Factors Influencing
Prioritization:
·
Severity
of illness:
Patients
with more severe conditions
are generally prioritized.
·
Urgency
of the situation:
Patients
requiring immediate intervention, like those with life-threatening conditions,
are prioritized.
·
Risk
of harm:
Patients
at risk of falling, bleeding, infection, or airway obstruction should be
prioritized.
·
New-onset
symptoms:
Patients
with new-onset symptoms or life-threatening conditions take precedence over
routine care.
·
Potential
for rapid deterioration:
Patients
whose condition could worsen quickly if not addressed promptly should be
prioritized.
·
Specific
healthcare needs:
Some patients may require specialized care
or interventions that necessitate earlier access to resources.
Benefits of
Prioritization:
·
Improved
efficiency:
By
prioritizing patients, healthcare providers can focus on those with the most
pressing needs, streamlining the workflow.
·
Fair
and equitable care:
Prioritization
ensures that those in the most urgent need receive timely attention, promoting
fairness in healthcare delivery.
·
Reduced
wait times:
Prioritization
can reduce wait times for patients who are not in dire need, improving their
overall experience.
·
Better
resource utilization:
By focusing on the most critical cases,
healthcare resources can be used more effectively and efficiently.
Tools and Techniques:
·
Triage
systems:
These
systems use a standardized approach to assess patients and assign them a
priority level based on their clinical needs.
·
Prioritization
tools:
These
tools can be used to help healthcare providers make informed decisions about
patient prioritization.
·
Data
analysis:
Analyzing patient data can help identify
patterns and trends in patient needs, allowing for more efficient
prioritization.
Ethical
Considerations:
·
Fairness
and equity:
Prioritization
systems should be designed to ensure that all patients receive a fair and
equitable level of care.
·
Transparency
and accountability:
The
prioritization process should be transparent and accountable, allowing patients
to understand the rationale behind their placement in the queue.
·
Patient
autonomy:
Patients should have the opportunity to
express their preferences and concerns about their care.
In hospitals, patient
prioritization involves a process to determine who needs immediate attention
based on the severity and urgency of their medical condition. This is
often achieved through triage, a systematic method that assesses patients
upon arrival and assigns them a priority level.
Triage in Emergency
Departments:
·
Initial
Assessment:
Patients
are quickly assessed upon arrival to determine the urgency of their condition.
·
Priority
Levels:
Patients
are categorized into different priority levels based on their condition, with
the most critical cases receiving immediate attention.
·
Ongoing
Monitoring:
Triage nurses continuously monitor patients
and may re-assess or escalate their priority if their condition changes.
Factors Influencing
Prioritization:
·
ABCs
(Airway, Breathing, Circulation):
Conditions
affecting airway, breathing, or circulation are given top priority.
·
Life-Threatening
Conditions:
Patients
with immediately life-threatening conditions are prioritized over those with
less severe issues.
·
Patient
Acuity:
The
severity of a patient's condition is a key factor in prioritization, with more
acute conditions requiring immediate attention.
·
Resource
Availability:
Hospitals may also prioritize based on
available resources and staff.
Prioritization in
Other Settings:
·
Waiting
Lists:
Patient
prioritization is also used in non-emergency settings, such as waiting lists
for procedures or specialist appointments.
·
Pharmacy
Services:
In
pharmacy, prioritization may be based on factors like high-risk medications or
complex regimens.
·
Nursing
Care:
Nurses use prioritization principles to
focus on the most critical needs of their patients, considering factors like
Maslow's Hierarchy of Needs.
Examples of
Prioritization:
·
A patient with a
severe airway obstruction would be prioritized over a patient with a minor
headache.
·
A patient with a heart
attack would be prioritized over a patient with a mild cold.
·
In a pharmacy setting,
a patient taking multiple high-risk medications would be prioritized for
pharmacist consultation.
Prioritizing patient
care involves focusing on the most urgent and critical needs of patients while
considering the overall well-being and safety of all patients under
care. This can be achieved by utilizing tools like Maslow's Hierarchy of
Needs, the ABCs (Airway, Breathing, Circulation), and by considering the
patient's current condition and potential risks.
Examples of Prioritizing
Patient Care:
·
Addressing
life-threatening situations:
A
patient with a sucking chest wound would be prioritized over a patient with
new-onset leg pain and swelling, as the sucking chest wound is a more immediate
threat to life.
·
Using
the ABCs:
In
a medical emergency, ensuring a patient has a clear airway, breathing
effectively, and has adequate circulation is paramount.
·
Utilizing
Maslow's Hierarchy:
Addressing
physiological needs (food, water, warmth, rest) takes precedence over safety
and security needs, which in turn take precedence over belonging and love
needs.
