Fall Recertification Session

1. Fall Recertification Session CQI

2. CQI Issues from the desk of Steve • About Transfers • Documentation Issues • Trauma Triage Guidelines and Destination Determination • Learning from misteaks

3. Transfers • Increasing number of transfers of very ill patients from EDs • Crews have expressed concern re stability of patients • Who is responsible? What should we do?

4. Medical Responsibility • You assume care of all patients you carry on behalf of Dr. Welsford, our Medical Director unless the patient is escorted by a physician or nurse

5. The sending physician is responsible for ensuring that the patient will receive adequate care during a transfer • YOU could also be responsible if you accept a patient that is obviously ill without questioning or asking for an escort • You are also responsible to ensure that that physician understands your scope of practice

6. Ask for a report re patient’s condition • Examine the patient as appropriate for the complaints • At least one set of vitals at the scene is mandatory • Document assessment findings from when assuming care • If possibly unstable - consider contacting a BHP to consult about the patient

7. Do NOT accept orders for ongoing care from sending physician or RN • Can use protocols if the patient fits parameters • Can contact a BHP and advise of wishes of sending physician

8. Contact a BHP Prior to Transfer To: • Discuss care for a patient while enroute/ receive orders for anticipated treatment • Receive orders to treat a patient as per the wishes of a sending physician • Express concerns about transferring an unstable patient

9. Cannot administer a medication, perform a procedure or accept responsibility for equipment that you are not certified to use. • Some patients are responsible for their own medications / pumps / equipment • Some sending facilities could elect to send a patient recognizing that you are not taking responsibility (ie PICC line, capped off) • It must be clear that you are not accepting responsibility

10. Documentation Issues • Cancelled calls • CTAS scores • final primary problem • the majority of patients who refuse care will seek medical attention at a later date • Paperwork left with patient and /or at hospital

11. Documentation Issues • Heart Sounds • Not a required field • ‘Normal’ is not a valid description unless you can comfortably describe each sound and identify what is abnormal • Heart sounds are relevant for VSA patients • Present or absent is sufficient • Are not required for other patients and should not be documented unless you know what you are describing

12. Trauma Triage Guidelines • Know the guidelines, and document when used • Many concerns from receiving hospitals • Destination for trauma patients • Ultimately – get the patient to the right hospital • 30 minutes is a soft guideline

13. Ask for Air /Modified Scene Response if Appropriate • If you elect to take a trauma patient to a facility other than the Trauma Centre, • Ask CACC for an air response • Document request • Document reason for destination (> 30 minutes, uncontrolled airway)

14. Destination Determination • Destination for psychiatric patients • Overdoses • Dialysis patients

15. Learning from other’s misteaks • Patient with stab wound to chest • Appears superficial • No SOB, no subQ emphysemia • Patient refuses most interventions • Trauma Centre? • ACP or PCP?

16. Learning from other’s misteaks • A 30 year-old female patient c/o abdominal pain. • Treated and released, advised to come back if her condition worsens. • Approximately 3 hours later, calls back because her pain has worsened. • Transported again to the same Emergency Department

17. Found to have an ectopic pregnancy, requires emergency surgery and almost dies. • Does not complain about her care in the Emergency Department on her first visit, despite the fact that a near-fatal condition was not diagnosed. • Does complain that the second paramedics were rude and disrespectful.

18. Walking patients • Several recent complaints • Patients with medical complaints, encouraged to walk to the stretcher • Complaints from family members • Investigations by MOH, Service Operators, Base Hospitals and Coroners.

19. Partner errors • What to do? • Your partner is acting as the primary attendant and about to make a patient care error • You believe the proposed tx not in patients best interest

20. QUESTIONS?