CQI2004 Recert.

Prepared by:

Program Manager:

Steve Dewar

Destination Determination

Changes effective _____? To be distributed ‘History in past 14 days’ changed to

‘extensive or relevant history’ 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

Stroke Centre Contraindications

CTAS 1, or Airway, Breathing problems Symptoms are resolving (TIA) GCS <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 exclusion factor for O2 Easier to give it then justify not giving it

– eg - chest wall pain

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

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

Reminder - Who is 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. AN ACR IS STILL REQUIRED.

If in doubt, Assess and Document!

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.

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

Deliberate deviations from protocols

Learning from Errors Made

Triage when SR initiated

When is ACP canceled?

Learning from Errors Made

Take Home Points

Destination Determination will change Blood Glucose Testing Monitors and 02 for all significant

complaints Documentation with transfer of care

QUESTIONS?