1. Non Emergency Transport (NET) What you need to know! START This ePresentation will take you approximately 25 minutes to complete

2. This training package is primarily for nurses however leaders and unit clerks will find much of the content relevant to support their role in patient transport. Page 1 of 39 Next > < Prev

3. Learning Objectives By the end of this learning session you will have met the following learning objectives: You will know… Key decisions for patient transport between hospitals Locating and using the decision algorithm and user guide for Patient Transport Scope of practice for NET attendants and EMS paramedics Why paramedics should NOT be used as escorts How to book transportation How to answer key billing questions for patients How the service contract with Voyageur protects you and your patient Your accountabilities How to manage complaints and who to contact when you need help Page 1 of 39 Next > < Prev

4. Page 2 of 39 Why are we using Non Emergency Transport? CBC News: “an 87 year old Toronto woman dies after waiting 3 hours for an ambulance... Feb, 1912, http://www.cbc.ca/news/canada/story/1912/02 /12/ambulance-delay.html Ambulances need to be available in the community for work only they can do. Next > < Prev

5. How does this affect you? EMS is under pressure to respond to emergency calls and is having to further withdraw from providing non-emergency hospital transfer services South West LHIN Hospitals have hired Voyageur as the NET for the region This means that health care workers must make important decisions when patient transport is needed These decisions/actions are guided by a standardized algorithm and include but are not limited to: Selecting either EMS or Voyageur Determining the appropriate escort Choosing a vehicle; i.e. stretcher, wheelchair or taxi when Voyageur is used Preparing the patient for transport Page 3 of 39 Next > < Prev

6. The decision algorithm The decision algorithm guides you through three key decisions in the order in which they need to be made. It is standard across the region. It walks you through key steps for making transport and escort decisions for your patients, both medical and mental health populations. It gives you tips on how to obtain a quick response from EMS when your patient needs emergency transport. If properly followed, this guide assures you have done due diligence when making transport decisions and arrangements. Page 4 of 39 Next > < Prev

7. Decision 1?Decision 2?Decision 3? Page 5 of 39 Click on Decision 1 box to reveal the question for the first decision you will have to make.

8. Does this transfer require an ambulance or NET (e.g. Voyageur)? Decision 2 Decision 3 Page 5 of 39 Click on Decision 2 box to reveal the question for the second decision you will have to make.

9. Does this transfer require an ambulance or NET (e.g. Voyageur)? Does this patient require an escort? And if so, what kind? Decision 3 Page 5 of 39 Click on Decision 3 box to reveal the question for the third decision you will have to make.

10. Does this transfer require an ambulance or NET? Does this patient require an escort? If so, what kind? What type of NET vehicle does the patient need? Page 5 of 39 Next > < Prev Click Next to continue.

11. The Ambulance Act states that -"ambulance" means a conveyance used or intended to be used for the transportation of persons who: a) have suffered a trauma or an acute onset of illness either of which could endanger their life, limb or function or b) have been judged by a physician or a health care provider designated by a physician to be in an unstable medical condition AND require while being transported, the care of a physician, nurse, other health care provider, emergency medical attendant or paramedic, AND require the use of a stretcher; Decision 1 Does this transfer require an ambulance or NET (e.g. Voyageur)? Next > < Prev Page 6 of 39

12. First decision to be made - Does the patient meet the criteria of the ambulance act? If Yes - the patient requires an ambulance with an appropriate hospital escort If No, the patient may go via Non Emergency Transport (NET - Voyageur) with or without an escort depending on care needs Decision 1 Does this transfer require an ambulance or NET (e.g. Voyageur)? Next > < Prev Page 7 of 39

13. Decision 1 EMS or NET (Voyageur) Case Examples The following case examples have been designed to illustrate common situations. They are not intended to cover every situation you may come across These case examples focus on the Decision 1 (EMS or NET decision). We recognize that escort decisions are often done simultaneously however for learning purposes they will be managed in two separate sections in this module. A picture of the Decision 1 element of the algorithm has been provided for illustration. Before proceeding we recommend you have a copy of the algorithm to work with. For a full view of the algorithm click here. Page 8 of 39 Next > < Prev

14. A patient is needing transport to a higher level of care, their vitals continue to be of concern and they are at high risk of decompensating. Decision 1 Case Example 1 EMS NET (e.g. Voyageur) < Prev Page 9 of 39 Does this patient require EMS or NET?

15. Decision 1 Case Example 1 EMS NET Submit Page 9 of 39 A patient is needing transport to a higher level of care, their vitals continue to be of concern and they are at high risk of decompensating. Does this patient require EMS or NET?

16. Decision 1 Case Example 1 EMS NET Submit Page 9 of 39 A patient is needing transport to a higher level of care, their vitals continue to be of concern and they are at high risk of decompensating. Does this patient require EMS or NET?

