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Nursing Manual Protocols: General information Protocols are written instructions for staff to follow when persons have specific, chronic, or frequent problems from a condition that may or may not have a predictable outcome. Protocols are usually written regarding a person's medical condition that requires staff monitoring or interventions such as seizures or constipation. Protocols give guidance to the staff on signs and symptoms to look for, when and how to intervene and who to contact if further problems occur.Protocols are sometimes confused with procedures. Procedures are task oriented. They provide step-by-step instruction on how to do a task. For example: "How to Administer a Gastrostomy Feeding", "How to Assist Persons' with Dysphagia in Eating." Protocols are problem oriented. They explain what to do about a problem. They contain a description of the problem, when and how to intervene, when to become concerned and who to contact if further problems occur. Protocols need to be specific to the setting and the individual. For instance, if three people in the same home have seizure protocols, they would all read slightly different. There will be similarities, such as basic safety guidelines and charting requirements, but each should have an individual seizure description, and will vary on when to become concerned and what to do. Protocols need to be specified to the setting. A person's seizure protocol for the residential site would read slightly different than their seizure protocol for the vocational site. Protocols need to identify who wrote them. If a person has an RN involved in their care, the nurse would usually author all protocols involving health conditions. Occasionally, a physician will write directions on how to deal with a specific health issue. These directions should be included in the protocol, but usually are inadequate as a complete protocol. If the person does not require a nurse, the protocols would be written by someone in the agency who is knowledgeable about the condition and the person. This is likely to be the House Manager, Program Director, etc. Protocols need to be dated and reviewed periodically. As the person's condition changes, the protocol should be updated or abandoned. When orders are changed, the protocol may need to be revised, so that the current orders are reflected in the protocols. For instance, if a person's original constipation protocol stated to administer a Dulcolax suppository on day two of no stool and the physician discontinued the Dulcolax suppository, the protocol would need to be revised. Any changes made to the protocol need to be initialed and dated. |
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