Emergency care standards

Published: 24 August 2010

Standards for the recording of patient vital signs in the majors and resuscitation areas of the emergency department

In 100% of cases:

1. Patients triaged to the majors or resuscitation areas of the emergency department should have respiratory rate, oxygen saturation, pulse, blood pressure, GCS or AVPU score and temperature measured and recorded in the notes within 20 minutes of arrival or triage, whichever is the earliest.

2. Patients with abnormal vital signs, according to local guidelines or as defined below, should have their vital signs repeated and recorded in the notes within 60 minutes of the first set of observations. The following criteria are may be used to define abnormal vital signs in adults:

a. Respiratory rate < 12 or > 20 per min
b. Oxygen saturation < 92%
c. Pulse < 60  or  > 100
d. Systolic blood pressure < 100 or  > 160
e. GCS < 15 or not alert (AVPU)
f. Temperature < 35 or > 38.

3. Abnormal vital signs should be communicated to the nurse in charge of that clinical area and documented in the notes.

4. There should be documented evidence that appropriate action was taken. 
 

Standard for the management of pain in emergency care

1. Patients in severe pain (pain score 7 to 10) should receive appropriate analgesia, according to local guidelines: 

a. 50% within 20 mins of arrival or triage, whichever is the earliest
b. 75% within 30 mins of arrival or triage, whichever is the earliest
c. 98% within 60 mins of arrival or triage, whichever is the earliest.

2. Patients with moderate pain (pain score 4 to 6) should be offered or receive analgesia, according to local guidelines:

a. 75% within 30 mins of arrival or triage whichever is the earliest.
b. 90% within 60 mins of arrival or triage whichever is the earliest.

3. 90% of patients with severe pain should have documented evidence of re-evaluation and action within 30 minutes of receiving the first dose of analgesic.

4. 75% of patients with moderate pain should have documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic.

If analgesia is not given, the reason should be documented in the notes.

Fractured neck of femur

1. Patients in severe pain (pain score 7 to 10) should receive appropriate analgesia, according to local guidelines:

a. 50% within 20 mins of arrival or triage, whichever is the earliest
b. 75% within 30 mins of arrival or triage, whichever is the earliest
c. 90% within 60 mins of arrival or triage, whichever is the earliest.

2. 90% of patients with severe pain should have documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic.

3. Patients with moderate pain (pain score 4 to 6) should be offered or receive analgesia, according to local guidelines:

a. 75% within 30 mins of arrival or triage, whichever is the earliest
b. 98% within 60 mins of arrival or triage, whichever is the earliest.

4. 75% of patients with moderate pain should have documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic.

5. 75% of patients should have an X-ray within 60 minutes of arrival or triage, whichever is the earliest.

6. 98% of patients should be admitted within four hours of arrival.

If analgesia is not given, the reason should be documented in the notes.

Dislocated shoulder standards

1. Patients in severe pain (pain score 7 to 10) should receive appropriate analgesia, according to local guidelines:

a. 50% within 20 mins of arrival or triage, whichever is the earliest
b. 75% within 30 mins of arrival or triage, whichever is the earliest
c. 90% within 60 mins of arrival or triage, whichever is the earliest.

2. 90% of patients with severe pain should have documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic. 

3. Patients with moderate pain (pain score 4 to 6) should be offered or receive analgesia, according to local guidelines:

a. 75% within 30 mins of arrival or triage, whichever is the earliest
b. 98% within 60 mins of arrival or triage, whichever is the earliest.

4. 75% of patients with moderate pain should have documented evidence of re-evaluation and action within 60 minutes of receiving the first dose of analgesic.

5. 75% of patients should have an X-ray within 60 minutes of arrival or triage, whichever is the earliest.

6. In 75% of cases, first attempt at reduction should be within two hours and 90% within three hours of arrival.

If analgesia is not given, the reason should be documented in the notes.

Feedback?

If you have any comments, views or suggestions regarding any of these issues, please provide feedback to the RCN Emergency Care Association Committee, via ECA Chair Jim Bethel, on email: James.Bethel@wlv.ac.uk.