17. Decision 1 Case Example 1 Answer: This patient needs EMS Unstable vitals and needing a higher level of care would qualify this a transfer by Ambulance. This qualifies as an emergency transfer. Refer to the yellow caution box on the algorithm. Next > < Prev Page 9 of 39 A patient is needing transport to a higher level of care, their vitals continue to be of concern and they are at high risk of decompensating. Does this patient require EMS or NET?

18. Decision 1 Case Example 1 Next > < Prev Page 9 of 39 Answer: This patient needs EMS Unstable vitals and needing a higher level of care would qualify this a transfer by Ambulance. This qualifies as an emergency transfer. Refer to the yellow caution box on the algorithm. A patient is needing transport to a higher level of care, their vitals continue to be of concern and they are at high risk of decompensating. Does this patient require EMS or NET?

19. Decision 1 Case Example 2 EMS NET < Prev Page 10 of 39 A patient needs to be immediately transferred to a higher level of care for an urgent CT scan. Vitals have been within normal range. Risk of decompensating is low. What type of vehicle would you choose?

20. Decision 1 Case Example 2 EMS NET Page 10 of 39 Submit A patient needs to be immediately transferred to a higher level of care for an urgent CT scan. Vitals have been within normal range. Risk of decompensating is low. What type of vehicle would you choose?

21. Decision 1 Case Example 2 EMS NET Page 10 of 39 Submit A patient needs to be immediately transferred to a higher level of care for an urgent CT scan. Vitals have been within normal range. Risk of decompensating is low. What type of vehicle would you choose?

22. Decision 1 Case Example 2 Answer: NET is the correct choice The patient does not qualify for EMS as the patient is not critically ill - life or limb is not threatened and does not need emergency transport. Next > < Prev Page 10 of 39 A patient needs to be immediately transferred to a higher level of care for an urgent CT scan. Vitals have been within normal range. Risk of decompensating is low. What type of vehicle would you choose?

23. Decision 1 Case Example 2 Answer: NET is the correct choice The patient does not qualify for EMS as the patient is not critically ill - life or limb is not threatened and does not need emergency transport. Next > < Prev Page 10 of 39 A patient needs to be immediately transferred to a higher level of care for an urgent CT scan. Vitals have been within normal range. Risk of decompensating is low. What type of vehicle would you choose?

24. Decision 1 Case Example 3 EMS NET (e.g. Voyageur) < Prev Page 11 of 39 A patient is needing transfer to a higher level of care for emergency surgery. The accepting facility is waiting for the patient to arrive and is planning immediate surgical intervention. The patient's vitals are stable however the patient is at high risk of losing life limb or function, or high risk of deteriorating. What type of transport do you ask for?

25. Decision 1 Case Example 3 EMS NET Submit Page 11 of 39 A patient is needing transfer to a higher level of care for emergency surgery. The accepting facility is waiting for the patient to arrive and is planning immediate surgical intervention. The patient's vitals are stable however the patient is at high risk of losing life limb or function, or high risk of deteriorating. What type of transport do you ask for?

26. Decision 1 Case Example 3 EMS NET Submit Page 11 of 39 A patient is needing transfer to a higher level of care for emergency surgery. The accepting facility is waiting for the patient to arrive and is planning immediate surgical intervention. The patient's vitals are stable however the patient is at high risk of losing life limb or function, or high risk of deteriorating. What type of transport do you ask for?

27. Decision 1 Case Example 3 Answer: EMS is the correct choice Although the patient is stable they are at high risk and a surgical team is waiting for them for emergency surgery. This qualifies as an emergency transfer. Refer to the yellow caution box on the algorithm. Next > < Prev Page 11 of 39 A patient is needing transfer to a higher level of care for emergency surgery. The accepting facility is waiting for the patient to arrive and is planning immediate surgical intervention. The patient's vitals are stable however the patient is at high risk of losing life limb or function, or high risk of deteriorating. What type of transport do you ask for?

28. Answer: EMS is the correct choice Although the patient is stable they are at high risk and a surgical team is waiting for them for emergency surgery. This qualifies as an emergency transfer. Refer to the yellow caution box on the algorithm. Decision 1 Case Example 3 Next > < Prev Page 11 of 39 A patient is needing transfer to a higher level of care for emergency surgery. The accepting facility is waiting for the patient to arrive and is planning immediate surgical intervention. The patient's vitals are stable however the patient is at high risk of losing life limb or function, or high risk of deteriorating. What type of transport do you ask for?

29. Decision 1 Case Example 4 EMS NET (e.g. Voyageur) < Prev Page 12 of 39 A patient needs transfer to a higher level of care for urgent surgery the next day. The patient's condition is stable however they require a higher level of care within the next 24 to 48 hrs. What type of transport do you ask for?

