1. CQI 2004 Recert. Prepared by: Program Manager: Steve Dewar

2. Destination Determination t Changes effective _____? t To be distributed t ‘History in past 14 days’ changed to ‘extensive or relevant history’ t Pt preference is way down the list

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

4. 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

5. Stroke Centre Contraindications t CTAS 1, or Airway, Breathing problems t Symptoms are resolving (TIA) t GCS <10 t Hypoglycemia t Palliative care t Seizure at onset t Pediatric patients

6. Other CQI Issues Patient Care Issues

7. 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

8. 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 --

9. 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.

10. 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

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

12. Other CQI Issues Chart Review Issues

13. 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

14. 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

15. Reminder - Who is 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. AN ACR IS STILL REQUIRED. t If in doubt, Assess and Document!

16. 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.

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

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

19. Other Issues?

20. Take Home Points t Destination Determination will change t Blood Glucose Testing t Monitors and 02 for all significant complaints t Documentation with transfer of care

21. QUESTIONS?