·
Focusing
on unstable patients:
Patients
with unstable vital signs (low blood pressure, high heart rate) should be
prioritized over patients with stable vital signs.
·
Addressing
pain management:
Patients
experiencing significant pain should be addressed promptly, as uncontrolled
pain can negatively impact recovery and overall well-being.
·
Ensuring
patient safety:
Implementing
safety protocols and addressing potential hazards in the care environment are
crucial.
·
Clear
communication and collaboration:
Clear
communication and collaboration among healthcare professionals can prevent
medical errors and improve patient outcomes.
·
Involving
patients and their families:
Empowering
patients and their families to participate in their care plan can lead to
better outcomes and a more positive experience.
·
Continuity
of care:
Ensuring
seamless transitions between care settings and providers can reduce
readmissions and improve patient outcomes.
·
Self-care
for healthcare providers:
Prioritizing self-care can help healthcare
providers maintain their physical and mental well-being, allowing them to
better care for patients.
Patient prioritization
tools are instruments designed to help clinicians and decision-makers
manage healthcare resources effectively, particularly in situations with
limited access to care, by ranking patients based on specific criteria to
ensure equitable and efficient delivery of services. These tools aim to
support the prioritization process, making it more transparent and
fair. They can be used in various clinical settings, including
rehabilitation programs, hospital pharmacies, and emergency departments.
Key aspects of patient
prioritization tools:
·
Purpose:
To
manage patient access to care by ranking referrals and allocating limited
resources.
·
Functionality:
They
often involve scoring patients based on pre-determined criteria, such as
clinical urgency, risk factors, and potential benefits from interventions.
·
Examples:
·
Clinical Prioritization Programs: Tools used to
categorize patients in order of clinical urgency, considering their condition,
risk factors, and potential health inequalities.
·
Emergency Department Triage: Systems like the
Jump-START algorithm are used to quickly assess and prioritize patients based
on their immediate needs.
·
Pharmacy Prioritization Tools: Tools designed to
identify patients who would benefit most from pharmacist interventions, such as
medication reviews.
·
Outcome Prioritization Tools (OPT): Instruments that
help patients and providers align on the importance of different health
outcomes.
Considerations:
Prioritization
tools may need to address social equity considerations, such as the impact of
ethnicity or deprivation on health outcomes, to ensure fair access to care.
Implementation:
Successful
implementation of these tools often requires stakeholder engagement and
consideration of potential facilitators and barriers to adoption.
Benefits:
Prioritization tools can help ensure that
patients receive timely and appropriate care, improve the efficiency of
healthcare services, and reduce the burden and distress associated with
difficult decision-making.
|
1: Stable Client |
2: Moderate-Risk Client |
3: Complex Client |
4: High-Risk Client |
|
|
Assessment |
·
Q8h
VS ·
A
& O X 4 |
·
Q4h
VS ·
CIWA
< 8 |
·
Q2h
VS ·
Delirium ·
CIWA
> 8 |
·
Unstable
VS |
|
Respiratory |
·
Stable
on RA |
·
O2
< 2L NC |
·
O2
> 2L NC |
·
O2
via mask |
|
Cardiac |
·
VS |
·
Temp
< 98.7 F ·
Pacemaker/AICD ·
HR
> 130 |
·
Change
in BP ·
Temp
> 100.3 F |
·
Unstable
rhythm ·
Afib |
|
Medications |
·
PO/IVPB |
·
TPN,
heparin infusion, blood glucose, PICC for blood draws |
·
CBI ·
1
unit blood transfusion ·
Fluid
bolus |
·
>
1 unit blood transfusion ·
Chemotherapy |
|
Drainage Devices |
·
<
2 JP, hemovac, neph tube |
·
Chest
to water seal ·
NG
tube |
·
Chest
tube to suction ·
Drain
measured Q2 hrs |
·
Drain
measured Q1 hr ·
CT
> 100 mL/2 hrs |
|
Pain Management |
·
Pain
well- managed with PO or IV meds Q4 hrs |
·
PCA,
nerve block ·
Nausea/Vomiting |
·
Q2h
pain management |
·
Uncontrolled
pain with multiple pain devices |
|
Admit/Transfer/Discharge |
·
Stable
transfer, routine discharge |
·
Discharge
to outside facility |
·
New
admission, discharge to hospice |
·
Complicated
post-op |
|
ADLs and Isolation |
·
Independent |
·
Assist
with ADLs ·
Two-person
assist out of bed ·
Isolation |
·
Turns
Q2h ·
Bedrest ·
Respiratory
isolation |
·
Paraplegic ·
Total
care |
|
Client Score |
Most = 1 |
Two or > = 2 |
Any = 3 |
Any = 4 |