30. Decision 1 Case Example 4 EMS NET (e.g. Voyageur) Page 12 of 39 Submit A patient needs transfer to a higher level of care for urgent surgery the next day. The patient's conditions is stable however they require a higher level of care within the next 24 to 48 hrs. What type of transport do you ask for?

31. Decision 1 Case Example 4 EMS NET (e.g. Voyageur) Page 12 of 39 Submit A patient needs transfer to a higher level of care for urgent surgery the next day. The patient's conditions is stable however they require a higher level of care within the next 24 to 48 hrs. What type of transport do you ask for?

32. Decision 1 Case Example 4 Answer: NET is the correct choice The patient is not critical or requiring emergency interventions. They do NOT require EMS. However, due to their requirement for "a higher level of care" an escort may be considered. Next > < Prev Page 12 of 39 A patient needs transfer to a higher level of care for urgent surgery the next day. The patient's conditions is stable however they require a higher level of care within the next 24 to 48 hrs. What type of transport do you ask for?

33. Decision 1 Case Example 4 Answer: NET is the correct choice The patient is not critical or requiring emergency interventions. They do NOT require EMS. However, due to their requirement for "a higher level of care" an escort may be considered. Next > < Prev Page 12 of 39 A patient needs transfer to a higher level of care for urgent surgery the next day. The patient's conditions is stable however they require a higher level of care within the next 24 to 48 hrs. What type of transport do you ask for?

34. Decision 1 Case Example 5 EMS NET (e.g. Voyageur) < Prev Page 13 of 39 A Mental Health (MH) patient requires transport to a higher level of care facility for MH treatment. The patient has no medical condition - however the patient is on a Form 1, the patient is combative and of risk to themselves. Would you select EMS or NET?

35. Decision 1 Case Example 5 EMS NET (e.g. Voyageur) Page 13 of 39 Submit A Mental Health (MH) patient requires transport to a higher level of care facility for MH treatment. The patient has no medical condition - however the patient is on a Form 1, the patient is combative and of risk to themselves Would you select EMS or NET?

36. Decision 1 Case Example 5 EMS NET (e.g. Voyageur) Page 13 of 39 Submit A Mental Health (MH) patient requires transport to a higher level of care facility for MH treatment. The patient has no medical condition - however the patient is on a Form 1, the patient is combative and of risk to themselves Would you select EMS or NET?

37. Decision 1 Case Example 5 Answer: NET is the correct choice The patient does not have an unstable medical condition and thus is not considered under the Ambulance Act as needing an ambulance. NET (e.g. Voyageur) with the appropriate escort will be able to move this patient safely and quickly. Note: Patients formed under the Mental Health Act often require an escort. Follow the Mental Health Algorithm to determine the need for an appropriate escort. Next > < Prev Page 13 of 39 A Mental Health (MH) patient requires transport to a higher level of care facility for MH treatment. The patient has no medical condition - however the patient is on a Form 1. Would you select EMS or NET?

38. Decision 1 Case Example 5 Answer: NET is the correct choice The patient does not have an unstable medical condition and thus is not considered under the Ambulance Act as needing an ambulance. NET (e.g. Voyageur) with the appropriate escort will be able to move this patient safely and quickly. Note: Patients formed under the Mental Health Act often require an escort. Follow the Mental Health Algorithm to determine the need for an appropriate escort.. Next > < Prev Page 13 of 39 A Mental Health (MH) patient requires transport to a higher level of care facility for MH treatment. The patient has no medical condition - however the patient is on a Form 1. Would you select EMS or NET?

39. Decision 1 Case Example 6 Yes No < Prev Page 14 of 39 A patient requires transport to another hospital for the next part of their care. The patient is on IV meds that cannot be discontinued. The patient is stable. You do not have an Regulated Health Professional escort readily available to go with the patient. Should you call EMS to take this patient?

40. Decision 1 Case Example 6 Yes No Page 14 of 39 Submit A patient requires transport to another hospital for the next part of their care. The patient is on IV meds that cannot be discontinued. The patient is stable. You do not have an Regulated Health Professional escort readily available to go with the patient. Should you call EMS to take this patient?

41. Decision 1 Case Example 6 Yes No Page 14 of 39 Submit A patient requires transport to another hospital for the next part of their care. The patient is on IV meds that cannot be discontinued. The patient is stable. You do not have an Regulated Health Professional escort readily available to go with the patient. Should you call EMS to take this patient?

42. Decision 1 Case Example 6 Answer: NO is the correct choice Ambulance criteria are unmet and Paramedics/EMS is not an appropriate alternative when the patient does not require emergency transport. You will need to find an appropriate Regulated Health Professional escort to support this transfer. Next > < Prev Page 14 of 39 A patient requires transport to another hospital for the next part of their care. The patient is on IV meds that cannot be discontinued. The patient is stable. You do not have an Regulated Health Professional escort readily available to go with the patient. Should you call EMS to take this patient?

