I disagree.  We design our protocols to fit 80% of the patients with a
specific condition.  It helps with teamwork because the nurses know what
to expect rather than dealing with 20 different doctors doing things 30
different ways. In teamwork lingo, this fosters a shared mental model. It
helps the physician with cognitive overload so we can focus on more
important things than trying to remember,  for example,  how our
Endocrinologists like their insulin dosed. Standardization also reduces
errors and inefficiency and improves adherence to evidence -based

Fergus Thornton <[log in to unmask]> wrote:

I'm against most protocols.  In an effort to encompass all like
situations, they really fit none specifically.  If you're an ED MD then
you should be able to think your way thru a problem, specifically that
problem and not depend on a cookbook.  My experience with giving nurses
any protocols like you've mentioned have all had problems.  I agree with
your committee.

-----Original Message-----
>From: "Givens, Timothy" <[log in to unmask]>
>Sent: Apr 16, 2010 1:37 PM
>To: [log in to unmask]
>Subject: Use of protocols & pathways in the ED
>For the group:
>Have any of you encountered resistance to the use/implementation of
treatment protocols in the ED?  Our hospital P&T committee recently placed
a moratorium on the approval of new or revised protocols house-wide while
they engage in a philosophical debate about the appropriate use of
protocols in general.  Their objection to some recently submitted triage
protocols (decadron for croupers, zofran for vomiting patients, etc.) was
that it required nurses in triage to diagnose and or prescribe
medications, and this violated the scope of nursing practice.  I am
interested to hear what the group's opinions in this regard are--positive
and negative.  As in everything, we are trying to balance efficiency,
throughput, and patient satisfaction with safety concerns, and I'm certain
this is the crux of the issue.  What do you think?
>Tim Givens, MD
>Medical Director, Pediatric Emergency Department
>The Children's Hospital, Denver
>Acting Section Chief, Section of Emergency Medicine
>Department of Pediatrics
>University of Colorado, Denver
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Fergus Thornton
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