five days in-service education programme on Triage

1. Presented By- Dinesh Choudhary
(BSc Nursing 3rd Year) IGNOU, TGINE, Pune
ON

2. 3rd YEAR PB B.Sc NURSING STUDENTS BATCH 2015-17
NURSING ADMINISTRATION AND MANAGEMENT: SUPERVISED ACTIVITY 7
PREPARATION OF IN-SERVICE EDUCATION PROGRAMME
ACADEMIC COUNSELOR: ORGANISED BY:-
Dr. LILY PODDER MAM Mr. Dinesh Choudhary
(Associate professor at BVCON)
Mrs. STEFINA VARGHESE Mam
(CI-TGINE)

3. DEFINITION
In-service education in general terms, may
be defined as educational activities planned
and organized by the employers for the
employees to assist them in learning and /or
furthering the knowledge, skills and attitudes
required for the achievement of the specific
purpose of the organization

4. CONCEPT OF IN-SERVICE EDUCATION
Concepts
of In-
service
education
Planned
education
activities
Provided in
a job
setting
Closely
identified
with
service
Help a
person’s
performance
effectively
as a personal
work

7. In-service education is a process of helping the
nurse to carry out the functions commensurate
with her obligations for nursing services.
It also helps to develop their skills necessary to
reach the ultimate goals of health agency that is
1. The highest quality of patient care and
2. To keep abreast of changing techniques and
use of sophisticated tools and equipment

8. FOR THE ORGANIZATION
 Keeps the nursing staff enthusiastic in their
learning
 Develops interest and job satisfaction amongst
the staff
 Develops sense of responsibilities for being
competent and knowledgeable
 Creates and appropriate environment with
opportunities for growth and communication
 Helps the nurses in making appropriate and
sound decisions as well as using effective
problem solving techniques

9. For the individual employees
 Leads to improve professional practice
 Aids in updating knowledge and skills at all
level of organization
 Keeps the nurses abreast of the latest trends and
developments in techniques
 Equips the nurses with knowledge of current
research and development
 Helps the nurses to learn new and to maintain
old competencies

10. STEPS TO
IN-SERVICE EDUCATION AND
STAFF DEVELOPMENT
ASSESSMENT IMPLEMENTATION EVALUATION
• Pin points
needs
• Priorities needs
• Set training
• Develop
criteria
• Climatic
checking
• Actual
conduction
of training
with on going
monitoring
• Establishment of
criteria
• Pre test to
participants
• Post test following
completion of training
• Observation of
transfer of learning to
the job
• Follow up studies for
assessment of extent
of retention of
learning

11. Pin pointing needs
The needs can be identified by means of
 Survey
 Observation of Work Performance
 interview
In our in-service programed we have used survey
method for finding needs. We have given five
topics to 20 staff nurses of Emergency and
Trauma Centre

12. The Topics were
 NABH Protocol
 Shock
 Care of unconscious patient
 Soft Skills
 Triage

13. we have receive 50% response for Triage,
20% for Shock and 15% for NABH
Protocol and 15% for other topics
Thus we have planned the In-service
education programme on TRIAGE for 30
staffs as per their needs

14. At the end of this In-service education
programme the group will be able to have
knowledge about Triage

15. At the end of this In-service education
programme the group will be able to
The meaning of Triage
Types of Triage
Understand the basic principal of triage
Role of Nurse in Triage
Benefits of Triage

16. Specify content/ topic and learning experience
Teaching learning method and media
Developing evaluation criteria

17. The sequence of topics proceeds from general
to specific and from simple to complex,
continuity is another factor to make the
programme effective
To plan and design sessions usually
we use four steps procedure
• Divide the session content into (a) must
know (b) should know (c) could know
• Arrange the content in logical order
• Select training techniques
• Estimate segment times
SPECIFY CONTENT/TOPIC &
LEARNING EXPERIENCES

18. Methods and media of teaching learning
activates are simple ways to provide
learning experiences.
The selected method should be
1. Effective
2. Economic
3. In addition, methods should meet the
objective

19. CRITERIA FOR EVALUATION IS DEFINING IN
FOUR AREAS OF OUTCOME
 Reaction of the trainee to the programme
 Learning of the content by the trainee
 Behavioral changes of the trainee
 Effect of training programme on achievement of
organizational objectives

20. We student of 3rd year PB B.Sc. Nursing plan a
In-service education programme on Triage.
We have found needed topic amongst staff
nurses by survey method.
We have plan 5 days In-service education
programme for 20 staffs of RHC.