43. Decision 1 Case Example 6 Answer: NO is the correct choice Ambulance criteria are unmet and Paramedics/EMS is not an appropriate alternative when the patient does not require emergency transport. You will need to find an appropriate Regulated Health Professional escort to support this transfer. Next > < Prev Page 14 of 39 A patient requires transport to another hospital for the next part of their care. The patient is on IV meds that cannot be discontinued. The patient is stable. You do not have an Regulated Health Professional escort readily available to go with the patient. Should you call EMS to take this patient?

44. Decision 1 Case Example 7 EMS without Regulated Health Professional NET with Regulated Health Professional EMS with Regulated Health Professional < Prev Page 15 of 39 A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

45. Decision 1 Case Example 7 Page 15 of 39 Submit EMS without Regulated Health Professional NET with Regulated Health Professional EMS with Regulated Health Professional A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

46. Decision 1 Case Example 7 Page 15 of 39 Submit EMS without Regulated Health Professional NET with Regulated Health Professional EMS with Regulated Health Professional A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

47. Decision 1 Case Example 7 Page 15 of 39 Submit EMS without Regulated Health Professional NET with Regulated Health Professional EMS with Regulated Health Professional A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

48. Decision 1 Case Example 7 Answer: EMS with a Regulated Health Professional is the correct choice You need to send an escort. This patient requires EMS and your hospital is required to provide an appropriately trained Regulated Health Professional to be responsible for the care of your patient until handoff at the receiving site. The paramedics will assist the escort but all care decisions will be determined by the hospital escort and MRP. Next > < Prev Page 15 of 39 A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

49. Decision 1 Case Example 7 Answer: EMS with a Regulated Health Professional is the correct choice You need to send an escort. This patient requires EMS and your hospital is required to provide an appropriately trained Regulated Health Professional to be responsible for the care of your patient until handoff at the receiving site. The paramedics will assist the escort but all care decisions will be determined by the hospital escort and MRP. Next > < Prev Page 15 of 39 A patient requires emergency transport to a higher level of care. Vitals are unstable and patient has a high risk of decompensating. The patient is on IV meds and is intubated. Would you select EMS or NET?

50. Decision 1 Case Example 8 Call Voyageur and ignore the order Review the Algorithm with the physician to determine if ambulance criteria are met Call EMS as per order < Prev Page 16 of 39 The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take?

51. Decision 1 Case Example 8 Page 16 of 39 Submit Call Voyageur and ignore the order Review the Algorithm with the physician to determine if ambulance criteria are met Call EMS as per order The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take?

52. Decision 1 Case Example 8 Page 16 of 39 Submit Call Voyageur and ignore the order Review the Algorithm with the physician to determine if ambulance criteria are met Call EMS as per order The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take?

53. Decision 1 Case Example 8 Page 16 of 39 Submit Call Voyageur and ignore the order Review the Algorithm with the physician to determine if ambulance criteria are met Call EMS as per order The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take?

54. Decision 1 Case Example 8 Answer: Review the Algorithm with the physician to determine if ambulance criteria are met is the correct choice. Review the Algorithm with the physician and determine if the patient meets the criteria for EMS. Let the physician know that there may be a delay with EMS and that Voyageur is a safe option. Engage your leader to help with additional education for the medical team when needed. Next > < Prev Page 16 of 39 The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take?

55. Decision 1 Case Example 8 Answer: Next > < Prev Page 16 of 39 The patient's admitting physician has written an order "transport by ambulance". The patient does not meet the criteria for an ambulance. You know that to honour the order will result in a delay of transfer. Which of the following actions should you take? Review the Algorithm with the physician to determine if ambulance criteria are met is the correct choice. Review the Algorithm with the physician and determine if the patient meets the criteria for EMS. Let the physician know that there may be a delay with EMS and that Voyageur is a safe option. Engage your leader to help with additional education for the medical team when needed.

56. Decision 1 Case Example 9 Yes No < Prev Page 17 of 39 You have a patient who needs to be transferred within 45 - 90 minutes. When you call Voyageur they inform you that they can't get a vehicle there for 3 hours. If Voyageur is unable to come in the time needed may I call another company?

57. Decision 1 Case Example 9 Yes No Page 17 of 39 Submit You have a patient who needs to be transferred within 45 - 90 minutes. When you call Voyageur they inform you that they can't get a vehicle there for 3 hours. If Voyageur is unable to come in the time needed may I call another company?

58. Decision 1 Case Example 9 Yes No Page 17 of 39 Submit You have a patient who needs to be transferred within 45 - 90 minutes. When you call Voyageur they inform you that they can't get a vehicle there for 3 hours. If Voyageur is unable to come in the time needed may I call another company?

