293753955-Malaysian-Triage-Category-Mtc.pptx

MALAYSIAN TRIAGE CATEGORY (MTC) MOHAMMAD FIRDAUS ISKANDAR BIN MOHAMMAD ILIAS

OBJEKTIF •

Am

-mema -memaha hami mi peran peranan an Penolo enolong ng Pegaw egawai ai Peruba erubata tan n semas semasa a mela melaku kuk kan “triage” •

Khursus

-mengenalpas -mengenalpasti ti jenis-jenis jenis-jenis “triage” -bole -boleh h mene menent ntuk ukan an zon yang ang ber berses sesua uaia ian n deng dengan an keadaa eadaan n peny penyakit akit pesakit -dapat -dapat mengama mengamalk lkan an dan mempr memprakt aktikk ikkan an “triage” mengik mengikut ut jenis-j jenis-jenis enis yang dinyatakan

PENDAHULUAN •

Definasi •

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“Triage” berasal dari bahasa Perancis iaitu “trier ” yang membawa maksud menapis atau menyusun Cara ini digunakan untuk menilai kecederaan dan kesakitan pesakit dalam masa yang singkat untuk menetapkan priorities serta zon yang bersesuian untuk mendapatkan rawatan

SITUASI DI JAB. KECEMASAN •

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Jumlah kemasukan ke jabatan kecemasan tidak boleh diramalkan dengan tepat Hanya sebahagian tertentu daripada pesakit yang mempunyai masalah kesihatan membahayakan nyawa atau yang memerlukan perubatan segera

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Pesakit life-threatening injuries perlu dikenalpasti serta merta

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Overcrowding

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Permintaan untuk rawatan perubatan melebihi limitasi jabatan

Triage in Emergency Department •

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Designed to identify the most urgent (or potentially most serious) cases. To ensure that they receive priority treatment, followed by the less urgent cases. First-come, first-served basis

Triage officers routinely assess all patients who present for treatment to sort and prioritize them.

KLASIFIKASI TRIAGE •

Proactive

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Static

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Secondary

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Surveillance

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Definitive

Art of Triage •

Complex and dynamic process

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Mendapatkan maklumat yang berkaitan dalam masa yang singkat

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Keputusan dibuat dalam keadaan informasi yang limited 

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Keputusan dibuat berdasarkan garis panduan yang sedia ada serta menilai keadaan pesakit

Roles of Triage Officer •

Menentukan zon pesakit berdasarkan assessment terhadap pesakit •

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First aid, analgesia.

Berhubung dengan paramedic dan profession kesihatan yang lain •

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Escort patient Pass over relevant information

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Provide patient and public education where necessary 

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Documentation

Process of Triage •

Main complaint and brief history

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Vital signs

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Physical findings seen, heard, felt or smelt

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Setting the priority status of the patient

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Decision whether treatment should be started at triage

SOAP System Larry-Weed SOAP system •

S (Subjective) – main complaint and brief history

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O (Objective) – physical finding and vital signs

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A (Assessment) – setting of the priority status based on subjective and objective finding P (Plan) – preliminary diagnostic and treatment

Malaysian Triage Category •

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MTC diwujudkan untuk digunakan dalam perkhidmatan kecemasan di seluruh hospital Malaysia. Merupakan skala untuk menilai urgency  Merupakan tahap untuk menilai keberkesanan zon triage dengan pesakit (inpatient length of stay, ICU admission, mortality rate ) dan resource consumption (staff time, cost ). Memberikan analisis dan gambaran terhadap prestasi di dalam  jabatan kecemasan.

MTC Red (Critical)

Yellow (Semi Critical)

Green (Non-Critical)

CRITICAL (RED) Conditions that are threats to life (or imminent risk of deterioration) and require immediate aggressive intervention. The patient's condition is serious enough or deteriorating so rapidly that there is the potential of threat to life, or organ system failure, if not treated within 15 minutes of arrival

The potential for time-critical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinical outcome depends on treatment commencing within a few minutes of the patient's arrival in the ED

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Patients with life threatening injuries or illness which require immediate attention.

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Assessment and treatment simultaneously within 5 minutes.

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Subcategories: •

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R1 (immediate life-threatening) R2 (life-threatening)

Semi-Critical (YELLOW) The patient's condition may progress to life or limb threatening, or may lead to significant morbidity, if assessment and treatment are not commenced within thirty minutes of arrival

There is potential for adverse outcome if time-critical treatment is not commenced within thirty minutes

Human practice mandates the relief of severe discomfort or distress

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Assessment and treatment starts within 30 minutes.

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Usual presentation: •

Unable to walk but airway is secure, hemodynamically stable and on trolleys

Non-critical (green) The patient's condition may deteriorate, or adverse outcome may result, if assessment and treatment is not commenced within one hour of arrival in ED. Symptoms moderate or prolonged.

There is potential for adverse outcome if time-critical treatment is not commenced within hour

Likely to require complex work-up and consultation and/or inpatient management

Humane practice mandates the relief of discomfort or distress within one hour

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Assessment and treatment starts within 90 minutes

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Usual presentation: •

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 Airway secure, hemodynamically stable patients not in any distress and ambulant 

Subcatagories: •

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G1 (fast line) G2 (require initial management or first aid before seen by doctor) G3 (patients who can wait) G4 (triage away to primary care or another center) G5 (not seen in ED)

G1 (Fast Lane) •

Children < 2 years old

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Senior citizen > 65 years old

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Acute pain (trauma): pain score