Protocol for the Management of Burns in MIUs & WICs. Author s job title Professional Lead, Minor Injuries Unit Directorate

Transcription

1 Document Control Title Protocol for the Management of Burns in MIUs & WICs Author Author s job title Professional Lead, Minor Injuries Unit Directorate Department MIU Version Date Issued Status Comment / Changes / Approval 0.1 Apr 2015 Draft Initial version for consultation 0.2 Aug 2015 Draft Approved by (Clinical Director) and (Clinician) 1.0 Aug Final Approved Feb 2017 Revision Amendment to protocol, age reference under section Purpose Main Contact North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Medical Director Document Class Protocol Distribution List Senior Management Tel: Direct Dial Target Audience MIU Staff Distribution Method Trust s internal website Superseded Documents Burns Protocol V1.0 12Aug16 Issue Date Review Date August 2016 August 2019 Consulted with the following stakeholders Adult Burns Specialist Nurse Paediatric Burns Outreach Nurse ED middle Grade Review Cycle Three years Contact responsible for implementation and monitoring compliance: Professional Lead, Minor Injuries Unit Education/ training will be provided by: Professional Lead, Minor Injuries Unit Approval and Review Process Lead Clinician for Walk in Centres. Protocol for the Management of Burns V1.1 Feb16 Page 1 of 10

2 Local Archive Reference G:\Corporate Governance\Policies and Protocols Local Path MIU Filename Protocol for the Management of Burns v1.2 Feb17 Policy categories for Trust s internal website Tags for Trust s internal website (Bob) (Bob) None MIU, Protocol for the Management of Burns V1.1 Feb16 Page 2 of 10

3 CONTENTS Document Control Purpose Presenting Symptoms History Refer to protocol for history taking and clinical documentation Clinical Examination Treatment Pathway Refer Treatment Contacts References Discharge Pathway DOCUMENTATION TO BE COMPLETED BEFORE DISCHARGE ENSURE:... 7 APPENDIX A Essential Documentation for All Patients Attending Unit or Centre... 8 APPENDIX B Essential Documentation for All Patients Attending Unit or Centre... 9 APPENDIX C Competency Form Purpose This Protocol is for the use by staff employed by Northern Devon Healthcare Trust who have achieved the agreed clinical competencies to work under this protocol. The protocol is for all patients in the Walk-In Centres and for patients over two years old in the MIUs. Any child under this age must be referred to a GP. 2. Presenting Symptoms Erythema Pain Blistering Skin discolouration white / grey Mottled / blackened Exudate Loss of sensation Loss of function 3. History 3.1 Refer to protocol for history taking and clinical documentation Document a full history including: Mechanism and exposure Protocol for the Management of Burns V1.1 Feb16 Page 3 of 10

4 Time of injury First aid treatment Immersion in water post injury and for how long Analgesia taken Date of last immunisation for tetanus Relevant medical conditions, medication such as steroids, anticoagulants Allergies (to include dressings and adhesive tapes) 3.2 Clinical Examination Site of burn Size, depth, width, distinguish areas of erythema and blistering and percentage. Involved structures Swelling, inflammation Sensation over and distal to burn Capillary refill time Superficial: Erythema No blistering No loss of sensation Pain Skin in tact Superficial Partial Thickness: Salmon pink Blistering No loss of sensation Pain Blanches easily Deep Partial Thickness: Brick red or mottled in appearance Limited blanching Reduced sensation Full Thickness: White, brown, black or leathery appearance Loss of sensation No pain Protocol for the Management of Burns V1.1 Feb16 Page 4 of 10

5 4. Treatment Pathway 4.1 Refer All full thickness burns Circumferential burns or burns involving major joints Burns to the genitalia or perineum, face, neck or hands Electrical and chemical burns or cold injury burns Inhalation Injury Co-existing medical illness which may influence healing Co-existing trauma Co-existing psychiatric illness Burns not healed in 2 weeks Unwell / febrile patients with a burn Changes in burn wound appearance Signs of infection or concerns regarding toxic shock syndrome Any burn you do not feel confident to manage Suspected non-accidental injury or neglect (e.g. sunburn) Suspected safeguarding concerns (adult and child) Adults refer burns > 3% (classified as referral as 16+ years) Children refers burns > 1% as Bristol Guidelines. 4.2 Treatment Deep partial / full thickness burns Cool and immerse in cool water for at least 20 minutes Do not use ice Remove any jewellery Remove clothing, if stuck do not remove Cover with cling-film Refer to emergency department, plastics as appropriate Superficial / partial thickness burns Immerse / irrigate with cool water for 20 minutes Cooling can be effective for up to 3 hours Apply burn gel pads after cooling if available and required or cling film Do not use ice Leave adherent substances such as bitumen or wax, do not remove them Administer analgesia as PGD Only leave flat blisters < 2cm in tact Debride other blisters Clean normal saline Dress with non-adhesive dressing Check tetanus status refer to PGD if required Protocol for the Management of Burns V1.1 Feb16 Page 5 of 10