59. Decision 1 Case Example 9 Answer: Next > < Prev Page 17 of 39 You have a patient who needs to be transferred within 45 - 90 minutes. When you call Voyageur they inform you that they can't get a vehicle there for 3 hours. If Voyageur is unable to come in the time needed may I call another company? NO is the correct choice When Voyageur is not able to meet the timelines you must engage your immediate leader. Your leader will need to investigate why Voyageur was unable to meet the timeline.

60. Decision 1 Case Example 9 Answer: NO is the correct choice When Voyageur is not able to meet the timelines you must engage your immediate leader. Your leader will need to investigate why Voyageur was unable to meet the timeline. Next > < Prev Page 17 of 39 You have a patient who needs to be transferred within 45 - 90 minutes. When you call Voyageur they inform you that they can't get a vehicle there for 3 hours. If Voyageur is unable to come in the time needed may I call another company?

61. Decision 2 Escort Selection? Before learning about Decision 2 -Escort selection, it is important that you first understand Voyageur training (stretcher/wheelchair attendant) and the scope of practice for Paramedics. Next > < Prev Page 18 of 39

62. Decision 2 Escort Selection? Voyageur Attendant scope of practice Stretcher Services Stretcher vehicles are staffed with two attendants Attendants are trained in First Responder (can provide CPR, basic airway management, O2 maintenance, and vital sign monitoring) Attendants are also trained in Non Violent Crisis Intervention, Activities of Daily Living (ADL) and gentle persuasion ADL includes: assist with transfer, assist with toileting and can empty a Foley catheter or established Colostomy bag, open a sandwich pack, assist with medications (can only remind and hand over for self administration) Attendants also are required to practice standards for infection control, incident reporting, lifting, privacy, and many others - for more information review the user guide - standards appendix Next > < Prev Page 19 of 39

63. Decision 2 Escort Selection? Page 20 of 39 Next > < Prev Voyageur Attendant scope of practice Wheelchair Services Each vehicle is staffed with only a single driver. The driver is trained in: Activities of Daily Living Gentle persuasion Non Violent Crisis Intervention The will provide door to door assistance They are not able to provide direct oversight as they will be driving and unable to monitor the patient Attendants also are required to practice standards for infection control, incident reporting, lifting, privacy, and many others - for more information review the user guide - standards appendix

64. Decision 2 Escort Selection? EMS Paramedics are not to be used as escorts for patients who have been admitted to hospital or to an ED. Here's why: The MRP for a patient admitted to hospital is the hospital physician and the care team Paramedics may not assume care for a patient admitted to a hospital or an emergency department Paramedics receive their directions from a Regional Base Hospital physician and are not able to accept or carry out orders from a non Base Hospital physician unless that physician assumes full care and accompanies the patient Paramedics are not regulated health professionals Paramedics are not certified to practice independently outside of a certified ambulance For more details please see the user guide located on your hospital intranet site Page 21 of 39 Next > < Prev

65. Decision 2 Does your patient require an escort? Your patient assessment needs to consider the care needs of the patient during the entire time away. Because your patient is off the unit and "out of sight" it is even more important that you anticipate for the patient's comfort and care needs for the number of hours the patient will be traveling and waiting for treatment, diagnostics or admission. If care needs are anticipated, the escort must have the knowledge and skill to carry out all care needs as required. Regardless if there is an escort or not it is the responsibility of the primary nurse at the sending hospital to prepare for all patient care needs ( i.e. medical & personal supplies, medications, meals and or ambulatory, vision and hearing aids) for the anticipated duration of the transport including wait time and return transport if applicable. Page 21 of 39 Next > < Prev

66. Decision 2 Escort Selection Case examples The following case examples have been designed to illustrate some situations. The are not intended to cover every situation you may come across. For a better understanding of escort decisions please reference the User Guide section - Patient Transportation Assessment, Documentation and Escorts. Page 23 of 39 Next > < Prev For StaffFor Leaders

67. Decision 2 Case Example 1 Yes No < Prev Page 24 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 1 - Do you require an escort?

68. Decision 2 Case Example 1 Yes No Submit Page 24 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 1 - Do you require an escort?

69. Decision 2 Case Example 1 Yes No Submit Page 24 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 1 - Do you require an escort?

70. Decision 2 Case Example 1 Answer: YES is the correct choice The escort must have the knowledge and judgment to manage the IV and care interventions. Next > < Prev Page 24 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 1 - Do you require an escort?

71. Decision 2 Case Example 1 Answer: YES is the correct choice The escort must have the knowledge and judgment to manage the IV and care interventions. Next > < Prev Page 24 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 1 - Do you require an escort?

72. Decision 2 Case Example 1a Yes No < Prev Page 25 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 2 - What if we can't find an escort, may I call EMS?

73. Decision 2 Case Example 1a Yes No Page 25 of 39 Submit A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 2 - What if we can't find an escort, may I call EMS?

