Irish Childrens Triage System (ICTS) Project Presented by Ruth - - PowerPoint PPT Presentation

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Irish Childrens Triage System (ICTS) Project Presented by Ruth - - PowerPoint PPT Presentation

Sep 24, 2022 180 likes •345 views

Irish Childrens Triage System (ICTS) Project Presented by Ruth Devers CNM3 Children's University Hospital Temple St Mary Tumelty CNM3 National Children's Hospital, Tallaght Bridget Conway CNM3 Our Lady's Children's Hospital, Crumlin

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SLIDE 1

Irish Children’s Triage System (ICTS) Project

Presented by Ruth Devers CNM3 Children's University Hospital Temple St Mary Tumelty CNM3 National Children's Hospital, Tallaght Bridget Conway CNM3 Our Lady's Children's Hospital, Crumlin National Emergency Medicine Programme Seminar February 10th 2016

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SLIDE 2

What is ICTS

  • Irish Children’s Triage System (ICTS) is a

quality improvement initiative, the aim of which is to standardise a formal, comprehensive triage tool that would improve consistency between users and be suitable for triaging children in all emergency departments with paediatric attendances in Ireland.

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SLIDE 3

Objectives of ICTS

  • To develop a specific

triage tool to clinically assess children attending EDs that facilitates the prompt recognition of acuity for ill or injured children.

  • Develop a tool tailored to

include clinical elements such as, physiological vital signs, pain management, temperature and other special guidelines specific to the needs of children.

  • Provide an evidence-

based approach to the triage of children that supports clinical decision making

  • Develop a National

Standard for Children’s Triage which ensures that children receive the same standard and quality of care regardless of where in the country they present for treatment.

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SLIDE 4

Project Design

  • ICTS project steering

group convened in 2011 (Chair M.Forde, Nurse Lead EMP)

  • Literature review of

existing international triage tools

  • Flowchart design base on

MTS & existing tools developed locally in paediatric EDs in Dublin

  • Training package

developed & delivered by CNM3s from three Paediatric EDs

  • ‘Champions’ identified in

6 pilot sites to support staff & identify and resolve any issues/concerns highlighted during pilot phase

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SLIDE 5

Definition Triage categories General discriminators Colour Triage category Meaning of triage category Recommended time to be seen by doctor/reassessment Red 1 Immediate Immediate (ongoing assessment) Airway compromise Inadequate breathing Exsanguinating haemorrhage Currently seizing Age related abnormal pulse and respiratory rate * GCS ≤ 12 Oxygen saturations ≤ 90% Colour Triage category Meaning of triage category Recommended time to be seen by doctor/reassessment Orange 2 Very urgent ≤ 10 minutes Severe pain (pain score 7-10) Uncontrollable major haemorrhage GCS 13 or 14 Age related abnormal pulse and respiratory rate * Signs of compensated shock Oxygen saturations ≤ 92% Colour Triage category Meaning of triage category Ideal time targets Yellow 3 Urgent ≤ 60 minutes Moderate pain (pain score 4-6) Uncontrollable minor haemorrhage Age related abnormal pulse and respiratory rate * History of unconsciousness Colour Triage category Meaning of triage category Ideal time targets Green 4 Standard ≤ 120 minutes Mild pain (Pain score 1-3) Problem <48 hours Colour Triage category Meaning of triage category Ideal time targets Blue 5 Non urgent ≤ 240 minutes Problem > 48 hours

General Discriminators

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SLIDE 6

Vital Signs Reference Grids

Respiratory Rate Values

Table 1.

