Ear Drainage with Tubes – Suspected Infection in Pediatric Patients Standing Order
EFFECTIVE DATE: ____________________________________________________________
APPROVED FOR USE AS A POPULATION BASED STANDING ORDER BY: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
PURPOSE: To provide a population-based standing order for pediatric patients with classic symptoms of ear drainage with tubes in place – suspected infection without complications:
- Can't move neck normally AND fever
- Unexplained bleeding AND lasts > 10 minutes or large amount (Exception: If a few drops of blood, continue with triage)
- Fever > 105 F (40.6 C) by any route OR axillary > 104 F (40 C)
- Outer ear (pinna) is red, swollen and painful
- Bone behind the ear is red, swollen and painful
- SEVERE ear pain (or inconsolable crying) AND not improved 2 hours after pain medicine
- Balance problem (e.g., walking is very unsteady or falling) AND new onset
POLICY: This standing order follows AAP recommendations in addition to Schmitt-Thompson nurse triage protocols and is to be implemented by the registered nurse as part of the telephone triage encounter.
- The RN will follow Clear Triage software assessment pathway using Schmitt-Thompson approved protocols for nurse triage to include “Ear Tubes Follow-up Call”
- The RN will screen the patient for complicated symptoms or history to include neck pain, fever, bleeding, redness, swelling, ear pain, and balance problems.
- If the patient answers “yes” to any complicating factors or history the RN will advise the patient according to the care advice found in the selected protocol. If the patient answers “no” to any complicating factors or history the RN may continue with procedure for standing order.
- Symptomatic patients without complicating factors or history will be treated with ____________________________________________________________________.
- RN will provide the patient with care advice as indicated by Schmitt-Thompson protocols in Clear Triage software to include reasons to call back i.e., Any drainage of fever that lasts more than 3 days, pain is not helped by pain medicine, child becomes worse.