A practical approach to triaging rashes over the phone
Rashes present a challenge to any healthcare professional that handles phone calls. Even though most rashes are harmless, patients and providers would like to be able to diagnose and determine exactly what is causing the rash over the phone.
Remember, the main goal of the triage is to determine the appropriate level of care for the patient and to make sure you do not miss a serious illness.
Here are some practical tips to handle rashes over the phone:
Prepare for rash triage: As soon as you triage a rash, make sure you put yourself on the correct path – is this rash a sign of something serious that must be handled today or can it wait? Try to stay away from the urge to figure out the exact cause over the phone.
Set Expectations: Tell the patient, “The doctors tell me it is difficult to diagnose rashes over the phone. I am going to go through some specialized questions to make sure the rash is not a sign of anything dangerous, and then you can see your doctor to get more details and a full treatment plan.”
Questions to help you determine the proper outcome and select the appropriate rash protocols:
Where is the rash located?
How big is it?
It is itchy or painful? When did it start?
Have you recently tried any new foods, soaps, detergents, lotions?
Have you had any recent immunizations?
Do not automatically accept the parent’s diagnosis when determining the right protocol
Warning signs that a rash may be serious
- Bloody crusts on lips
- Purple or blood colored spots or dots with or without a fever
- Bright red skin that peels off in sheets
- On antibiotic treatment with hives and fever
- Localized painful rash with fever
- Tiny water blisters or pimples on an infant under 1 month old
- Large skin blisters
While presenting challenges to even the most seasoned providers, it is not the role of the triage nurse to diagnose a rash. Equipped with special protocols designed to rule out emergent symptoms such as purple spots or dots, bright red skin that peels off in sheets or large skin blisters, the nurse must be careful to follow her protocol as it was designed, use her nursing judgement and critical thinking skills to determine the safest disposition for her patient.
More often than not, rashes are non-serious and can be treated at home safely using treatments varying from simply avoiding allergens, taking antihistamines, sparingly using cortisone creams or simply observing the rash to be sure it does not change. While giving comfort and reassurance to the caller is essential part to any good triage call, it is equally important to take the time to educate the patient of the more urgent rashes and always encourage them to contact their doctor if the rash does not clear up or worsens.
What to read next: How to Calm an Anxious Parent as a Telephone Triage Nurse