Thursday, August 16, 2012

What is My Patient's Problem TODAY???

So many times I see nurses having difficulty discerning what the main focus of the call is, and therefore it impedes their advice ability as well as productivity. This is especially true when the patient has multiple complaints or many chronic illnesses.
Sometimes the caller has difficulty expressing what their main concerns are or reason for the call, and you simply have to just ask, "So what concerns you that made you call TODAY?" That will usually get the answer you are looking for so that you can determine the chief complaint, and find the correct protocol.
Focus on what the current symptoms are, and not symptoms they had last week that are no longer an issue such as, the patient now has a fever for 3 days, but diarrhea a week ago. The protocol used should be fever, and if the patient is now having normal BMs, why would you even ask any questions about the diarrhea?
One good way to determine if you have done a thorough assessment of the complaint is by remembering
*P Problem/Chief Complaint
*H (How are you feeling?)
*O Onset
*S Associated Symptoms
*H Pertinent History
*P Precipitated by
*A Aggravated or Alleviated by
*T Timing
*E Etiology (Have I overlooked anything?)

Problem- Listen to decide what the chief complaint is. Ask for all adjectives used to describe this problem. If not able to determine the complaint, ask the appropriate questions to draw out the information, like "What is bothering you the most?"

Onset- Did it come on suddenly or gradually? When did the symptoms start?

Associated symptoms- What else is bothering them? Use caution to "not put words in the patient's mouth".

Pertinent history- Have you been ill or seen the doctor recently? Have they had this problem before, and if so, what was it? Who said? How was the decision made?

Precipitated by- Is there anything they do that brings it on? Is there any way they can predict it's recurrence?

Aggravated or Alleviated by- What makes it better? What makes it worse?

Timing- Is there any time of the day, week or month that you notice this problem more?

Etiology- Have I overlooked anything? Did I consider all the pertinent findings?

Following this will ensure an accurate and complete assessment, will keep the call in focus and productivity at it's best. 

(Carol Rutenberg2012)