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Library of Resources & Solutions

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The following are documents, FAQs, and exemplars of solutions prepared by others and made available by them in the public interest. Anyone using these as the basis in preparing a similar document, or clinical recommendation, or proposes implementation of any contents elsewhere assumes full responsibility for doing so and insuring the accuracy and legality of it in their own setting.
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This page last revised: 08/08/2007
Clinical Guidelines:

    ACLS Drips & Drugs:

ACLS Drugs & Drips-Finalpdf.gif (130 bytes)  by Willi Kirenko, RN(EC) BScN DipAdEd ENC(C) PHCNP who writes: "A few revisions were made to the ACLS "Drugs and Drips" charts that I developed.

1. Amiodarone is now available in multi-dose vials (3mL, 6mL and 18mL) and we've made the switch so that we are less likely to be injured while snapping open the 3mL glass ampoules. The chart and "recipe cards" for the kits were adjusted to reflect that change.

2. The procainamide (Pronestyl) section on the chart was difficult to work with. The previous chart suggested using a syringe to inject 4mL per minute until the end points were met, requiring someone to manually inject the drug over time. The new chart describes a "kit" with a 20mg/min drip that is stopped with the end points are met. Not as much fuss.

3. All of our staff and physicians were really pleased with the original charts, but asked for the addition of a few drugs. Another page including verapamil, vasopressin, norepinephrine, labetolol and dobutamine was added as requested.

Again, the dose rates and calculations have been carefully checked by our pharmacy team, and it's all a go ... as of June 27, 2002. Laminated copies of the charts and "kit bags" containing the amiodarone and procainamide contents and instructions have been placed on every arrest cart throughout our hospital Alliance."


Guidelines for the use of Sucrose Solution in management of Neonatal Pain by Willi Kirenko, RN, ENC(C)
Procedure: Application Of LET Solution For Wound Anaesthetic (Lidocaine, Epinephrine and Tetracaine Solution)
by Willi Kirenko, RN, ENC(C)


Analgesia Protocol - Adult
Analgesia Protocol - Pediatric
Australian Nomenclature
These charts for Triage Nurse Initiated Pain Relief Management were developed by a collaborative team at Austin & Repatriation Medical Centre, Melbourne, Australia and are made available by Chris Hawkins, Nurse Practitioner candidate, Austin Health Melbourne, Australia


Nurse Initiated Pain Management
Back Pain Management Nurse Initiated Protocol.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

Dental Pain Management Nurse Initiated Protocol.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

ED Acute Pain Management Protocol.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc
This protocol does need the physician to order it—but all of the others are done by nurses prior to the patient being seen by the physician.

Extremity Injury Pain Management Nurse Initiated Protocolc:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

Eye Pain Management Nurse Initiated Protocol.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

Nitrous Oxide Nurse Initiated Protocol.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

These protocols for Nurse Initiated Pain Management were developed at St. Joseph Hospital, Bellingham, Washington, and are kindly submitted by Diana Meyer, RN MSN CNS.

    Cardiac Care Team:
Protocol, MD Orders Template, PowerPoint Presentation
These documents, prepared by St. Rose Dominican Hospital, Las Vegas, for a Cardiac Care Team streamlining STEMI & CHF care, are submitted by Pamela Rowse, RN. She also includes links for evaluation processes.
Cardiac Care Team Protocol for Chest Pain and STEMI Patients.doc c:\audaci\eudora\attach\Cardiac Care Team Protocol for Chest Pain and  STEMI Patients.doc

Cardiac Care Team Physician Order Setc:\audaci\eudora\attach\S1076_proof.pdf

Cardiac Care Team Presentationc:\audaci\eudora\attach\St. Rose Dominican Hospital.ppt

http://www.cms.hhs.gov/quality/hospital/HeartAttack.pdf - This  file prepared by CMS outlines the current standards and the standards upon which mandatory reporting (starting in July, 2004 ) will be based.

http://www.cms.hhs.gov/quality/hospital/Listof10Measures.pdf - Quality Outlines for the reporting.

http://www.cms.hhs.gov/manuals/110_qio/qio110c14.pdf - This outlines the mandatory reporting  and how it will affect all acute care facilities whether cardiac care centers or not.

    Procedural Sedation: These documents regarding Procedural Sedation were developed at Chatham-Kent Health Alliance and provided by Willi Kirenko, RN(EC) BScN DipAdEd ENC(C) PHCNP . She also gives "Special thanks to Jean A. Proehl, RN MN CEN CCRN who shared much information a few years ago when this information was being developed."
Procedural Sedation/Analgesia/Anaesthesia Chart-2003pdf.gif (130 bytes) Finalized quick reference to drugs and precautions

Policy: Procedural Sedation & Analgesia

Procedural Sedation Documentation Form

Procedural Sedation Discharge Instructions (children & adults)


Ethics Statement/Agreement for Employees:

Ethics.doc submitted by Carol Minnis, RN CEN

logo-ENA.jpg (6065 bytes)Weapons of Mass Destruction Workgroup Resources  
LARGE download-Please redistribute locally!   [6.145megabyte zip file]


