Policies, Procedures and Protocols

To read more about or view the complete Geriatric Emergency Department Guidelines please visit: https://www.acep.org/geriedguidelines/

In order to facilitate elderly care in the Emergency department, the guidelines strongly encourage the implementation of some policies, procedures and protocols. The following list is mostly suggestions and is non-exhaustive:

• Triage and initial evaluation: involve the family/friends as much as possible (gathering of valid informations)
• Early screening for high-risk elderly (Use a tool, for example the ISAR)
• Protocol for suspicion of elder abuse
• Sedation/Analgesia
• Delirium protocol (assessment with the CAM)
• Restraint policy (with detailed non pharmacological method of agitation management)
• DNR (information about level of care previously discussed available)
• Palliative care protocol
• Urinary catheter placement guidelines
• Falls education and reference guide
• Wound assessment and care
• Transition of care protocol (for example, a check list)
• Medication reconciliation guidelines (for example education about the BEERS criteria)

For more information or samples, click on each items.

A note on developing protocols

Here are a few tips before engaging into the protocol “Asterix mansion”:

1. Develop them in team (nurses, physician, pharmacist, OT, PT, GEM nurse)
2. Evaluate, modify, re-evaluate
3. Make it accessible (intranet, paper copies well identified)
4. Educate health professionals users
5. Monitor their uses

The key word here: creativity!

That is what I like about geriatric emergency medicine. The issues are so obvious and big, any project or idea could turn out to be a GREAT solution.