Republic of the Philippines

Province of Rizal
City Government of Antipolo

Rizal Provincial Hospital System- Antipolo Annex II

Provincial Road, Brgy. Dalig, Antipolo City
Tel No. (+632) 941-8518

EMERGENCY ROOM

S - STANDARD
O - OPERATING
P - PROCEDURES

INTRODUCTION

Emergency nursing is a specialty area of the nursing profession like no other.

Emergency nurses must possess both general and specific knowledge about health
care to provide quality patient care for people of all ages. Emergency nurses must be
ready to treat a wide variety of illnesses or injury situations, ranging from a sore throat
to a heart attack.
The ER nurse as a member of the emergency response team has been
responsible for triaging and caring for patients at the emergency department for care.
This includes assessments, diagnosing, planning, therapeutic interventions, care
delivery and evaluation. Emergency nurses specialize in rapid assessment and
treatment when every second counts, particularly during the initial phase of acute illness
and trauma. Emergency nurses must tackle diverse tasks with professionalism,
efficiency and above all caring.
This scope of service for the Emergency Department aims to offer guide to ER
nurses so as to provide quality care to patients in the Rizal Provincial Hospital System Antipolo Annex II Emergency Department.

GOAL OF THE EMERGENCY DEPARTMENT

To provide quality emergency care in the most effective and efficient manner to

all patients presenting to the RPHS Antipolo Annex II ER.

To provide an efficient transition into the hospital for the patients requiring

admission.
To provide accurate triage assessment of all direct admission patients who pass

through the department.

To strive in improving the quality of emergency care provided by the reviewing
practice and adopting performance improvement projects as a vehicle for

change.
To reflect contemporary practice in emergency care.

OBJECTIVES OF EMERGENCY DEPARTMENT

Primary objective of Emergency Department is to render immediate quality care

to emergency patients.
Contributory objectives are:
1. To have an understanding of survival procedures and emergency life
saving measures.
2. To provide the best clinical experience for nurses and other members of
the health care team.

PRIORITIES OF EMERGENCY MANAGEMENT

The major goals of emergency medical treatment are:

To preserve life.
To prevent deterioration before definitive treatment can be given.
To restore the patient for useful living.
GUIDELINES IN EMERGENCY DEPARTMENT
1. Attend to patient immediately for emergency measures.

2. Obtain patients data records, vital signs and refer patient to the physician on
duty.
3. For old patients, ask relatives to get OPD records in the record section.
4. Place patient in a comfortable position, maintain patients airway, provide
adequate ventilation and employ resuscitative measures when necessary.
5. Assess the patient whether or not he/she can follow command and evaluate
the size and sensitivity of the pupils and motor responses.
6. If vital signs are absent, give immediate resuscitative measures and refer
patient to the physician on duty.
a. Administer oxygen inhalation and medications as ordered.
b. If resuscitation measures failed and the doctor pronounces DOA (dead
on arrival) give POSTMORTEM CARE.
7. Assist the Doctor while examining the patient and carry out orders promptly
and accurately.
8. If patients condition needs admission, obtain informed consent.
a. Give initial medications, IVFs skin testing, forward laboratory requests, xray etc.
b. Notify ward nurse before patient is brought to the ward.
9. Record pertinent information regarding patients condition and management
in the patients chart.
10. Accompany patient to the ward and endorse properly to ward nurse.
a. Name and Diagnosis
b. Complaints and Appearance.
c. Medications and Treatments given.
d. Any special procedures.
Note: If patient is for referral to the agencies for further management, be sure to
have referral slip and proper coordination and make arrangement with the
ambulance driver. Make sure that the ambulance is properly equipped with
emergency kit.

RESPONSIBILITIES OF ER DOCTORS
1. Examine patient and write order for medications and treatment needed.
2. If resuscitative measures failed to the patient without vital signs, pronounce
patient as Dead on Arrival (DOA).

3. If patient is for admission, write and sign admitting order and notify ER nurse on
duty.
4. If patient is for surgery, write statistical orders on the patient chart for immediate
work-ups like CBC, urinalysis and any special procedures.
5. If patient is for referral to the other health facilities prepare referral slip with
proper coordination to the Referring hospital.
6. If patient is for observation advice ER nurse and give instructions.
Note: Observation of patient is good up to 12 hours only. If patient will stay for
more than twelve hours, admit patient and follow admitting procedure.
7. If patient is for discharge, instruct patient and relatives to comply with the
discharge requirement.

