pica protocol you do not need permission to call 911

Дата канвертавання25.04.2016
Памер25.08 Kb.


You do not need permission to call 911

Person’s name:


Location of use:




Describe how you know this person is at risk of ingesting inedible objects: (include any diagnosis, history, or description of observed behaviors such as items the person sucks on or places in his/her mouth, objects that have been found in BM, and how often pica behavior has been seen.)      
This individual’s favored objects are:      

SECTION 1: Description of Preventions

 Remove and keep the environment free of all objects that the person could put in his/her mouth.

 Observe the person at all times for putting anything in his/her mouth.



 Conduct environmental scan of every place a person could access. Instructions for scanning environment: (include how often, locations to check, and any other special instructions)      

SECTION 2: Signs and Symptoms of Pica

Most signs and symptoms of pica can be the same as constipation, aspiration, or other stomach problems.

Inedible objects found in BM

 Has refused to eat for       meals

 Refusing to eat or drink

 Abdominal pain with or without fever

 Spitting up saliva or vomiting

 A hard, protruding abdomen

Stomach is tender to touch

 Complaining of not feeling well or not wanting to get out of bed, go to work, or do the things that the person usually enjoys

Walking stooped over, if not usual for the person

 Excessive drooling in persons who normally don’t drool

 Has had no stool or only ‘small’ stool in       days (must match any timelines indicated on a Constipation protocol, if present)



SECTION 3: What to do if any signs and symptoms are observed

These are steps to take if pica episode is witnessed or if signs and symptoms of pica are observed that do not require an urgent response.

1. Contact and follow any instructions given:  Supervisor  Nurse  Physician      

2. Document incident in:  Progress notes  Incident Report  Other:      

3. Notify:  Work  Home  Family/Guardian  School  Other:      

4. Monitor BMs until object passes. Notify physician if monitoring of stools shows object has not passed after       days.

SECTION 4: Urgent Response Instructions

CALL 911 and START EMERGENCY AND FIRST AID PROCEDURES as trained, if any occur:

 Person is blue or not breathing.

 Person is wheezing and working really hard to breathe, speak, or cry.

 Person is having difficulty swallowing.

 Person appears gravely ill or you are concerned about their immediate health and safety.

 Person is severely coughing.

CALL POISON CONTROL (Phone: 1-800-222-1222) if the material swallowed might be a poison or is a medicine and follow their instructions.

CALL PHYSICIAN IMMEDIATELY if the individual has swallowed magnets, batteries or any sharp object, or has developed a hard, painful abdomen. If unable to obtain medical care within an hour, take to urgent care or emergency department.

CALL PHYSICIAN WITHIN ONE DAY for the following objects: (examples may include rocks, threads from fabric, or other items as directed by physician)      


After calling 911,

Contact and follow any instructions given:

 Supervisor  Serv. Co./Res. Spec.  Physician __________

 Nurse  Family/Guardian  Other: __________

After the person is stable, document incident in:

 Incident Report  Progress notes  Other: __________

Written by:


Pica Protocol – ODDS 2.21.2013 Page of

База данных защищена авторским правом ©shkola.of.by 2016
звярнуцца да адміністрацыі

    Галоўная старонка