if they were a member of your family.

54. Communicating to patients with
Special Needs
A. Hearing Impaired Patients
 Identify yourself by showing your badge
 Touch the patient
 Face the patient when you speak so he/she can see your
lips and facial expressions.
 Speak slowly and distinctly; do not shout.
 Watch the pt’s face for expressions of understanding or
uncertainty.
 Repeat or rephrase comments in clear, simple language.
 Write down your questions
 offer paper and pencil for the patient to respond

55. Communicating to patients with Special
Needs ...
B. Visually Impaired Patients
 Observe for the general appearance of the patient
that may show a clue for visual impairment such
as manner of gaze, use of eye glass and walking
with assistant.
 Tell the patient what is happening.

56. Communicating to patients with
Special Needs …
C. Non Afan Oromo, Amharic/English
Speaking Patients
 Determine how much the patient could able to speak
Afan Oromo, Amharic, English or others according
to the area, if not, try to find an interpreter.
 Try to ask your questions using;
 hand gestures,
 finger pointing, and
 facial expressions.

57. Communicating to patients with Special Needs ...
D. Geriatrics
 Do not assume that all older patients have physical or mental
impairments.
 Assess all patients carefully and give them time to respond to your
questions.

58. Communicating to patients with
Special Needs …
E. Pediatric Patients
 Familiar objects and faces can help reduce fear for
children.
 Talk to parents and child as much as possible and tell
them what is happening.
 Ask a parent to hold the child if illness or injury permits.
 Tell the child your first name and explain what you are
doing.
 Squat, kneel, or sit down to the child’s level
 Establish eye contact
 Be honest

59. Communicating to patients with Special
Needs con..

60. Communicating to patients with Special
Needs ...
F. Developmentally Disabled Patients
 Ask the family about patient’s level of
communication.
 Speak slowly, using short sentences and simple words
 May need to repeat or rephrase statements several
times until the patient understand what you want.

61. Communicating to patients with Special
Needs ...
G. Persons Displaying Disruptive Behavior
 Assess the situation, try to determine the causes of
patient’s disruptive behavior
 Protect the patient and yourself
 Do not take your eyes off the patient or turn your back.
 If patient has a weapon, call law enforcement and stay
clear until scene is safe.
 As soon as your personal safety is assured, carry out the
appropriate emergency medical care.
 You cannot take a disruptive patient to the hospital
against his or her wishes.

62. Therapeutic Communication
 An application of the process of communication to promote the
well-being of the client.

63. Skills for the Therapeutic Relationship
 Listen actively – Active Listening
 Help identify the client’s feelings
 Be empathetic, honest, genuine, and credible
 Use ingenuity - the ability to solve difficult
problems, often in original and creative ways.
 Be aware of cultural differences
 Maintain confidentiality
 Know your role and your limitations

64. Why communication in hospital
is so important?
 Because hospitalized people die as a result of
medical errors due to poor communication.
E.g. Patients with class iV CHF….Vs fluid
management.

65. Barriers to Communication
1. Failure to listen. -Listening failure
2. Improperly decoding intended message
3. Placing the nurse’s needs above client’s
4. Giving advice
5. Expressing approval or disapproval ??
6. Defending with out reasoning
7. Changing the subject
8. Lack of structure and standards

66. Strategies to improve
Communication
 In an effort to improve communication in the
health care field, in US, standardized approach
was adopted.
 The approached field used by US was called
“SBAR”.
 SBAR model provides effective and efficient
way to communicate, mirror for a scientific
process, and creates a common language.

67. Strategies to improve
Communication
 SBAR
 S=Situation: what is the immediate problem?
 Introduction about patient
 Patient chief complaint
 Stated concerns
 B=Back ground: What is the relevant
background to the situation?
 Medication
 Lab test results
 Response to interventions

68. Strategies ….
SBAR ….
 A= Assessment: What are your conclusions
about the present situation?
 I think the problem is ----
 R=Recommendation: What are we doing to
correct the problem?
 I suggest/request that you: Transfer the patient,
come to see the patient, talk to the patient etc.