JOB DESCRIPTION OF THE NURSE ON DUTY

In Patient Care

a.
b.
c.
d.
e.

Plan to meet the total nursing needs of the patient.

Evaluate the effectiveness of patient care.
Promote the improvement of patient care.
Give direct nursing care to the patient
Responsible for the accurate assessments and documenting treatments and care

rendered whether it may be independent, interdependent or dependent.

f. Responsible for execution of doctors order.

In Unit Management

a. Plan for the environment conducive to the physical and spiritual well-being of the
patient.
b. Participate in the formulation, interpreting and implementing objectives and
c.
d.
e.
f.
g.
h.

policies of nursing care.

Promote good nurse-patient relationship.
Promote the improvement of nursing service in the unit.
Teach and guide all new nursing personnel in the unit.
Assist in the orientation program of the new nursing personnel in the unit.
Demonstrate new procedures and use of the new equipment in the unit.
Impart health teaching in personal hygiene to the patient and member of the
family.

DUTIES AND RESPONSIBILITIES OF THE ER NURSE ON DUTY

The continuity of nursing care is maintained throughout a 24-hour period by the
three 8-hour shifts. The ER Nurse is responsible for the individualized patient care,
placing patient in rooms and liaising with case management.
Staff Nurse: 6-2 Shift
I.

II.

Endorsement
Receive endorsement from 10-6 shift
Receive the unit , check supplies and instruments available for the ER

Department
Receive and check patients in the ER beds as well as the incoming

patients during shift transition.

Check the available room per department for admission of patient foe the

shift.
Check ER Logbook and verify if records from previous shift were returned

to the record section.

Patient Care
Give oral and IV medication as ordered.

III.

Prepare and administer intravenous therapy as ordered.

Assist in treatment and special procedure to be done for the patient.
Prepare the patient with medicine secured from supplies if indigent.
Explain the diagnostic procedures like X-Ray, ECG, Ultrasound that the

patient will be subject to.

Ward Policies
Answer telephone calls.
Make sure that only one to two companion comes with the patient in the

Ward.
Make sure that the patient or relative is informed about any procedure
prior to execution.

IV.

Proper Documentation
Check the admission documents, referral request and prescription before

patient were discharged or transferred.

Document all medical treatment and nursing intervention given to the

patient.
Document or report any untoward incident during the shift in a clean piece
of paper. Indicate the date and time of incident, people involved, actual
scenario, with the signature over printed name of the Nurse on Duty and

V.

address it to the Supervisor on duty.

Housekeeping and Maintenance
Supervise and guide the Institutional Worker assigned in the area within

the shift.
Report out of order equipment and instruments to the Charge Nurse on

duty.
The Charge Nurse should request supplies from the Central Supply Room
for ER use.

Staff Nurse: 2-10 Shift

I.

Endorsement

Receive endorsement from 6-2 shift

Receive the unit , check supplies and instruments available for the ER

Department
Receive and check patients in the ER beds as well as the incoming

patients during shift transition.

Check the available room per department for admission of patient foe the

shift.
Check ER Logbook and verify if records from previous shift were returned
to the record section.

II.

Patient Care

Give oral and IV medication as ordered.

Prepare and administer intravenous therapy as ordered.
Assist in treatment and special procedure to be done for the patient.
Prepare the patient with medicine secured from supplies if indigent.
Explain the diagnostic procedures like X-Ray, ECG, Ultrasound that the
patient will be subject to.

III.

Ward Policies

Answer telephone calls.

Make sure that only one to two companions come with the patient in the
Ward.

Make sure that the patient or relative is informed about any procedure
prior to execution.

IV.

Proper Documentation

Check the admission documents, referral request and prescription before

patient were discharged or transferred.

Document all medical treatment and nursing intervention given to the

patient.
Document or report any untoward incident during the shift in a clean piece
of paper. Indicate the date and time of incident, people involved, actual
scenario, with the signature over printed name of the Nurse on Duty and
address it to the Supervisor on duty.

V.

Housekeeping and Maintenance

Supervise and guide the Institutional Worker assigned in the area within

the shift.
Maintain the cleanliness of the ER Department.
Extend help in cleaning through dusting and scrubbing off the equipment
used like urinals, bedpans, surgical instruments, suction machines and the

likes.
Report out of order equipment and instruments to the Charge Nurse on
duty.