Age

≤ - 2 S/D

  • 1 S/D

Normal + 1 S/D + 2 S/D > + 2 S/D 0 – 3 months < 20 21 – 30 30 - 60 60 – 70 70 – 80 > 80 4 – 6 months < 20 20 – 30 30 – 60 60 – 70 70 – 80 > 80 7 -12 months < 17 17 – 25 25 – 45 45 – 55 55 – 60 > 60 1 – 3 years < 15 15 – 20 20 – 30 30 – 34 35 – 40 > 40 4 – 6 years < 12 12 – 16 16 – 24 24 – 28 28 – 32 > 32 > 7 years < 10 10 – 14 14 – 20 20 – 24 24 – 26 > 26

Heart Rate Values

Table 2. Age ≤ - 2 S/D

  • 1 S/D

Normal + 1 S/D + 2 S/D > + 2 S/D 0 – 3 months < 65 65 – 90 90 – 180 180 – 205 205 – 230 > 230 4 – 6 months < 63 63 – 80 80 – 160 160 – 180 180 – 210 > 210 7 -12 months < 60 60 – 80 80 – 140 140 – 160 160 – 180 > 180 1 – 3 years < 58 58 – 75 75 – 130 130 – 145 145 – 165 > 165 4 – 6 years < 55 55 – 70 70 – 110 110 – 125 125 – 140 > 140 > 7 years < 45 45 – 60 60 – 90 90 – 105 105 – 120 > 120 Colour Triage category Red Triage category 1 Orange Triage category 2 Yellow Triage category 3 White Triage category not determined by pulse or respiration rate

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SLIDE 7

Data Collection Pilot Phase

  • Champions in each pilot site collected data:

– % of each category patient presenting to ED – Admission rates per triage categories – Triage categories of all patients admitted to PICU

  • Staff satisfaction questionnaire completed by staff at

pilot sites

  • Feedback from champions informed revision of ICTS

flowcharts.

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SLIDE 8

Audit Results

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SLIDE 9

Attendance rate per triage category (across 6 pilot hospitals Mar-May

2012 & 2013)

Attendance rates per triage category March- May 2012 10 20 30 40 50 60 70 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 Category 1 Category 2 Category 3 Category 4 Category 5

Attendance per triage category March - May 2013

10 20 30 40 50 60 70 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6

Category 1 Category 2 Category 3 Category 4 Category 5

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SLIDE 10

Admissions as an overall %

  • f admissions per triage

category

Mar- May 2012 & 2013

Admissions as an overall admission % per triage category 2012 10 20 30 40 50 60 70 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 %

Category 1 Category 2 Category 3 Category 4 Category 5 Admissions as an overall admission % per triage category 2013 10 20 30 40 50 60 70 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 %

Category 1 Category 2 Category 3 Category 4 Category 5

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SLIDE 11

Admission rate per triage category

Mar- May 2012 & 2013

Admissions per triage category 2012 10 20 30 40 50 60 70 80 90 100 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 % Category 1 Category 2 Category 3 Category 4 Category 5 Admissions per triage category 2013 10 20 30 40 50 60 70 80 90 100 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 % Category 1 Category 2 Category 3 Category 4 Category 5

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SLIDE 12

Patients admitted to PICU

Triage categories of patients admitted to PICU 2012 62% 31% 7% 0% 0% Category 1 Category 2 Category 3 Category 4 Category 5 Triage categories of patients admitted to PICU 2013 45% 49% 6% 0% 0% Category 1 Category 2 Category 3 Category 4 Category 5

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National Implementation Plan

  • Pilot sites request

to continue using ICTS

  • Support for

national roll out from Centre of Children's Nurse Education

  • CNM3s delivered

Train the Trainer education sessions in 5 locations around the country in 2014

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SLIDE 14

Successes & Challenges

  • 10 out of 18 EDs have

implemented some ICTS training as result of ‘Train the trainer’ programme

  • 6 sites (3 PEDs) already

trained & available to support other sites

  • ED staff enthusiastic &

willing to use a child specific triage tool

  • Electronic version ICTS in

IPMS supported EDs

  • No dedicated funding for a

coordinator for a national rollout

  • Skill mix / RCN’s not

available on each shift in all EDs

  • Time constraints on

trainers due to poor staffing levels

  • Crowding & trollies
  • Inconsistent access to IT
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SLIDE 15

Next Steps

  • Continue to work through identifying the

barriers at sites who currently do not have ICTS

  • Resource additional train the trainer

day(s)

  • Publish & launch National EMP ICTS

document