ER Day 1 Notes

Legal Issues
EMTALA Emergency Medical Treatment and Active Labor Act
The first question you ask the patient is not about your insurance
The first person the patient sees is the Triage Nurse
MSE Medical Screen Exam = All patients that present to the ER before you ask them
anything else they get medically screened. Cant ask about insurance till after this
o Must be done by an RN, PA, or DR
o Part of the regulatory legislations
o Ask them about pain and listen for bowel sounds, percuss, and vitals
Triage nurse then assigns a level of care
You cant send someone somewhere without their permission Autonomy
You cant send someone to another hospital if your hospital can provide the same level of
care
o Cant send just because they dont have insurance
o Can only send if they want their personal physician who only has privileges at a
particular hospital
Always make sure that you document - Many lawsuits come from the ER because of no
documentation
When a patient dies in the ER you can almost always count on a lawsuit Especially in
trauma
The nurse needs to make sure that she documents quickly documentation needs to be
done before the patient leaves to go to the OR or another department
Try not to use restraints They can cause more harm than good
Unapproved abbreviations Not legal to use
o QD and OD every day or left eye also QOD
o MS magnesium sulfate, morphine sulfate, could mean a lot of things
o To avoid errors make sure that you read back Document that you did a verbal read
back
Ask patient always do they have an advanced directive Even if they have a sore throat
o If they dont have evidenced of an AD then they get the full code unless they have
cancer or some other terminal disease and they can prove that
Forensic nursing Collect specimens, work with police, preserve and collect evidence,
have to follow the chain of custody
SANE nurse Female RNs can get certified to do this
o Examine and collect evidence on victims of rape
o This becomes evidence in a court of law so very important
o There is a SANE kit to collect the evidence
o For domestic violence, sexual assault, rape, abuse on children
Active shooter Protocols in the ER for this
85% of medical-surgical patients have a mental illness of some type
Patients will get violent so be careful
DUI patients Sometimes you have to be the one that has to draw the blood for it Can
go to court so usually the forensic nurse is the one that does that
Try to deescalate the situation first and talk them down
There are panic buttons you can press
Never want to be totally alone in an ER room with the door closed
The triage nurse will know whos at risk for this behavior
There will be a lot of verbal abuse from patients that are waiting
Psychiatric patients, withdrawal, behavioral issues