VI.

Supplies and Equipment

Check available instrument for procedures

Refill containers with supplies like dried or wet cotton balls soaked with

saline alcohol or betadine.

Clean instruments and gloves for autoclaving.
List supplies, instruments and equipment needed for the following day that
needs to be endorsed to the incoming 10-6 shift for requisition of the
charge nurse in the 6-2 shift.

Staff Nurse: 10-6 Shift

I.

Endorsement

Receive endorsement from 2-10 shift

Receive the unit , check supplies and instruments available for the ER

Department
Receive and check patients in the ER beds as well as the incoming

patients during shift transition.

Check the available room per department for admission of patient foe the

shift.
Check ER Logbook and verify if records from previous shift were returned
to the record section.

II.

Patient Care

Give oral and IV medication as ordered.

Prepare and administer intravenous therapy as ordered.
Assist in treatment and special procedure to be done for the patient.
Prepare the patient with medicine secured from supplies if indigent.
Explain the diagnostic procedures like X-Ray, ECG, Ultrasound that the
patient will be subject to.

III.

Ward Policies

Answer telephone calls.

Make sure that only one to two companions come with the patient in the

Ward.
Make sure that the patient or relative is informed about any procedure
prior to execution.

IV.

Proper Documentation

Check the admission documents, referral request and prescription before

patient were discharged or transferred.

Document all medical treatment and nursing intervention given to the

patient.
Document or report any untoward incident during the shift in a clean piece
of paper. Indicate the date and time of incident, people involved, actual
scenario, with the signature over printed name of the Nurse on Duty and
address it to the Supervisor on duty.

V.

Housekeeping and Maintenance

Supervise and guide the Institutional Worker assigned in the area within

the shift.
Maintain the cleanliness of the ER Department.
Extend help in cleaning through dusting and scrubbing off the equipment
used like urinals, bedpans, surgical instruments, suction machines and the

likes.
Report out of order equipment and instruments to the Charge Nurse on
duty.

VI.

Supplies and Equipment

Check available instrument for procedures

Refill containers with supplies like dried or wet cotton balls soaked with

saline alcohol or betadine.

Clean instruments and gloves for autoclaving.
List supplies, instruments and equipment needed for the following day that
needs to be endorsed to the incoming 6-2 shift for requisition of the charge
nurse on duty.

REFERRAL OF PATIENT TO OTHER HOSPITAL

Patients with condition requiring tertiary care need to be transferred to a tertiary
hospital for further management, referral form is given to the patient addressed to the

agency they are being endorsed to or their hospital of choice. Communicable Disease
cases and Psychiatric cases are transferred to a specialty hospital that caters such
conditions.

PROCUREMENT MEDICINE
Prescription should be given as soon as possible to the patient or their significant
others when medications are not available at the hospitals pharmacy. Relatives are
instructed to buy outside the hospital pharmacy whenever supplies are not available.
Emergency Room (ER) supplies used in critical cases should be replaced as soon as
possible. In case that the patient cannot afford to replace the ER supplies used, the
NOD should inform the charge nurse for the immediate replacement of the medication
used.

POLICIES REGARDING EMERGENCY SUPPLIES

1. ER cabinet must be maintained filled adequately with supplies and emergency
kit for urgent cases. It is the responsibility of the ER nurse to determine and
monitor the adequacy of equipment, instruments and supplies for the use of the
Emergency Department.
2. No instrument or articles should be brought outside the unit except if it is subject
to sterilization.
3. Borrowing instruments or articles for personal use and for use outside the unit is
not allowed.
4. If an instrument, catheter or drainage tube is attached to the patient upon
transfer to the ward, the nurse in charge must replace as soon as possible for
use.
5. The outgoing and incoming nurse on duty must have endorsement of all
equipment and articles.

DISPOSITION OF BROKEN ARTICLES

1. If in case of breakage of anything in the unit, a letter of explanation must be
written and forwarded to the proper authority.
2. There should be a replacement at once of any breakage and losses in the unit.
3. Condemning of article that cannot be use should be brought to the central supply
office for replacement.

PATIENT PRESENTATION

Patient Age Range

The Emergency Department provides health care for emergency presentations of all
triage categories of patients ranging from newborn to aged.

