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Assessment Questions if Schmitt-Thompson protocols

  • 1.  Assessment Questions if Schmitt-Thompson protocols

    Posted 10-11-2023 10:54

    Good morning,

    I am reaching out to see how those using Schmitt-Thompson telephone triage protocols document the assessment questions under the dispositions. The S-T user guides says you do not need to document all of the negatives, that it is charting by exception. Charting all the negatives also makes the note very busy and difficult to follow. However, one of our nurses was involved in a legal case, and she felt the fact that she documented the negatives was very important in the legal proceedings.  Looking for opinions and info on how others document.  

    Thanks so much,



    ------------------------------
    KIm Trost BSN, RN
    Manager-Clinical Operations
    Co-chair AAACN Telehealth SIG
    Nurse Triage Call Center
    WellSpan Health
    York, PA
    717-851-3458
    ------------------------------


  • 2.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 08:21

    Good Morning,

     

    Our nurses chart the negatives up to the Yes response. We do not chart anything beyond the Yes.

     

     

    Mia Graff MSEd, RN, BSN |Patient Access Manager, Clinical Team

    NorthShore – Edwards-Elmhurst Health | 4901 Searle Parkway, Skokie
    847-663-3612
    | mgraff@northshore.org

     

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  • 3.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 08:51

    Thank you for your response, Mia!



    ------------------------------
    KIm Trost BSN, RN
    Manager-Clinical Operations
    Co-chair AAACN Telehealth SIG
    Nurse Triage Call Center
    WellSpan Health
    York, PA
    717-851-3458
    ------------------------------



  • 4.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 14:07

    We do the same thing, chart negatives just to the yes response.



    ------------------------------
    Melanie Simpson
    Call Center Nurse Consultant
    The University of Kansas Health System
    Overland Park KS
    (913)744-8278
    ------------------------------



  • 5.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 11:38

     Our team also selects the negatives so that the documentation shows that information was asked / verified.  Once we get a yes we stop, and then based on s/s we either go with the suggestion or upgrade if the nurse feels it is warranted.  I agree it does make it seem busy, but you always chart today as if it will be read in court tomorrow.

    Hope that helps.

    Patricia H. Yon, BSN, RN, AMB-BC, CMOM

    Clinical Nurse Manager Triage Nurse Advice Line

     

    Office: 757-252-3247    Mobile: 757-633-4408

    Email: pxbradle@sentara.com

    800 Independence Blvd.

    4th Floor

    Virginia Beach, Virginia 23455

     


     



    ------------------------------
    Patricia Yon, BSN, RN, AMB-BC
    Clinical Manager Nurse Triage
    Sentara Ambulatory Services
    Norfolk, Virginia
    757-252-3247
    ------------------------------



  • 6.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 11:52

    Thank you, Patricia!



    ------------------------------
    KIm Trost BSN, RN
    Manager-Clinical Operations
    Co-chair AAACN Telehealth SIG
    Nurse Triage Call Center
    WellSpan Health
    York, PA
    717-851-3458
    ------------------------------



  • 7.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-12-2023 15:14

    Thank you for sharing. We currently outsource our triage services, but leadership is wanting to bring this service in-house. This would be a new department that will run under my leadership. I just had a demo with clearTriage, whose protocols were created by Schmitt-Thompson. Ensuring that the negatives are noted to me confirms that those areas were reviewed and based on all information gathered, the recommendation was for XYZ. This would also be important if we deviated from the protocol based on the nurse's assessment. 



    ------------------------------
    Kristyl McCray MSN RN-BC
    RN Clinical Director, Education & Prof. Practice
    PIH Health Physicians
    Whittier CA
    (562)698-0811
    ------------------------------



  • 8.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-13-2023 08:04

    Good morning,

    Clarifying question here....when you all are saying "chart the negatives" do you mean physically type out the negatives in your documentation section? Or do you mean check off the "no" button next to the question in the protocol? We have our S-T protocols embedded in our EMT (Epic) so the negatives are clearly documented by clicking the "no" button. In my opinion, it is redundant and unnecessary to then again physically type out all those negatives. And the S-T users guide does specifically refer to charting by exception. From my own experience in a legal case, the documented negatives by clicking the "no" button held up. 

