cqi 2004 certification prepared by: program manager: steve dewar
TRANSCRIPT
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?