Volume 1 / Issue 1Fall 2006 |
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2007 Workshops February San Francisco, CA March Albuquerque, NM April Charlotte, NC May St. Louis, MO June Washington, D.C. (Exact dates to be determined) For more details on upcoming workshops, call toll-free (866) 369-8029 or see the Triage First website at www.triagefirst.com. Triage First, Inc. Phone: (828) 628-8029 Email: info@triagefirst.com www.triagefirst.com |
Case Presentation A young woman in her early 20’s presents to the emergency department triage desk in the early evening hours complaining of fever and “not feeling well.” She arrives to the emergency department ambulatory and her skin is warm, pink, and dry. Vital signs are within the normal range except for a low-grade fever of 100.2 F (oral). She complains of moderate pain to her legs. She states that the fever has been becoming worse over the last several days and indeed the previous night had reached 106.2 F (oral). The patient appears well, is oriented to person, place, time, and purpose. Further objective assessment reveals moist mucous membranes, unlabored respirations, and clear breath sounds. The patient denies any pertinent medical or surgical history and the only current medication she is taking is an antipyretic (last taken 2 hours prior to arrival). Using a 3-level acuity scale, the triage nurse assigns the patient a level 3 – nonurgent category.  Since beds are available, the patient is taken to a treatment room almost immediately. The nurse assists the patient into a gown and is shocked to discover that the patient has a flaming-red, hot, weeping cellulitis extending from the lumbar spine area all the way to her heels.
What Went Wrong? This actual case history is a classic example of some issues that triage nurses must always be on guard against in order to protect patients from being mistriaged. 1. Beware of your intuition—nurses must never let intuition influence them to lower a patient’s acuity. The triage nurse assumed that the patient had misread the thermometer and that the fever at home was 102.6 (F), not 106.2 (F) as the patient reported. Therefore, she disregarded this critical information and let her intuition lead her to believe that the patient was less ill than she really was. Triage nurses must trust their intuition only when it advocates for the patient and moves the patient forward in the treatment process. Triage nurses should never trust their intuition when it works against the patient or influences them to lower a patient’s acuity. 2. See the big picture. The triage nurse did not “connect the dots” in this presentation. She failed to recognize the significance of the patient’s fever continuing (albeit low-grade) in spite of having taken an antipyretic two hours prior to arrival; the nurse also failed to make a connection between the leg pain and the complaint of fever. The patient in this case did indeed have a fever of 106.2 (F) at home. 
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