74. Decision 2 Case Example 1a Yes No Page 25 of 39 Submit A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 2 - What if we can't find an escort, may I call EMS?

75. Decision 2 Case Example 1a Answer: No is the correct choice The patient does not meet the criteria for an ambulance and EMS/Paramedics may not assume care for a patient that has an MRP. Remember, the most responsible MRP for this patient are the sending physician and the care team. You may need to work with your leader to help find an appropriate Regulated Health Professional escort with the knowledge and skill to care for your patient. Next > < Prev Page 25 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 2 - What if we can't find an escort, may I call EMS?

76. Decision 2 Case Example 1a Answer: No is the correct choice The patient does not meet the criteria for an ambulance and EMS/Paramedics may not assume care for a patient that has an MRP. Remember, the most responsible MRP for this patient are the sending physician and the care team. You may need to work with your leader to help find an appropriate Regulated Health Professional escort with the knowledge and skill to care for your patient. Next > < Prev Page 25 of 39 A patient is being transferred to a higher level of care for admission. The patient does not meet the criteria for an ambulance. The patient is on continuous IV medication. Part 2 - What if we can't find an escort, may I call EMS?

77. Decision 2 Case Example 2 Yes No < Prev Page 26 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient has been medicated. Do you need to send an escort?

78. Decision 2 Case Example 2 Yes No Submit Page 26 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient has been medicated. Do you need to send an escort?

79. Decision 2 Case Example 2 Yes No Submit Page 26 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient has been medicated. Do you need to send an escort?

80. Decision 2 Case Example 2 Answer: YES is the correct choice Because the patient is medicated you must provide an escort with the judgment and knowledge to manage this patient. You may need a second escort such as security/police if safety is a concern. You must send the original copy of the Form 1 when transferring the patient. Next > < Prev Page 26 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient has been medicated. Do you need to send an escort?

81. Decision 2 Case Example 2 Answer: Next > < Prev Page 26 of 39 YES is the correct choice Because the patient is medicated you must provide an escort with the judgment and knowledge to manage this patient. You may need a second escort such as security/police if safety is a concern. You must send the original copy of the Form 1 when transferring the patient. You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient has been medicated. Do you need to send an escort?

82. Decision 2 Case Example 3 Yes No < Prev Page 27 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 1 - Do you need an escort?

83. Decision 2 Case Example 3 Yes No Submit Page 27 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 1 - Do you need an escort?

84. Decision 2 Case Example 3 Yes No Submit Page 27 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 1 - Do you need an escort?

85. Decision 2 Case Example 3 Answer: YES is the correct choice The patient is combative, therefore an escort is required. The MRP and care team are ultimately responsible for this patient however because there is no medical requirement for a Regulated Health Professional, an alternate hospital escort with the skill and ability may be selected e.g. security or orderly with MH experience or police if available. Next > < Prev Page 27 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 1 - Do you need an escort?

86. Decision 2 Case Example 3 Answer: YES is the correct choice The patient is combative, therefore an escort is required. The MRP and care team are ultimately responsible for this patient however because there is no medical requirement for a Regulated Health Professional, an alternate hospital escort with the skill and ability may be selected e.g. security or orderly with MH experience or police if available. Next > < Prev Page 27 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 1 - Do you need an escort?

87. Decision 2 Case Example 3a Yes No < Prev Page 28 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 2 - What if the patient is compliant with family, can I send the patient in a family vehicle instead?

88. Decision 2 Case Example 3a Yes No Page 28 of 39 Submit You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 2 - What if the patient is compliant with family, can I send the patient in a family vehicle instead?

89. Decision 2 Case Example 3a Yes No Page 28 of 39 Submit You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 2 - What if the patient is compliant with family, can I send the patient in a family vehicle instead?

90. Decision 2 Case Example 3a Answer: No is the correct choice You are responsible for this patient. Should anything happen en route you and your hospital could be held liable. Best Practice is to select the appropriate vehicle and escort as per the Mental Health Decision Guide. This patient is/has been combative and may be unpredictable. For safety of the patient and the escort(s), a family vehicle may not be suitable due to the patient’s unpredictability. Sending facility will need to consider escort safety due to the patient’s unpredictability and combativeness and send an appropriate escort (e.g. Security). Also more than one escort may be required (e.g. Nurse and Security). Next > < Prev Page 28 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 2 - What if the patient is compliant with family, can I send the patient in a family vehicle instead?

91. Decision 2 Case Example 3a Answer: Next > < Prev Page 28 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is combative. The patient is not medicated. Part 2 - What if the patient is compliant with family, can I send the patient in a family vehicle instead? No is the correct choice You are responsible for this patient. Should anything happen en route you and your hospital could be held liable. Best Practice is to select the appropriate vehicle and escort as per the Mental Health Decision Guide. This patient is/has been combative and may be unpredictable. For safety of the patient and the escort(s), a family vehicle may not be suitable due to the patient’s unpredictability. Sending facility will need to consider escort safety due to the patient’s unpredictability and combativeness and send an appropriate escort (e.g. Security). Also more than one escort may be required (e.g. Nurse and Security).