21. TOPIC:- TRIAGE
PARTICIPANTS:- 20 STAFF NURSES
DATE:- 01/06/17 TO 05/06/17
TIME:- 9 AM TO 4 PM
VENUE:- B.Sc.(N) 4th Yr. Class Room, TGINE, Pune
METHOD OF TEACHING:- LECTURE, DISCUSSION,
DEMONSTRATION
CREDIT:- CERTIFICATE OF ATTENDANCE
EVALUATION:- PRE TEST AND POST TEST

22. Permission Letter
Group B
Date: 29th May 2017
To ,
The Principal
TGINE Ruby Hall Clinic, Pune
Sub: Conducting 5 Day In service Education Programme
Respected Madam,
We 3rd Year IGNOU BSC Student planned to conduct 5 days In service
Education Programme for Ruby Hall Clinic Staff Nurses on Triage From 1st
June to 5th June 2017.
Please allocate us a B.Sc. 4th Year Class Room for these 5 days.
Hope you would accede to our request
Thank You
Yours Faithfully

23. Circular
Office Of The Director Of Nursing Ruby Hall Clinic
Circular No: Inservice.edu/Staff Nurses/38-2017. Date: 29th May 2017
Sub: In service education on Triage.
IGNOU BSC(N) PB Student planned to conduct 5 days In service
Education Programme for Ruby Hall Clinic Staff Nurses on the Triage.
from 01st June to 05 June 2017, 9:00am to 4:00pm at TGINE college
pune
Ward sisters of all wards should give list of staff to DNS office before
30th June 2017,
Copy To:
-CEO Of Ruby Hall clinic
-Principal TGINE
- All Ward In-charge
Sign of Director Of Nursing

24. DATE DAY TIME PROGRAMME PERSON PLACE
01/06/17 Thursday 8-9 am
9-9.30
am
9.30-10
am
10-10.30
am
10.30-11
am
11-11.30
am
11-12pm
12-1 pm
1-2 pm
2-3 pm
3-4 pm
Reception of delegates
Registration
Inauguration and message by guest
of honor
Breakfast
Pre-test
Distribution of booklets introduction
of 5 days programme schedule
Introduction of in-service education
Lunch
Overview of Triage
What is Triage
Definition of Triage
Programme
co-ordinator
Student nurses
B.Sc (N), 4th
Year Class
Room, 2nd Floor,
TGINE

25. DATE DAY TIME PROGRAMME PERSON PLACE
02/06/17 Friday 9-10.00
am
10-10.30
am
10.30-12
pm
12-1pm
1-2 pm
2-4 pm
Revision of Last Session
Breakfast
Aims of Triage
lunch
Objectives of triage
Types of Triage
Student Nurse
DNS
B.Sc (N), 4th
Year Class
Room, 2nd Floor,
TGINE

26. DATE DAY TIME PROGRAMME PERSON PLACE
03/06/17 SATURDAY 9-10.00
am
10-10.30
am
10.30am
-12 pm
12-1pm
1-4 pm
Revision of last session
Breakfast
Triage Priorities (1)
lunch
Triage Priorities (2)
DMS
B.Sc (N), 4th
Year Class
Room, 2nd Floor,
TGINE

27. DATE DAY TIME PROGRAMME PERSON PLACE
04/06/17 SUNDAY 9-10.00
am
10-10.30
am
10.30am
-12 pm
12-1pm
1-2 pm
2-4 pm
Revision of last session
Breakfast
S T A R T(Simple Triage algorithm
and Rapid Treatment)
lunch
S T A R T cont……
Nurses Role in Triage
Principal
B.Sc (N), 4th
Year Class
Room, 2nd Floor,
TGINE

28. DATE DAY TIME PROGRAMME PERSON PLACE
05/06/17 MONDAY 9-10.00
am
10-10.30
am
10.30am
-12 pm
12-1pm
1-2 pm
2-4 pm
Revision of last session
Breakfast
Benefits of Triage
lunch
Post Test
Vote of thanks and group
photograph
Programme
co-ordinator
B.Sc (N), 4th
Year Class
Room, 2nd Floor,
TGINE

29. Invitation
Dear sir/madam,
We cordially invites you for 5 day In-service
Education Programme for Staff Nurses of Ruby Hall
Clinic on TRIAGE From 1st June to 5th June 2017
Organized by 3rd Year PB BSC(N) Students at TGINE .
Date: 01st June 2017
Time: 9:00am to 4:00 pm
Venue:
4th Year B.Sc.Nursing Class Room
2nd Floor, Themi Grant Institute of Nursing Education,
Tadiwala Road, Pune.

