Supported by Navigating the emergency department

Supported by

Navigating the emergency department

PURPOSE

Patients with bleeding disorders often have to

visit the emergency department. This module will

help you prepare for these visits by planning

ahead and by being

informed about how emergency

departments function.

1. WHEN TO GO to the emergency department

2. PREPARE in advance

3. WHO’S WHO at the emergency department

4. AFTER A VISIT to the emergency department

NAVIGATING THE EMERGENCY DEPARTMENT

WHEN TO GO TO THE EMERGENCY DEPARTMENT

WHEN TO GO

GO TO THE EMERGENCY DEPARTMENTGO TO THE EMERGENCY DEPARTMENTIF YOU OR YOUR CHILD:IF YOU OR YOUR CHILD:

might have a head, neck or abdominal bleed(even without prior injury);

feels a lack of sensation in an arm or leg

has had an accident with trauma;

is experiencing uncontrollable vaginal bleeding;

experiences an uncontrollable nose bleed (more than 30 minutes);

passes blood in the stool or vomits blood;

has any kind of unusual bleeding, such as in the groin;

is not on home infusion and you suspect a bleed;

is on home infusion but you can’t access a vein.

a medical identification tag such as MedicAlert®

PREPARE IN ADVANCE

OBTAIN AND WEAR…OBTAIN AND WEAR…

BENEFITS…PREPARE IN ADVANCE…

COMPLETE AND CARRY…COMPLETE AND CARRY…

your FactorFirst or TreatFirst treatment card

SET UP…SET UP…

an emergency contingency plan if necessary such as an emergency babysitting plan

a personal emergency plan

PREPARE IN ADVANCE

DEVELOP…DEVELOP…


precise information about patient

details about bleeding disorder and treatment product used

emergency contact numbers

PREPARE IN ADVANCE


OBTAIN…OBTAIN… a copy of your CHARMS individual treatment protocol form which

contains all the information regarding the management of your bleeding disorder.

AND…AND…BE KNOWLEDGEABLE!BE KNOWLEDGEABLE!

Take control of your bleeding disorder.

Know more aboutyour personal care than anyone.

Visit your local emergency department and bring:

− your FactorFirst or TreatFirst treatment card− a copy of the instructional manual for health care

providers: Emergency Care for Patients with Hemophilia or Emergency Care for Patients with von Willebrand Disease

− your treatment product including the package insert

Ask questions about how the emergency department works

Find out if your clotting factor concentrate or your medication (desmopressin or Cyklokapron®) is stocked in the blood bank or in the hospital pharmacy.

PREPARE IN ADVANCE

PRIOR TO AN EMERGENCYPRIOR TO AN EMERGENCY


PREPARE IN ADVANCE

EMERGENCY PACKEMERGENCY PACK


A copy of your personal emergency plan

An empty Ziploc® bag for your treatment product. Just before leaving the house, pop in the product along with a flexible ice pack.

Another Ziploc bag with supplies for infusion (tourniquet, gloves, alcohol wipes, syringe, butterfly needle, saline, Emla cream, gauze dressings, adhesive tape & bandages, and, if your child has a port, port needles and betadine and haparin)

An entertainment pouch (books, video games, crayons)

A utility pouch (money, pen, notebook)

A first-aid pouch (tissues, acetaminophen, thermometer, adhesive bandages, instant cold pack, alcohol swabs, anti-bacterial wet wipes or hand washing lotion)

A clean towel

myemergency

pack

PREPARE IN ADVANCE

BEFORE GOING TO THE EMERGENCY DEPARTMENTBEFORE GOING TO THE EMERGENCY DEPARTMENT

BENEFITS…PREPARE IN ADVANCE

Follow your personal emergency plan.

Contact HTC nurse coordinator/doctor – write down name of person you spoke to and instructions given. Ask them to phone ahead to the emergency department.

Infuse prior to going to the emergency department and bring along empty factor vials and boxes.

Bring along your emergency pack.

WHO’S WHO AT THE EMERGENCY DEPARTMENT

RECEPTIONIST/REGISTRATION CLERKRECEPTIONIST/REGISTRATION CLERK

BENEFITS…WHO’S WHO…

In some hospitals, this is the first person you will meet.

If you or someone else called ahead, let him/her know.

