CQI2004 Certification

Prepared by:

Program Manager:

Steve Dewar

Destination Determination

Changes effective June 1st? To be distributed ‘Extensive or relevant history’ explained

but will be contentious Pt preference is way down the list

Stroke Criteria

Hamilton General Hospital is now a Regional Stroke Centre

(St. Joes is not) Provincial Stroke Card will be distributed

Stroke Card criteria

Facial Droop Unilateral Arm weakness or drift Slurred speech Time of onset of symptoms is clearly

known and patient can be transported to Stroke Centre within 2 hours of onset

Symptoms are not resolving (TIA)

Stroke Centre Contraindications

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

Other CQI Issues

Patient Care Issues

Blood Glucose Testing

Indications Any patient who exhibits any of the

following serious symptoms: agitation, decreased LOA/LOC, syncope, confusion, seizure or symptoms of stroke

Blood Glucose Testing

Hx of diabetes is not a criteria All stroke patients meet criteria Most reasons for not testing are not

acceptable (no time, knew it was a CVA)

HOWEVER --

CHF Protocol

Hamilton BH introduced a CHF protocol before the rest of the Province, but required BHP contact. A history of Nitro use was not required

The Standing Order was introduced by the Province, and we introduced it as written.

ADMINISTERING NITRO FOR CHF REQUIRES A HISTORY OF NITRO USE.

Monitors are not just for Chest Pain

monitor should be used for most medical complaints, including – Dizziness– Nausea and vomiting – Shortness of Breath– any SR treatment

Give ‘em the Oxygen

O2 sat is not an excusion factor for O2 Easier to give it then justify not giving it

– eg - chest wall pain

Trauma Triage Guidelines

Are in the protocol book Please indicate on the ACR if you are

specifically following the guidelines The age for an adult for trauma centre is 16

(17 for all other pediatrics)

DNR

MOH DNR forms are acceptable only during calls for which they are written.

BH does not have a current DNR policy 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

General Appearance - still needs to be documented

SOB patients - Presence of cough and/or fever is relevant

ACR strips - we are collecting wallpaper Final Primary Problem ACP /PCP documentation when both at a

scene

When is a Patient not a Patient?

If a person:– Denies any injury or complaint– Is not obviously injured– Did not call for help

You may considered them not to be a patient, and do not need to assess the patient.

If in doubt, Assess and Document!

When is a Patient not a Patient?

Note that persons requesting Lift Assists ARE patients.

At least one set of Vital Signs Document if patient is being left alone Code for Chief Complaint is 99 (other

medical / trauma)

ACR Completion

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?

ACP PRU on scene first, stays with patient ACP PRU on scene first, hands over care PCP transport on scene first, ACP arrives

and stays with patient PCP on scene first, ACP arrives and leaves ACP PRU on scene first, ACP transport

arrives

Peer Auditing

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

Paramedic Response to Reviews

Your comments - constructive questions and responses - are welcome

Signature required Dated

What to do when you make a medication or other error?

Deliberate deviations from protocols

Learning from Errors Made

When Errors Occur

Contact the Base Hospital office 905-527-4322 ext 42393 905-317-5811 Advise your Operations Supervisor Advise the receiving medical staff

Other Issues?