30. WORKING COMMITTEE
S.
NO
Name of Comittee Committee Memberss Responsibilities
1 Organizing Committee Mr. Mansoor Ali
Mrs. Deepika Solanki
Decide topic, make schedule of
lecture and organization of
programme
2 Registration Committee Mrs. Seema Puri
Mr. Shoaib Rehman
Reception, Registration of
candidates, kit & ID card
Distribution
3 Budget Committee Mr. Dinesh Choudhary
Mr. Mansoor Ali
Finance and Funding
4 Accommodation Committee Mr. Sabir Khan Accommodation and travelling
5 Inauguration Committee Mrs. Deepika Solanki Welcome conducting
inauguration function
6 Catering Committee Mr. Dinesh Choudhary
Mr. Sabir Khan
Selection of Menu for
Breakfast, Lunch, Budgeting for
food expenses

31. Budget
Sr. No. Content Approximate Cost
1 Stationary: Printing, pen, Conference
pad, file other
4000/-
2 Catering: Tea ,Lunch, Breakfast 25000/-
3 Honorarium to resource person 12000/-
4 Accommodation and traveling 16000
5 Gift, Flowers, Memento 7000/-
6 Miscellaneous 6000/-
Total 70000/-

32. We Selected Various Resource Person
Name Designation Contact No.
• Dr. Ashish MS 9878975xyz
• Dr. S. Ram Dy.Director 9685475xyz
• Dr. Deepshikha DMS 9878975xyz
• Mrs. Sonali NS 9832565xyz
• Mrs. Dumbery mam Principle 9854783xyz

33. Certificate
Grant Medical Foundation
Ruby Hall Clinic Pune
This certificate is awarded to
……………………………
For successful completion of workshop on
TRIAGE
From 1st June to 5th June 2017
Principal Co-ordinator Chair Person

34. Given below are the statements
tick mark ( ) in any of the four column given
here according to your opinion

35. S.
no
statement 5
Strongly
Agree
4
Agree
3
Partially
Agree
2
Disagree
1
Strongly
Disagree
1 The objectives of the
programme were clearly
stated
2 The programme was well
planned
3 Concept of disaster
management is clear
4 Breakfast and lunch was good
5 At the end of In-service
education programme you
gain knowledge regarding
topics which was presented

36. 1. How much type of Triage?
A. one
B. Two
C. Three
D. Four
2. Triage Means ?
A. To Sort
B. To Hold
C. To wait
D. None of the above
3. The Types of Triage are all EXCEPT
A. Simple
B. Advance
C. Reverse
D. Latent

37. 4. All are Colour code of Triage EXCEPT
A. Red
B. Pink
C. Yellow
D. Green
5. The aims of triage are
A. Right Patient
B. Right Time
C. Right Place
D. All of above

38. Please mark True or False
1. Triage is the process of determining the
priority of patients'
2. Objective of triage is to maintain balance
between Resources and Casualties
3. Red color code is indicate the death of person
in Triage
4. START stands for SIMPLE TRIAGE ALGORITHM
AND RAPID TREATMENT
5. Decisions need to be made slowly in triage

39. Climate setting is significant in the actual
presentation phase.
Once the climate has been set, its time to
implement the learning experience.

40. Evaluation is a continuous process at each and every
step of development and implementation.
It is integral part of programme
Five steps of evaluation are:-
1. Evaluation criteria should be established
2. Participants should be given a pre test
3. After training is completed a post test should be given
4. Transfer of the learning to the job should take place
5. Follow up studies should be under taken to see how
well learning was retained

41. TRIAGE

42. OVER VIEW
 INTRODUCTION OF TRIAGE
 DEFINITION OF TRIAGE
 APPLICATION OF TRIAGE
 AIMS AND OBJECTIVES OF TRIAGE
 TYPES OF TRIAGE
 TRIAGE CODING
 START
 NURSES ROLE IN TRIAGE
 BENEFITS OF TRIAGE

43. Triage
 To sieve or sort

44. INTRODUCTION
(WHAT IS TRIAGE?)
Triage is the process of determining the priority of
patients' treatments based on the severity of their
condition

45. DEFINITION
The term Triage derived from the French verb
‘trier’ meaning to “sort or to choose”
 It’s the process by which patients classified
according to the types and urgency of their
conditions to get the
Right patient to the
Right place at the
Right time with the
Right care provider

46. Application of Triage
 Pre Hospital setting
 Disasters
 Emergency Room

47. Aims of Triage
 Right patient
 Right place
 Right time
 Right Care
Provider

48. THE INITIAL PROBLEM
ON SCENE
Casualties Resources

49. Casualties Resources

50. Casualties Resources

51. Casualties Resources

52. Casualties Resources

53. Casualties Resources

54. Casualties Resources

55. Casualties Resources
THE OBJECTIVE

56. TYPES OF TRIAGE
1. Simple Triage
2. Advance Triage
3. Continuous Integrated Triage
4. Reverse Triage
5. Under Triage and Over Triage

57. SIMPLE TRIAGE
Simple triage is usually used in a scene of an
accident or "mass-casualty incident" (MCI), in
order to sort patients into those who need
critical attention and immediate transport to the
hospital and those with less serious injuries.
This step can be started before transportation
becomes available

58. ADVANCE TRIAGE
In advanced triage, doctors and specially
trained nurses may decide that some seriously
injured people should not receive advanced
care because they are unlikely to survive. It is
used to divert scarce resources away from
patients with little chance of survival in order
to increase the chances for others with higher
likelihoods.