Have personal information ready (health or hospital card, family physician, etc.).

Show your FactorFirst or TreatFirst card.


TRIAGE NURSETRIAGE NURSE


Sometimes the first person you will meet.


Initial assessment will be done.

State concerns clearly.

Make sure bleeding disorder clearly written on triage form.

He/she will decide the level of triage.

Give the triage nurse all the information with regardto your bleeding disorder such as:

type of bleeding disorder severity type of bleed the treatment product you use and the current dosage the presence of an inhibitor or a port-a-cath

other medication other complications


TRIAGE OF BLEEDING DISORDERSTRIAGE OF BLEEDING DISORDERS


The evaluation of cases according to urgency, from most urgent to least urgent.

There are five levels of triage

Level I Resuscitative

Level II Emergent » major or moderate bleeds

Level III Urgent » mild or moderate bleeds

Level IV Less Urgent

Level V Non Urgent

As seen above, the Canadian Emergency Department Triage and Acuity Scale

(CTAS) has classified triage of bleeding disorders as LEVEL II and LEVEL III

depending on the severity of the bleeds.


TRIAGE OF BLEEDING DISORDERSTRIAGE OF BLEEDING DISORDERS


If you are not seen within 30 minutes, go back to the triage nurse to inquire on your situation.

If symptoms get worse and you are still not seen, consider calling the HTC hematologist from the waiting room phone.


EMERGENCY DEPARTMENT NURSEEMERGENCY DEPARTMENT NURSE



Make sure the nurse knows what bleeding disorder you have, the type of bleed, the treatment product you use and the existence of an inhibitor if necessary.

State concerns such as prompt infusion, preferred needle size, easiest vein to access, etc.

Know how to calculate your factor dosage.

Know how to prepare factor (offer to do it).

Inform the nurse that there is “no overdose”; the entire vial should be infused.


EMERGENCY DEPARTMENT DOCTOREMERGENCY DEPARTMENT DOCTOR

BENEFITS…WHO’S WHO


Make sure the doctor knows what bleeding disorder you have, the type of bleed, the treatment product you use and the existence of an inhibitor if necessary.

If HTC nurse or hematologist called ahead, let doctor know.

Make sure you understand the treatment ordered.

If you feel you are not getting the proper care, phone your HTC.

It is your right to question/refuse treatment.

THE EMERGENCY DEPARTMENT

BENEFITS…SUCCESS

TIPS FOR SUCCEEDING AT THE EMERGENCY DEPARTMENTTIPS FOR SUCCEEDING AT THE EMERGENCY DEPARTMENT

Stay calm

Listen

Speak up! Be assertive!

Be knowledgeable about your bleeding disorder

Repeat yourself, if necessary

Be polite and courteous

Focus on the problem, not the people

Use “I-statement” not “you-statements”

Be prepared for difficult situations

Phone your HTC again, if necessary

Know your rights as a patient!

helpfultips

EMERGENCY DEPARTEMENT

AFTER A VISIT TO THE EMERGENCY DEPARTMENT

BENEFITS…AFTER A VISIT

Call your HTC to let them know of the details of your visit and follow-up instructions

AFTER A VISIT TO THE EMERGENCY DEPARTMENTAFTER A VISIT TO THE EMERGENCY DEPARTMENT

REMEMBER! Prepare in advance.

Stay calm.

Be assertive.

Use positive, proactive ways of communicating.

Be knowledgeable.

ƒShow your FactorFirst or TreatFirst treatment card.

ƒCall your treatment centre for assistance if necessary.

ACKNOWLEDGEMENTS

The CHS would like to acknowledge those people who contributedto the development of Navigating the emergency department.

DORINE BELLIVEAU, RNMoncton Children’s Hospital, Moncton, NB

CLARE CECCHININational Program Manager, Canadian Hemophilia Society (retired)

WADE KEAN, MDBoudreau-Ouest, NB

DAVID PAGENational Executive Director, Canadian Hemophilia Society

SHERRY PURCELL, RNKingston General Hospital, Kingston, ON

Supported by

Bon Voyage! Travelling with a bleeding disorder

Charting your course

Home care: The road to independence

Destination fitness

Roadmap for managing pain

Navigating the emergency department

Documents

Supported by Navigating the emergency department