Introduction to the Use of Manchester Triage in Accident and Emergency Emergency Triage Introduction to the Use of Manchester Triage in Accident and Emergency Dobbs

Aims of the Study Session To give an understanding of what Triage is and why it is useful in an A&E Setting Introduction to Emergency Triage and Manchester Triage System Pain Scoring and Analgesia Administration How to apply Manchester Triage to Patient Assessment in A&E

What is Triage? Originated and was first formalised by French Doctors during WW1 as a way of “sifting and sorting” battlefield wounded at the aid stations behind the frontline. Introduced differently within each A&E setting in the late 1980s/early 1990s and Manchester Triage System produced to formalise and standardise Triage in 1997 Triage Prioritises patients based on their condition and ensures that patients attending A&E are pointed to the most appropriate level of care for them as individuals (NP service, Minor Injuries area, Majors, Resuscitation, Primary Care setting etc) When resources are overwhelmed Major Incident Assessment takes over from Manchester Triage.

Manchester Triage System Flowchart Systems available for all patients presenting to the A&E Department Limit Points relate to how much of the assessment has been carried out in Triage and therefore the need to prioritise patient for further assessment is necessary 5 prioritisation categories available

Prioritisation RED – Immediate - Assessment on arrival ORANGE – Very Urgent – Seen within 10 mins YELLOW – Urgent – Seen within 60 mins GREEN – Standard – Seen within 120 mins BLUE – Non-urgent – Seen within 240 mins

Pain Scoring at Triage Pain Scores must be carried out using the pain ladder available for adults and children in the Emergency Triage Handbook All pain scores will be out of 10.

Analgesia Administration All patients with pain will be offered analgesia appropriate to their injury either by PGD or by prescription (Medical Team and Non-Medical Prescribers) Blind prescribing is not permitted at point of assessment – patients with a pain score above 4/10 must be triaged as a category 3 or higher if Medical Assistance is required for timely pain relief management (clearly stated in Manchester Triage flowcharts) Reassessment of the pain score should be 1 hour following administration, this should be by the triage nurse if they are still waiting medical assessment.

First Aid Measures Application of a sling Application of a temporary dressing, to stop bleeding pressure / elevation Cooling of burns Washout of an eye

Importance of Observations Not all patients require observations All Head Injuries Patients from RTC / Assaults (no matter how serious) All major patients

Special considerations for children Who is accompanying the child? How many previous attendances does the child have? What school does the child attend? Is there a delay in attendance?

Important considerations Quick sift and sort Department of health guidelines on patient assessment Emergency care guidelines on pain management Department documentation standards Escalation of concerns and time problems to the NIC

Case Studies 78 year old female presenting with Shortness of breath for 2/52. O/A: Walked in to Triage, c/o SOB on exertion but comfortable sitting in Triage. No evidence of cyanosis, able to talk in full sentences. Reports coughing++ especially at night. RR 22, PR 80BPM, BP 160/85, SpO2 98% on air, Temp 37.5, Cap Refill < 2seconds

Case Studies 22 year old Male presenting with Inversion Injury to Right Ankle after falling down five steps 6 hours ago. NWB since incident. In wheelchair on assessment O/A Swelling and bruising to Lateral Malleolus ++, Bony Tender Lateral Malleolus. No obvious deformity but difficult to differentiate due to the amount of swelling. Pain Score 8/10 and difficult to move due to pain. No other obvious injury sustained in the incident. Pedal Pulse Present and Cap Refill Time < 2 secs NPMH, N/K allergies, No Meds

Case Studies 6 year old female presenting with Head Injury sustained from falling from a garden swing within the last half an hour. Brought in by Ambulance O/A 1cm Laceration and Bruising to forehead requiring closure, paler than normal according to worried mum in attendance. ? LOC at scene. Fully alert and orientated on arrival but had an episode of confusion and disorientation on initial treatment by Ambulance crew and they report that she was very sleepy initially. GCS 15/15 on arrival to the A&E Department. No other obvious injury. All other observations within normal range. Pain Score Moderate on arrival and patient crying.

Case Studies 34 Year old Male presenting following splashing chemical in eye at work 2 hours ago O/A R eye red, watering +, burning sensation to eye, pain score moderate. Chemical unable to be determined, ? Cleaning fluid Eye Ph 9

Any Questions? ???