Presenting Conditions
A. Surgical Cases
Cases which require usual and operative procedures are catered. These include
burns, cuts, fall, fractures and vehicular accident which happened few minutes prior
to consultation. Hernia that requires emergency operation is accommodated,
however elective cases are referred OPD.
B. Pediatric Cases
Febrile patients are asked to consult at OPD except when there is possible
convulsion. Patient having LBM and vomiting that would require hydration are
treated within the Hydration Partition of the Emergency Room.
C. Medical Cases
Patients under medical cases presenting to the ER will be assessed and given
immediate care if necessary. They will be managed based on the presentation of the
illness by the Resident on Duty. Patients with condition requiring tertiary care will be
advised and assisted to transfer to a tertiary hospital for further management.
D. Obstetric and Gynecologic Cases
Obstetric and Gynecologic patients presenting to the ER will be triaged, assessed
and should be given initial treatment before referring to the Resident on Duty.
Patients who are in labor, with vaginal bleeding and the likes are assessed, given
immediate care then referred. For those coming from consultation and follow up,
they are referred to OPD. Pre-natal checkup is asked to come on their scheduled
date.

E. Medico-Legal Cases
This includes vehicular accident, mauling, stab wounds, gunshot wound, suicidal
attempt or injection of poison that happened few minutes or hours prior to
consultation.
F. Dead on Arrival (DOA)
Relatives are advised to send patient for autopsy and death certificate shall be
issued by the Medico-Legal Officer who performed the examination. In case that the

patient has no relatives available, it should be reported to the guard for proper
coordination to the police officer.

MINOR PROCEDURES AT ER
INCISION AND DRAINAGE
Surgical procedure of an inflamed and superlative wound must frequently carried out
because of infection. The cavity is usually irrigated and wound packed and allowed
to heal by granulation. The causative organism is often Staphylococcus.
Nursing Intervention for Patients undergoing I and D

1. Inform patient about the procedure and indicate how he can be helpful.
2. Obtain an informed consent.
3. Gather instruments needed in the operation:
Scalpel with balde
Curved forcep
Eye sheet
Drain
Syringe with needle
Sterile gauze
Local anesthetic
Sterile gloves
4. Position patient with operative site exposed.
5. Paint the site with antiseptic solution before surgeons apply the drape.
6. After the procedure, pressure dressing is applied to seal the wound.
7. Evaluate patients response to procedure.

EXCISION
Removal of tissue, organ or tumor from the body.
Nursing Intervention for Patient undergoing Excision
1. Inform patient about the procedure
2. Secure consent from the patient.
3. Check the order of the surgeon.
Determine the equipment needed for the procedure.

Scalpel with blade

Needle holder
Cutting needle
Silk cutting suture
Allis forceps
Metz scissors
Tissue forceps
Sterile gloves
Gauze pad
Cotton with betadine
Lidocaine
Syringe with needle

4. Position patient with operative site exposed.

5. Paint the site with antiseptic solution before surgeons apply the drape.
6. After the procedure, pressure dressing is applied to seal the wound.
7. Evaluate patients response to procedure.

SUTURING
Nursing Intervention for Patients undergoing Suturing
1. Inform patient about the procedure.
2. Secure consent form the patient.
3. Prepare the instruments needed for the procedure:
Cutting needle
Needle holder
Suture silk
Sterile 4 x 4 gauze pad

Cotton with betadine

Local anesthetic
Syringe with needle
Sterile gloves

4. Position the patient exposing the affected area.

5. Arrange the instruments in the mayo table.
6. After donning the gloves to the surgeon, assist in obtaining local anesthetic.
7. After suturing, a clean dressing is then put in place.
8. Evaluate patients response to the procedure.

REMOVAL OF FOREIGN BODY

Removal of foreign body like needle, fish hook, bone, wood or glass and the likes which
penetrates the skin and underlying tissue.
Nursing Intervention for Patient undergoing Removal of Foreign Body
1. Position the patient exposing the affected area.
2. Instruct the patient not to remove the foreign body since unskilled manipulation
produces swelling or infection which makes removal difficult.

3. The physician places marker near the foreign body before any attempt of surgical
removal is made.
4. Request for x-ray as ordered to confirm the success of the surgery.
5. Ensure x-ray examination is done before the procedure.
6. During the procedure, instruct patient to relax to prevent trauma and decrease
movement that may affect the affected surgical area.
7. Dressing is then applied after the removal of foreign body.
8. Instruction in cleaning and home management is given to the patient.