Triage/Immedediate Action Guidelines:

Medical Directive Set.zip by Willi Kirenko, RN, ENC(C)
   Protocols for Advanced Triage and initiation of immediate treatment

Medical Directive Final Set 2.doc by Willi Kirenko, RN, ENC(C)
               Three more Medical Directives for addition to the previous set

Clinical Screening Tools:

Nutritional Screening as practiced at Frederick Memorial Hospital in Maryland. Submitted by Cynthia Russell, RN

ED Process/Public Relations

Your Visit to the Emergency Department submitted by Donna Toohey, RN CEN SANE CNC
    Brief brochure explaining ED process and expectations for family members. (MS Word format) (Download as .pdfpdf.gif (130 bytes) file)

CKHA ED Your Guide.doc An Informational Brochure For Local Clientele submitted by Willi Kirenko, RN, ENC(C)

CKHA ED InfoTriage.doc "You feel you have an emergency and then you are asked to wait " Waiting Room explanation of ED Process and rules. submitted by Willi Kirenko, RN, ENC(C)

Interim Admission Orders; temporary post- ED care of Admitted Patients, written by Emergency Physician
Submitted by: Diana Meyer, RN MSN, Clinical Nurse Specialist

Interim Admission Orders
Here is a sample of our Interim Admission Orders-- We use this form to prevent delays in patients being admitted to the floors from the ED due to
waiting for orders from the inpatient physician. They are not used for ICU or pediatric patients.

Reimbursement Matters: Assessment Tools for Charging by "APC" Standards

Nursing Interventions.doc submitted by Shawn Keenen
    A "points" system for assigning levels to equal one of the four levels of billing for reimbursement according
to federal APC coding standards. (MS Word format)
Final Draft

Quantify the Level of Nursing Care.doc submitted by Brian Cesar, RN
    A final-draft "points" system for assigning levels to equal one of the four levels of billing for reimbursement according
to federal APC coding standards. (MS Word format)
Final Draft

ED charge sheet 981.xls   ED interventions and def1.xls  submitted by Alicia Gardella, RN CEN
These are Microsoft Excell spreadsheets. To download, Right-Click your mouse on the filename, and choose "Save Link as" or "Save Target as" You may then download to your hard drive.
    Alicia Gardella, RN CEN writes: "We are still working on it regarding the number of points and what equals an appropriate level so it is not a final draft. What I have sent you is the charge sheet itself and then the list of definitions and interventions that define each of the items noted on the charge sheet.


Triage -  Standards

flag-Andorra-small.gif (515 bytes)Andorra:

Andorran Triage Model (MAT)

flag-Australia-vsmall.gif (908 bytes)Australian:

Submitted by Toni McCallum Pardey of Emergency Nurses Association of NSW, Inc. are four documents concerning Australian Triage Scales:

Australian Triage Scales Guidelines Australian Triage Scales Policy Australian Triage Scales References Australian Triage Scales Comments
logo-ACEM-Aus.gif (12018 bytes)Australasian College of Emergency Medicine's website posting of
"Guidelines for Implementation of the Australasian Triage Scale in Emergency Departments"

flag-Canada-vsmall.gif (896 bytes)Canada:

logo-CAEP.gif (3067 bytes)The Canadian Triage & Acuity Scale (CTAS) for Emergency Departments

Canadian Acuity Triage Scale Implementation Guidelines

CTAS Wall Poster

flag-Eire-small.gif (875 bytes)Irish Republic:

logo-StJames'sHospitalDublin.gif (11900 bytes)Triage Levels At St.James's Hospital, Dublin, Ireland

flag-UK-vsmall.gif (928 bytes)United Kingdom:

Emergency-Nurse.com's Triage Bibliography

flag-USA-vsmall.gif (896 bytes)United States of America:

Agency for Healthcare Research and Quality (AHRQ) "Implementation Handbook and DVDs Emergency Severity Index, Version 4"

logo-ACEP-White.gif (8802 bytes)ACEP Information Paper "A Uniform Triage Scale In Emergency Medicine"

logo-TriageFirstDotCom.jpg (12505 bytes)Rebecca S. McNair's Five Tier Acuity Lecture - ENA Reno - 2001 from www.triagefirst.com   ENW!'s Archived Copy

ENA-logo-mini.gif (1712 bytes) National Five-Level Triage System Resolution Adopted by the Emergency Nurses Association

Triage & Clinical Assessment - ED Initial Documentation

submitted by Willi Kirenko, RN, ENC(C)
This is a 2-sided page, with one side containing the triage documentation, and the other, the initial assessment information for all patients - no matter the acuity.
Our staff have found it all most helpful, as there is space for quality nursing documentation, and it's a separate sheet, so there's no need to chase the chart down. Our physicians appreciate it, as well, and . . .  note it with their initials.


Library of Solutions & Resources from Emergency Nursing World ! [http://ENW.org/Solutions.htm]
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Tom Trimble, RN [[email protected]]ENW Webmaster
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2003 ASA
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Airway 10 Commandments
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Using Anesthesia Bags
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Heat Emergencies
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