6 Advise OTC analgesia or analgesia to trace home as per PGD Review all burns in 24 hours 5. Contacts Adult Burns Referrals 16+ years Refer to Plastics SHO on call at Southmead Hospital on bleep 1311 Southmead Hospital Children Bristol Royal Hospital for Children Karen Highway Adult Burns Specialist Nurse, bleep 1380 Ishbel Penn Paediatric Burns Outreach Nurse, Derriford Hospital Facility for <5% for children and < 10% adults or bleep plastics SHO on call. 6. References NICE Clinical Knowledge Summaries (May 2013) Consent Policy V3.3(2014) NDHCT Guidelines (2012) NDHCT National Burn Care Referral Guidance (version 1 Feb2012) Patient Group Direction Policy (2013) 7. Discharge Pathway 7.1 DOCUMENTATION TO BE COMPLETED - Clinical treatment record as per Documentation and record keeping policies. - Copy of clinical treatment record to General Practitioner; to be sent to surgery as per Record keeping policy. - For patients being transferred to secondary care, ensure a copy of the clinical treatment record is sent with patient. A copy will also be sent to surgery in the normal manner. Protocol for the Management of Burns V1.1 Feb16 Page 6 of 10

7 - For patients seeing their General Practitioner in next 24 hours ensure patient is given a copy of the clinical treatment record to take with them. A copy will also be sent to surgery in the normal manner. 7.2 BEFORE DISCHARGE ENSURE: - Those patients who have been referred for further acute intervention has appropriate transport to meet their needs, all relevant treatment has been prescribed and administered and correct information and documentation is given to the patient. - The patient understands that if condition deteriorates or they have further concerns they should seek further advice. - The patient demonstrates understanding of advice given during consultation. - The patient has been provided with written advice leaflet to re-enforce advice given during consultation. - The patient demonstrates an understanding of how to manage subsequent problems. Protocol for the Management of Burns V1.1 Feb16 Page 7 of 10

8 APPENDIX A Essential Documentation for All Patients Attending Unit or Centre Adults Consent Gain consent to be seen by a nurse practitioner Gain consent for treatment and sharing information Clinical Presentation If unwell assess for: - Airway - Breathing - Circulation - Disability - Exposure Document a full set of observations including neurological observations including Glasgow coma score if applicable. Record EWS: if 7 or above arrange immediate transfer to secondary care. Document pain score using numeric rating scale. For cognitively impaired patients document any signs of pain (e.g. grimaces or distress). Safeguarding - Assess for mental capacity and if person is a vulnerable adult. - Assess for learning disability and whether patient has a hospital passport in place. - Assess for risk of domestic abuse. - Assess falls risk. Complete falls referral if applicable. - Document names of persons accompanying patient. Protocol for the Management of Burns V1.1 Feb16 Page 8 of 10

9 APPENDIX B Essential Documentation for All Patients Attending Unit or Centre Child and Young Persons under 18 Years Old Consent Gain consent to be seen by a nurse practitioner Gain consent for treatment and sharing information Assess and document Gillick competency according to Fraser guideline if applicable. Document the name of persons accompanying patient. Clinical Presentation If unwell assess for: - Airway - Breathing - Circulation - Disability - Exposure Record PEWS: if any one parameter is triggered transfer to secondary care or seek advice from medical practitioner. Use guideline Traffic Light System (NICE) 2013 if applicable. Use guideline Feverish Illness (NICE) 2013 if applicable. Document pain score using FLACC, Wong Baker Faces or numeric rating scale. Safeguarding - Assess safeguarding - Assess for domestic abuse in the home - Assess for learning disability DOCUMENT ALL FINDINGS IN THE CLINICAL TREATMENT RECORD AND ACT ON THEM FOLLOWING NDHCT GUIDELINES. Protocol for the Management of Burns V1.1 Feb16 Page 9 of 10

10 APPENDIX C Competency Form Protocol for the Management of Burns Operational from April 2016 and expires end of February 2019 The registered health professional named below, being employees of Northern Devon Healthcare Trust based at. have received training and are competent to operate under this protocol NAME (please print) PROFESSIONAL TITLE SIGNATURE AUTHORISING MANAGER (please print) MANAGER S SIGNATURE DATE Keep original with the authorising manager and send a copy to:, Northern Devon Healthcare Trust NHS, Raleigh Park, Barnstaple, Devon EX31 4JB Protocol for the Management of Burns V1.1 Feb16 Page 10 of 10