92. Decision 2 Case Example 3b Yes No < Prev Page 29 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort? It Depends

93. Decision 2 Case Example 3b Page 29 of 39 Submit You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort? Yes No It Depends

94. Decision 2 Case Example 3b Page 29 of 39 Submit You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort? Yes No It Depends

95. Decision 2 Case Example 3b Page 29 of 39 Submit You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort? Yes No It Depends

96. Decision 2 Case Example 3b Answer: It Depends is the correct choice This patient is on a Form 1. If the assessment of the care team determines the patient is not at imminent harm to self or others during the entire time away, is cooperative and agreeable to care and transfer then an escort may not be required. It is the decision of the sending facility, using the MH algorithm, to determine if an escort is needed since the patient is still the responsibility of the sending facility should anything happen during transport. If in doubt send an escort. Next > < Prev Page 29 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort?

97. Decision 2 Case Example 3b Answer: It Depends is the correct choice This patient is on a Form 1. If the assessment of the care team determines the patient is not at imminent harm to self or others during the entire time away, is cooperative and agreeable to care and transfer then an escort may not be required. It is the decision of the sending facility, using the MH algorithm, to determine if an escort is needed since the patient is still the responsibility of the sending facility should anything happen during transport. If in doubt send an escort. Next > < Prev Page 29 of 39 You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort?

98. Decision 2 Case Example 3b Answer: Next > < Prev Page 29 of 39 It Depends is the correct choice This patient is on a Form 1. If the assessment of the care team determines the patient is not at imminent harm to self or others during the entire time away, is cooperative and agreeable to care and transfer then an escort may not be required. It is the decision of the sending facility, using the MH algorithm, to determine if an escort is needed since the patient is still the responsibility of the sending facility should anything happen during transport. If in doubt send an escort. You have a patient in the ED who needs to be transferred to another facility. The patient is on a Form 1 and is cooperative and not combative. The patient is agreeing to the transfer and is not medicated. Does this person need an escort?

99. Decision 2 Case Example 4 No It Depends Yes < Prev Page 30 of 39 You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin.. Do you need to send an escort?

100. Decision 2 Case Example 4 No It Depends Yes Page 30 of 39 Submit You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin.. Do you need to send an escort?

101. Decision 2 Case Example 4 No It Depends Yes Page 30 of 39 Submit You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin.. Do you need to send an escort?

102. Decision 2 Case Example 4 No It Depends Yes Page 30 of 39 Submit You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin.. Do you need to send an escort?

103. Decision 2 Case Example 4 It Depends Answer: NO - If the travel time plus any potential delays will not negatively impact ongoing care and comfort then you do not need to send an escort. YES - If the travel time plus any potential delays could impact or delay necessary care interventions and or if medications administered prior to the transfer will require monitoring then you need to send an escort with the judgment and knowledge to provide care interventions. Ultimately, the primary nurse at the sending hospital is required to use their critical thinking and professional judgment to determine the need for an escort and to provide all essential supplies for the duration of the trip i.e. medical and personal supplies, medications, meals and personal aids for ambulation, hearing, or vision. Next > < Prev Page 30 of 39 You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin. Do you need to send an escort?

104. Decision 2 Case Example 4 Next > < Prev Page 30 of 39 You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin. Do you need to send an escort? Answer: NO - If the travel time plus any potential delays will not negatively impact ongoing care and comfort then you do not need to send an escort. YES - If the travel time plus any potential delays could impact or delay necessary care interventions and or if medications administered prior to the transfer will require monitoring then you need to send an escort with the judgment and knowledge to provide care interventions. Ultimately, the primary nurse at the sending hospital is required to use their critical thinking and professional judgment to determine the need for an escort and to provide all essential supplies for the duration of the trip i.e. medical and personal supplies, medications, meals and personal aids for ambulation, hearing, or vision.

105. Decision 2 Case Example 4 Next > < Prev Page 30 of 39 You have a patient being transported to another facility for a CT scan. The patient is stable and likely to return to your hospital. The patient's IV is locked/capped for the length of transport. The patient is 75 years of age and history of Type 1 Diabetes. Patient self monitors and administers own insulin. Do you need to send an escort? Answer: NO - If the travel time plus any potential delays will not negatively impact ongoing care and comfort then you do not need to send an escort. YES - If the travel time plus any potential delays could impact or delay necessary care interventions and or if medications administered prior to the transfer will require monitoring then you need to send an escort with the judgment and knowledge to provide care interventions. Ultimately, the primary nurse at the sending hospital is required to use their critical thinking and professional judgment to determine the need for an escort and to provide all essential supplies for the duration of the trip i.e. medical and personal supplies, medications, meals and personal aids for ambulation, hearing, or vision.

