CQI 2004 Certification Prepared by: Program Manager: Steve Dewar

Destination Determination t Changes effective June 1 st ? t To be distributed t ‘Extensive or relevant history’ explained but will be contentious t Pt preference is way down the list

Stroke Criteria t Hamilton General Hospital is now a Regional Stroke Centre t (St. Joes is not) t Provincial Stroke Card will be distributed

Stroke Card criteria t Facial Droop t Unilateral Arm weakness or drift t Slurred speech t Time of onset of symptoms is clearly known and patient can be transported to Stroke Centre within 2 hours of onset t Symptoms are not resolving (TIA)

Stroke Centre Contraindications t CTAS 1, or Airway, Breathing problems t LOC <10 t hypoglycemia t Palliative care t Seizure at onset t Pediatric patients

Other CQI Issues Patient Care Issues

Blood Glucose Testing Indications t Any patient who exhibits any of the following serious symptoms: agitation, decreased LOA/LOC, syncope, confusion, seizure or symptoms of stroke

Blood Glucose Testing t Hx of diabetes is not a criteria t All stroke patients meet criteria t Most reasons for not testing are not acceptable (no time, knew it was a CVA) t HOWEVER --

CHF Protocol t Hamilton BH introduced a CHF protocol before the rest of the Province, but required BHP contact. A history of Nitro use was not required t The Standing Order was introduced by the Province, and we introduced it as written. t ADMINISTERING NITRO FOR CHF REQUIRES A HISTORY OF NITRO USE.

Monitors are not just for Chest Pain t monitor should be used for most medical complaints, including –Dizziness –Nausea and vomiting –Shortness of Breath –any SR treatment

Give ‘em the Oxygen t O2 sat is not an excusion factor for O2 t Easier to give it then justify not giving it –eg - chest wall pain

Trauma Triage Guidelines t Are in the protocol book t Please indicate on the ACR if you are specifically following the guidelines t The age for an adult for trauma centre is 16 (17 for all other pediatrics)

DNR t MOH DNR forms are acceptable only during calls for which they are written. t BH does not have a current DNR policy t If a DNR is presented on patient contact, it is acceptable initiate care and make BHP contact for consideration of pronouncement. PCP should only consider consulting about pronouncements under extenuating circumstances.

Other CQI Issues Chart Review Issues

ACR Documentation t General Appearance - still needs to be documented t SOB patients - Presence of cough and/or fever is relevant t ACR strips - we are collecting wallpaper t Final Primary Problem t ACP /PCP documentation when both at a scene

When is a Patient not a Patient? t If a person: –Denies any injury or complaint –Is not obviously injured –Did not call for help t You may considered them not to be a patient, and do not need to assess the patient. t If in doubt, Assess and Document!

When is a Patient not a Patient? t Note that persons requesting Lift Assists ARE patients. t At least one set of Vital Signs t Document if patient is being left alone t Code for Chief Complaint is 99 (other medical / trauma)

ACR Completion t As per the MOH ACR completion manual: An ACR is to be completed on calls where the crew arrives at the call scene or on all calls involving an unusual or noteworthy occurrence enroute to the scene.

Who Documents What? t ACP PRU on scene first, stays with patient t ACP PRU on scene first, hands over care t PCP transport on scene first, ACP arrives and stays with patient t PCP on scene first, ACP arrives and leaves t ACP PRU on scene first, ACP transport arrives

Peer Auditing t Goals: t Improve patient care t Improve documentation t In a peer-based, professional manner

Paramedic Response to Reviews t Your comments - constructive questions and responses - are welcome t Signature required t Dated

t What to do when you make a medication or other error? t Deliberate deviations from protocols Learning from Errors Made

t Triage when SR initiated t When is ACP canceled? Learning from Errors Made

When Errors Occur t Contact the Base Hospital office t ext t t Advise your Operations Supervisor t Advise the receiving medical staff

Other Issues?