69. Documentation
 is any written or electronically generated information
about a patient that describes the care or service
provided to that patient.
 may be paper documents or electronic (computer
based).
 is defined as written evidence of:
 The interactions between and among health
professionals, clients, their families, and health care
organizations.
 The administration of tests, procedures, treatments,
and client education.
 The results or client’s response to these diagnostic
tests and interventions.

70. Documentation
 Importance
 Verifies your actions with written record
 Provides a record for others
 Legal record of the actions you took
 Provides basis to evaluate quality of care

71. Proper documentation includes
1. Age and sex of the patient
2. History of incident
3. Condition of patient when found
4. Patient’s description of injury or illness
5. Patient’s chief complaint
6. Patient’s level of responsiveness
7. Initial and subsequent vital signs status
8. Results of physical examination

72. Purposes of Health Care Documentation
1. Professional Responsibility and
Accountability
2. Communication
3. Education
4. Research
5. Legal and Practice Standards
6. Recording provides written evidence of what
was done for the client, the client’s response,
and any revisions made in the care plan.

73. Elements of Effective
Documentation
1. Use of Common Vocabulary
2. Legibility
3. Abbreviations and Symbols
4. Accuracy
5. Documenting a Medication Error
6. Confidentiality

74. Forms for Recording Data
1. Kardex
2. Flow Sheets
3. Nurses’ Progress Notes
4. Discharge Summary

75. Characteristics of Good
Recording
1. Brevity – concise, start with a capital letter and
end with a period. (Brief).
2. Use black ink pen. (Can stay long time w/o fading
and clearly copied).
3. Accuracy – must be objective
4. Appropriateness
5. Completeness and chronology/timing
6. Use of standard terminology
7. Confidentiality

76. What are the things to be documented?
 Basic components of the patient’s Care
Record/Chart are:
1. Nursing admission ass’t form
2. Physician’s order sheet
3. Medical hx and P/E sheet
4. Physician’s progress notes
5. Nurse’s notes: care plan, progress notes, discharge
planning, etc
6. Special records/reports: referrals, x-ray and
laboratory results, medication and vital sign sheets, I
& O, IV fluid administration, etc
7. Discharge Summary

77. Reporting
 Verbal communication of data regarding the client’s
health status, needs, treatments, outcomes, and
responses.
 Summary of current critical information to facilitate
clinical decision making and continuity of client care.
 2 or more people share information about patient
care:-
 Can be:
 face to face,
 telephone

78. Types of reporting
1. Telephone orders
 Nurses/other health professionals may receive
telephone orders
 If the receiver is a nurse, it needs to be verified by a
2nd nurse and repeating it clearly and precisely.
2. Face to face reporting's
 Nurses’ interventions
 Transfer reports - transferring a patient from one
unit to another.

79. Reporting con…
 Telephone reports
 Clear, accurate, concise information
 When the call was made
 Who made the call/report
 To whom and what information was given
 What information was received

80. Nurse-to-Nurse shift
report/handover
 Follow the format below for performing nurse-to
nurse shift report
1. Patient name, age, chief complaint
2. Patient Dx: present all current Dx
3. Current V/S , Tests completed or pending
4. Abnormal lab findings: do not report normal
findings.
5. Patient progress
6. Equipments available and drugs to be refilled etc.

81. Nurse-to-Physician reporting
 Reporting to Physicians
1. Whenever a patient’s status changes, the physician should
be informed.
2. The status should be reported in an objective manner,
allowing for the physician’s recommendation(s).
3. Any physician’s order should then be documented in the
medical record by the nurse as a verbal order.
4. Verbal orders from a physician to a nurse must be told to 2
nurses to ensure instructions are clearly understood and
verified.
5. The physician should sign beneath the order within 24
hours.

82. Physician Order
 Should have the following components:
 Date and time
 Full name of the medication
 Dosage
 Concentration – amount and type of diluents
 Duration
 Time and frequency
 Route
 Physician signature

83. 10Q FOR SAVING MY…. LIFE!!!

84. Assignment
1. What is Nursing Practice?
2. What is Clinical Nursing?
3. Elaborate Scope and Practice of Emergency
Nursing
4. Elaborate differences and similarities between
EU/ED and ICU
5. What does an ER nurse do?
6. What does an ICU nurse do?