Triage Part 3: Principle of SOAP

Triage S.O.A.P principle stands for 

S: Subjective Data - Collects data about what patient is telling you.

O: Objective Data - What are you actually seeing
                                 ( Parameters, Injuries)

A: Assess - Assess the objective for objective finding

P: Plan - Establish a plan for the patient.

A typical SOAP will cover

S: Subjective Data ( Chief complaint, Pain assessment, time of onset, duration, frequency, effects to other body systems and whether self treat is done)

O: Objective data( Vital signs, GCS level, patient general appearance, physical injuries)

A: Assess

P: Plan( Plan priority status and perform point of care testing actions such as ECG, capillary blood sugar, urinalysis, urine pregnancy test, visual acuity test, x-ray) and perform necessary first aid if necessary

Triage SOAP principles is not only applied in the emergency department, but also on telephone, mass casualty situations and also at pre hospital care level. The algorithms may differ between peace time, hospital level and field level, but the SOAP principles remain unchanged. (*supported with ads*)


Next, we shall look at doing ECG and the landmarks of doing ECG

Triage- Part 2

In Singapore restructured hospitals, the triage system is Patient acuity Category ( PAC) scale as recommended by Ministry of Health  from 1st April 1999.

PAC triage system is one of the most advanced system which involves 4 categories. There are written standards or protocols for the triage process include initiation of diagnostic test e.g. ECG, selection of treatment and re evaluation of patients.

PAC Scale

PAC Scale 1:

Patients are either already in a state of cardiovascular collapse or in imminent danger of collapse and would therefore be required to be attended to without a moment's delay.

They require maximum allocation of staff and equipment resources for initial management


PAC Scale 2:

Patients are ill, non ambulant, and in various forms of severe distress. They are in stable state on cardiovascular examination and are not in danger of imminent collapse. The severity of their symptoms required very early attention, failing which early deterioration of their medical condition is likely.


PAC Scale 3:

Patients are ambulant and have acute mild to moderate symptoms. Acute treatment will result in resolution of their symptoms over time.


PAC Scale 4:

There are non emergency patients who should more approriately be  managed in the primary health care setting. They do not require immediate treatment and there is no immediate threat to life or limb.

Patient acuity status is determined after triage assessment using the principles of SOAP. SOAP principles of triage will be discussed in further details in next post.


There are other triage models which are used in disaster situations which is  START(Simple Triage and Rapid Treatment) triage flow model. (*supported with ads*)

Triage - Part 1

Triage is a very important skill for emergency nurses to pick up during their course of their nursing career as an emergency nurse. It is because triage decision making is an every day practice in the emergency department and decision made may affect the patient's timely care and outcomes.

For novice emergency nurse, the blog will introduce you to the concept of triage and what's involves in doing triage.

Note:

You are not expected to do triage without supervision

To be able to triage in ambulatory areas, the triage nurse need to be experienced and undergone in house triage officer's course or external course.

Other self learning triage course modules are available here.

Triage is defined as " the categorization of patients to determine their priorities in medical attention, treatment and disposal"

There is other definitions of triage here.

In Australia, College of emergency nursing has a position statement for triage nurse to define their role( However their triage system slightly differ from us).

Principles of triage:

1. Should be immediate and timely
2. Assessment should be adequate and accurate
3. Decisions are made based on assessment
4. Provide intervention according to acuity of condition
5. Patient satisfactionis achieved through establishment of a good rapport and support of their emotional needs.

Triage process in summary: Right patient to the right place at the right time at the right care provider

Part 2, we shall discuss the triage system used in Singapore.