General ED Questions
Patient Flow, Access, and Overcrowding
Person-centered care & Communication
Consent, Rights, Privacy, and Ethics
Patient Identification, Treatment, and Equipment Safety
100

What are the 4 moments of hand hygiene?  

  • before patient environment contact
  •  Before an aseptic procedure.
  •  after body fluid exposure.
  • after patient environment contact.
100

What are your responsibilities during a resuscitation or emergency code?

  • Grab code role badge within your skill and scope to identify your role, clear closed loop communication, respect
  • Emergency codes: refer to emergency preparedness binder in department, follow specific emergency code polices to know your role during an emergency code found on intranet as well
100

 How do you involve patients and families in decisions about care and treatment?

  • Including: Partnering with patients, families, loved ones and care partners in everything we do.
  • Listen: what matters most to this person?  Encourage questions
  • Include and involve them in decisions. Provide clear information
  • Respect: The individual needs or preferences, safety and privacy
  • Receive feedback
100

How is privacy protected during registration, triage, assessment, and bedside discussions?

  • Private triage bay with doors; private registration bay with doors
  • EMS desk separate from rooms with curtains; SNT assessment bays have privacy curtains divider
  • Curtains or doors in rooms for assessment and discussions, chart kept in slots
100

When must at least two patient-specific identifiers be used? 

Which identifiers are acceptable, and which identifiers should not be used?

  • Before providing care
  • Acceptable: Name and DOB
  • Not: Room number and bed location
200

What education helps staff provide safe and respectful care to patients with mental health or addictions needs?

  • Crisis Intervention Training required every 1-2 years
  • LMS course: Seclusion and Safe Room Training
  • Suicide Risk policy and the importance of completing the Columbia Suicide risk tool
200

What access barriers may affect ED patients, and how can staff help reduce those barriers?

  • High volume and/or long wait times due to one physician or an emergency= follow clear protocols, utilize clear communication and collaboration with the team, call ED back-up if required, utilize SNT pathway, initiate surge procedures if necessary, practice compassion
  • Communication gaps, physical and equipment limits: offer interpreter service (number available at nursing station and in resus and on intranet), assistive devices (pocket talker, walker) offer discharge handouts, use age and developmentally appropriate language, employ all supports (caregivers, parents)
  • Staffing: short staffing due to sick call, transfer: pull a nurse from the inpatient unit for support, support from educator or charge
  • No mental health beds: practice compassion, advocate for your patient, frequent follow-up and communication
200

How do you verify that the patient or family understands the information provided?

  • Encourage questions
  • Have the patient and/or family repeat it back verbally or demonstration if appropriate
200

What should happen when a patient is unable to provide informed consent?

  • Review advanced directives if applicable, durable power of attorney
  • Identify a surrogate decision maker (legal guardian, spouse, parent, adult child)
  • Last resort: court appointed guardianship
  • Exception: emergency
200

At which ED care transitions is a best possible medication history required?

What sources can be used to verify a patient’s medication history?

  • Triage, admission, transfer and discharge
  • Patient, pharmacy, blister back, medication bottle, up to date medication list, family/Support
300

How do you access training or support if you are not confident using a piece of equipment or performing a required task?

  • Utilizing the educator
  • Utilizing Elsevier for clinical skills review
  • Utilizing the training and education link on the intranet for clinical education resources and fast facts
  • Referring to the clinical guidance documents in the department
  • Referring to the LMS video for alaris pumps and clinical links for the alaris user manual
300

How do you coordinate timely access to medicine, critical care, surgery, diagnostic imaging, laboratory, pharmacy, and other hospital services?

  • Proper timely triage, Timely initial assessment, initiation of medical directives
  • Utilizing consults, utilizing criticall if required, good communication amongst the team, charge nurse going to huddles, good communication with bed allocation
300

How can patients and families share concerns, complaints, compliments, or suggestions for improvement?

  • Patient satisfaction survey or go to our website to patients and visitors sections for patient relations
  • Provide the patient with a patient experience card and/or link them to the patient relations team
300

How do you determine whether a patient has the capacity to provide informed consent?