    All our calls are recorded, so one of the things we do as part of our QA review process is make sure that if the nurses have clicked "no" they actually verbally asked the question, too. That is definitely where it would get dicey in court.......if the call recording does not reflect the nurse verbally asking the question but the "no" button is clicked. 

    Karen



    ------------------------------
    Karen Lafferty MSN,RN,CPN
    Clinical Supervisor- Office Hours Nurse Triage Program
    The Children's Hospital of Philadelphia
    267-250-4601
    laffertyk@chop.edu
    ------------------------------



  • 9.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-13-2023 08:15

    Hi Karen,

    I am referring to checking the "No" button in the protocol, not physically typing out the negative response. Our calls are recorded as well, but only on file for 90 days. Thank you for your response!



    ------------------------------
    KIm Trost BSN, RN
    Manager-Clinical Operations
    Co-chair AAACN Telehealth SIG
    Nurse Triage Call Center
    WellSpan Health
    York, PA
    717-851-3458
    ------------------------------



  • 10.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-13-2023 08:36

    Hi Kim, 

    This is such a great discussion, because I have been interpreting the statement in the users guide about the nurse not needing to chart all the negatives as the nurse not needing to include all the negatives in his/her/their documentation- what he/she/they physically types out. Because I do have some nurses that will still type out, "no fever, no wheezing" etc, when those are clearly already checked off in the protocol- which is to me is unnecessary. So that is what I thought S-T meant. 

    I always go back to the part in the users guide where it says- I'm paraphrasing here-"within a given disposition category, the nurse must know the answer to all the questions (either from asking or from inferring from initial assessment) before moving on to the next disposition category". To me, that means if you haven't answered "yes" to anything in that category, all the "no" should be checked off. And to me that means you know the answers from either 1) asking the question, or 2) it was very clear from your initial assessment (i.e, can answer "no" to "laying down and unable to walk" because mom has already told you he is in school today ( we are pediatrics)"

    So to me, all the negatives should be checked off until you get to the first "yes" question.

    However, he also points out that within a specific disposition category, if there is a "yes" answer, then not all the questions within that same category need to be answered. For example, if I know immediatley what "yes" I need to pick from what I heard in my initial assessment, I can go right to that "yes" within the specific category and do not have to answer the "no" questions that came right above it in that specific category. But I DO need to know the answers to the questions in the disposition category ABOVE the category where my "yes" is, because those are higher acuity questions and should be asked first. 

    Hope this all makes sense and isn't too rambling!

    Karen



    ------------------------------
    Karen Lafferty MSN,RN,CPN
    Clinical Supervisor- Office Hours Nurse Triage Program
    The Children's Hospital of Philadelphia
    267-250-4601
    laffertyk@chop.edu
    ------------------------------



  • 11.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-14-2023 09:34

    Hello fellow Epic users of S-T protocols,

     

    We have modified our triage notes so that all of the negative responses are "hidden"  - they don't bog down the note but are accessible to the provider or anyone reviewing the record who would want to see if certain questions were assessed with the patient/family.

     

    Hope this helps,

    Danielle

     

    Danielle Smith, MSN, RN, CNL

    Pronouns: she/her/hers

    Clinical Practice Leader, Primary Care

    Children's Wisconsin

    Cell: 262-989-1999

    childrenswi.org

     

    Please note: My email address is now dsmith2@childrenswi.org

     

     

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  • 12.  RE: Assessment Questions if Schmitt-Thompson protocols

    Posted 10-14-2023 13:35
    It is true that you never 'need' to chart the pertinent negatives, but that only works well when the reader is another healthcare professional. Keep in mind, if a question was pertinent enough to ask about, one should take credit for decision to ask. The pertinent negatives often cover you in a medical-legal manner,  because  as you well know, if is it not documented, it was not addressed (or considered). Pertinent negatives allow others to discern the comprehensiveness of your assessment. 

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

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