59. CONTINUOUS INTEGRATED
TRIAGE
Continuous integrated triage is an approach to
triage in mass casualty situations which is both
efficient and sensitive to
psychosocial and disaster behavioral health
issues that affect the number of patients seeking
care (surge), the manner in which a hospital or
healthcare facility deals with that surge (surge
capacity) and the overarching medical needs of
the event.

60. REVERSE TRIAGE
Usually, triage refers to prioritizing admission. A similar
process can be applied to discharging patients early when
the medical system is stressed. This process has been called
"reverse triage". During a "surge" in demand, such as
immediately after a natural disaster, many hospital beds
will be occupied by regular non-critical patients. In order
to accommodate a greater number of the new critical
patients, the existing patients may be triaged, and those
who will not need immediate care can be discharged until
the surge has dissipated, for example through the
establishment of temporary medical facilities in the region.

61. UNDERTRIAGE AND
OVERTRIAGE
Undertriage is the underestimating
the severity of an illness or injury. An
example of this would be categorizing a
Priority 1 (Immediate) patient as a
Priority 2 (Delayed) or Priority 3
(Minimal). Historically, acceptable
undertriage rates have been deemed
5% or less.

62. Overtriage is the overestimating of
the severity of an illness or injury. An
example of this would be categorizing a
Priority 3 (Minimal) patient as a Priority
2 (Delayed) or Priority 1 (Immediate).
Acceptable overtriage rates have been
typically up to 50% in an effort to avoid
undertriage. Some studies suggest that
overtriage is less likely to occur when
triaging is performed by hospital
medical teams, rather than paramedics
or EMT

63. Triage Priorities
P T Description Colour
1 T1 Immediate Red
2 T2 Urgent Yellow
3 T3 Delayed Green
Dead T4 Expectant Black
Dead

64. T1 (Immediate) RED
 Casualties who require immediate life-
saving interventions (advanced life
support within 1 hour and/or primary
surgery within 2 hours)
 Cardio Pulmonary Arrest
(Cardic Failure,Chocking)
 Severe Respiratory Distress
 Major Trauma(e.g. Head Injury, Open
Chest or abdominal Trauma)
 Uncontrolled Bleeding
 Status Epileptics
 Severe Burn
 Shock

65. T1

66. T2 (Urgent) YELLOW
 Casualties who require surgical
or other interventions within
2-4 hours
 Multiple Fracture
 Stable Abdominal wound
 Moderate Burn
 Multiple Injuries requiring
extensive care
 Eye & CNS injury

67. T2

68. T3 (Delayed) GREEN
 Casualties whose
treatment may be safely
delayed for >4 hours
 Minor burns
 Minor Fractures
 Minor bleeding

69. T3

70. T4 (Expectant)
 Casualties whose injuries are
either so severe that they
cannot survive, or whose
injuries are so severe that their
treatment would compromise
the care of others
 Unresponsive
 High spinal cord injury
 Dead

71. T4 (EXPECTANT)T3 (MINIMAL)
T2 (DELAYED)T1 (IMMEDIATE)

72. START
(SIMPLE TRIAGE ALGORITHM AND RAPID TREATMENT)

73. Triage
 Decisions need to be made quickly,
safely and reproducibly

74. NURSES ROLE IN TRIAGE
 Determine magnitude of the event
 Define health need of the effected groups
 Establish priorities & objectives
 Identify actual & potential public health
problems
 Determine resources needed to respond to
need identify
 Collaborate with other professional
disciplines, governmental and non-
governmental agencies
 Maintain unified chain of command
 communication

75. BENEFITS OF TRIAGE
• Effectively distributed care among injured
patients
• If a patient’s medical condition changes
while still in triage, medical personnel can
simply tag the patient again with the
updated information and label the tags
sequentially
• Information can be obtained and added
onto the triage tag throughout the triage,
and referred to as needed.

76. REVIEW
 INTRODUCTION OF TRIAGE
 DEFINITION OF TRIAGE
 APPLICATION OF TRIAGE
 AIMS AND OBJECTIVES OF TRIAGE
 TYPES OF TRIAGE
 TRIAGE CODING
 START
 NURSES ROLE IN TRIAGE
 BENEFITS OF TRIAGE

77. Role Play
on
TRIAGE
Situation- Bomb Blast