106. Decision 3 What type of NET vehicle does the patient need? The following are guidelines - you must always use your professional judgment and knowledge to make the decision Taxi may be used when the patient is independently ambulatory can tolerate sitting for the duration of the travel time and is not violent. Wheelchair vehicle may be considered if the patient is not independently ambulatory, requires use of a wheelchair, can tolerate sitting and requires no more than minor assistance to ambulate short distances. Stretcher vehicle should be used for all other NET transports, including patients who require restraints. Page 31 of 39 Next > < Prev

107. Your patient must be ready for pick-up when the attendants arrive. Ready for pick-up: Medical Transport # (MT #) is obtained, the patient is dressed, personal items packed, medications etc. ready, supplies ready, escort ready, documentation is complete. Documentation must go in a sealed Patient Transport Envelop. The envelope must include all items listed on the envelope checklist. Have the patient ready for pick-up Page 32 of 39 Next > < Prev

108. Booking procedure Obtain an Medical Transport number (MT #) Determine the appropriate vehicle and escort using the decision guide Call or book on-line (where available) Ensure the patient is ready for pick up Document the transport confirmation number in the patient record Refer to the decision guide for more information Booking and Billing Procedures Page 33 of 39 Next > < Prev

109. Booking and Billing Procedures Billing Practice - who pays? Hospitals will pay for transports between hospitals within the province of Ontario Patients are required to pay for transport home, to LTC, to appointments not associated with their current admission and/or out of province transfers A brochure is available to provide patients with key information about making their own arrangements for transport when they have been discharged and are leaving the hospital Page 34 of 39 Next > < Prev

110. The Voyageur Contract and How it Protects You and Your Patient In 2011, after a full investigation and finding several gaps in safety, the Ombudsman recommended the MOHLTC regulate this industry. Currently these companies remain unregulated. To ensure our patients are safe, hospitals in the SW LHIN co-created clinical and vehicle standards that Voyageur must comply with under contract. The standards include but are not limited to: Page 35 of 39 Next > < Prev patient and staff safety infection control practice privacy patient information security incident management procedures vehicle and equipment safety attendant training - First responder and appropriate driving certificates including defensive driving, Non violent crisis intervention, ADL and gentle persuasion

111. To use EMS for transports as determined by the Decision Guide To only use the NET supplier contracted by your hospital (Voyageur) - they meet standards set out by a contract To follow the decision algorithm - vehicle, escort and mode of transport To call or book the transport on-line (where available) To have the patient ready when the attendants arrive (and if receiving a patient, be prompt at helping to offload) Remember, until hand-off at the receiving facility, you and your care team are responsible for the patient for the duration of transport. Your Responsibiliti es Page 36 of 39 Next > < Prev

112. Each hospital has an on-site NET expert. This person is identified in your online User Guide as the Hospital NET Contact (link to guide available at end of module) Your NET contact represents you and your hospital at the regional operations committee for NET If you have complaints, concerns, compliments or suggestions for improvement, work with your immediate leader to pass on to your hospital NET contact What to do if you have complaints or concerns? Page 37 of 39 Next > < Prev

113. An electronic User Guide is available online on your hospital intranet site. It provides details and guidance on a number of issues Topics include: Your Role Ambulance Act Scope of Practice (NET and Attendant) Patient Transportation Assessment, Documentation and Escort Decision Health Care Provider Accompaniment Guidelines for Patient Transfers Booking and Billing Instructions Your hospital specific information and NET Contact Person NET Patient Pamphlet Frequently Asked Questions (FAQs) Definitions and Terminology Do Not Resuscitate Confirmation form (DNRC) Guideline. Refer to the DNRC procedure in the User Guide User Guide Book Page 38 of 39 Next > < Prev

114. Where to find the Algorithm and Guide for Patient Transport? A laminated copy of the decision algorithm is available in your unit. If you do not have adequate copies please have your leader contact your hospital representative. The electronic version of both the algorithm and the user guide is on your hospital intranet. You can view a copy here: Page 39 of 39 Next > < Prev AlgorithmUser Guides

115. Subject Matter Experts: Ann Toman, London Health Sciences Centre Strategy & Project Leadership Regional Clinical Standards Committee ePresentation Developer Cindy Pandke, St. Joseph's Health Care London Organizational Development and Learning Services Photopgraphs Presentermedia.com Articulate Storyline © 2013, 2014 SW LHIN Hospitals (Version 2) Reproduction and distribution of this document in whole or in part is prohibited without the expresses permission of the publisher c/o St. Joseph's Health Care London 518- 646-6100 x65441 Acknowledgements Exit Module