  • If the nurse felt the patient didn’t have the understanding, appreciation or reasoning they would voice their concerns to the physician who would have to assess the patient for capacity to consent.
  • To determine whether a patient has the capacity to consent to a medical treatment, a healthcare clinician must perform a clinical assessment of the patient's decision-making abilities at that specific moment.
  • Refer to policy: consent and refusal to consent # 2-5-10390 and Policy capacity evaluation # 2-5-5920
300

How are medication discrepancies identified, communicated, and resolved?

  • Can be identified by physician, nursing, pharmacist, patient, when checking order against BPMH, notify ordering physician, pharmacy, nurse, RL6 if required, order fixed to accurately portray proper order.
400

Where do you find pediatric dosing and equipment information?

  • At all ED bays, in the stock room, at triage, in resus, on the broselow and crash cart, in the med room
400

How does the ED recognize that it is becoming overcrowded or entering a surge situation?

  • No beds available to see ED patients, wait times, holding several admitted patients with no inpatient bed availability
400

How are patients and families involved in planning and preparing for a transition?

  • Discuss their care goals and safety concerns
  • Provide clear information at handovers and transition
  • Offer bedside TOA and patient involvement if requested
400

What should you do when a patient refuses recommended treatment or chooses to leave?

  • Refer to policies: Consent and Refusal to Consent and Leaving Against Medical Advice
  • Communicate clearly including the benefits of the treatment or staying and the risk with refusing or leaving to make sure they understand; inform the MRP as well
  • Documents clearly and in detail; have them sign the chart or the AMA form
400

What monitoring is required after a patient receives narcotics, sedatives, or procedural sedation?

  • Narcotics: pre and post administration vitals
  • Sedation: 2 physicians
  • Procedural sedation: Vital signs including assessment of respiratory rate and quality, SpO2, ETCO2 every 5 minutes during procedure
  • Vital signs including assessment of respiratory rate and quality, SpO2, ETCO2 every 15 minutes post procedure x 1 hour - including Aldrete Score - until score of 10 is attained; 1:1 nursing care til patient is Aldrete score of 9
500

How do you recognize and respond to falls, skin, or VTE risks?

  • During triage and/or the secondary assessment we screen all patients for risk factors
  • Once a positive screen means we take action: we complete any required further assessment using standardized screening tools, identify the patient specific needs, implement appropriate prevention or safety strategies and update the care plan.
500

How do you know when the ED surge or overcrowding plan is activated?

What actions are taken when the ED surge or overcapacity protocol is activated?

Refer to Surge Capacity Policy and Procedure #2-5-1260 on intranet

  • Good communication with the charge nurse and leadership team
  • Use of flex spaces within the ED (hallway stretcher/chairs), using the SNTR room 2-265
  • Modifying SNT hours
  • Sending patients back to WR for results if appropriate
  • Expand into DI space if sufficient staffing
  • Upstaffing for holding of inpatients in ED
  • Opening of flex spaces and unconventional beds in the inpatient units
  • pulling from other department for support


500

What information must be communicated during shift handover, admission, transfer, and discharge?

  • patient identification, allergies, risks, current status, outstanding orders, and any safety concerns 
  • following our TOA policy using the SBAR framework (see framework at nursing station)
500

Where can staff obtain support when facing an ethical or medico-legal concern?

  • Follow the YODA framework- up in the back hall of the ED
  • Refer to the ethics framework policy # 1-5-860
  • Speak with our bioethicist on call 24/7 Dr. Steve Abdul
500

How are outstanding test results, referrals, and follow-up responsibilities communicated and documented?

  • Imaging discrepancy process checked by clerks and physicians daily
  • LABORATORY/ DIAGNOSTIC IMAGING FOLLOW-UP REPORT Form #WN682: abnormal or outstanding results are faxed to our department and the form is completed by clerks/nursing and reviewed by the physician and follow-up instructions are fille out and put up for the nurse to complete (e.g. call patient and send script, tell patient to return to ED etc)
M
e
n
u