The Challenges of Triaging Rashes Over the Phone
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. This has become easier as telemedicine technology has evolved to include the ability for patients to send their providers or nurses images from their smartphones, such as the my247Healthcare app from TriageLogic. However, there are still challenges of triaging rashes over the phone that the triage nurse must be aware of.
Remember, the main goal of the triage is to determine the appropriate level of care for the patient and to make sure a serious illness is not overlooked.
Tips to handle rashes over the phone:
Prepare for rash triage: The nurse must be on the correct path as soon as they triage a rash – is this rash a sign of something serious that must be handled today or can it wait? The nurse should try to stay away from the urge to figure out the exact cause over the phone.
Set Expectations: The telephone triage nurse should 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 determine the proper outcome and select the appropriate rash protocols:
Where is the rash located?
How big is it?
Is it itchy or painful? When did it start?
Have you recently tried any new foods, soaps, detergents, lotions?
Have you had any recent immunizations?
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 those listed above, the nurse must be careful to follow the protocol as it was designed, as well as use her nursing judgment 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 an 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.
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