We will never forget.



QA/QI

NCEMS - CPH Continuous Quality Improvement Task Force

This Task Force is a joint effort between North Country Program Agency and Canton-Potsdam Hospital.

Mission Statement

“The goal of the North Country EMS/Canton-Potsdam Hospital Continuous Quality Improvement Task Force is to meet the requirements set forth by governing authorities, and to create a positive learning environment that continually enhances the quality of patient care provided by all parties involved.”

(If interested in attending, please contact the North County EMS Program Agency)

June 17, 2010
PCR # 1 Random Review ALS

  • 71 y/o female, Chief Complaint: Could not breathe
  • The PCR met the 75% completion standard set forth by the audit tool with the following comments:
  • Good documentation of delay on scene
  • Incomplete vitals, the time vital signs done were confusing. (1 set documented prior to documented time on scene)
  • Vital signs were not obtained every 15 minutes
  • No IV established, no documentation of why IV was not established
  • No documentation of consideration or administration of Solu-Medrol per protocol

PCR # 2 Random Review BLS

  • 80 y/o female, Chief Complaint: “My back is killing me”
  • The PCR met the 75% completion standard set forth by the audit tool with the following comments:
    • Age Documented but digits reversed to 08
    • Shows other EMS in care prior to arrival, no documentation of that care
    • No focused assessment of back
    • No documents of events leading up to injury/illness
    • No reason for deviation from protocol on Oxygen administration. O2 administered at 4 lpm via NC.
    • BLS protocol is 12 lpm via NRB or 6 lpm NC
    • Consider ALS for pain management

PCR # 3 Random Review BLS
(ALS linked up with BLS on this call, ALS PCR not reviewed)

  • 65 y/o male, Chief Complaint: Unresponsive/Fainting
  • This PCR did not meet the 75% completion standard set forth by the audit tool with the following comments:
  • Documentation is not consistent or adequate for chief complaint
  • No documentation of detailed assessment by BLS to rule out injuries
  • No Medications listed but documentation that they were taken to hospital
  • No pulse or respiratory quality documented
  • No Skin color, condition, or temperature documented

PCR # 4 Random Review ALS

  • 82 y/o male , Chief Complaint: Chest Pain
  • The PCR met the 75% completion standard set forth by the audit tool with the following comments:
    • Great documentation
    • Third set of vitals missing; respirations and LPM of O2 not documented under treatment given but it is documented that O2 was administered via NRB

PCR # 5 Random Review ALS

  • 74 y/o male, Chief Complaint: Can’t breathe
  • The PCR met the 75% completion standard set forth by the audit tool with the following comments:
    • Good documentation
    • Medications not listed
    • Skin color, condition and temperature not documented

August 10, 2010

PCR Review - 71 Charts were reviewed with the presenting problem marked as respiratory distress.

PCR Review Findings

  • For many of the charts we were unable to follow up with the hospital as to the treatment/diagnosis of the patient due to the large number of charts reviewed,  but  it was noted that the treatment of the patient in the pre-hospital setting corresponded with the patient’s hospital treatment/diagnosis on those we did have. Very interestingly it was noted on a couple of occasions that patients were treated under the Respiratory Distress Protocol because of their presentation but laboratory test leaned toward the diagnosis of CHF. It was also noted that the patients were treated appropriately according to presentation, and would not have been able to identify CHF without the lab test.
  • During review it was noted that many of the ALS patients received medications without full routine medical care including IV and Monitor.
  • There was a lack of documentation of the initial assessment (ABC’s) including skin color, temp, condition and this is a key sign when treating respiratory patients.
  • It was noted that providers are not obtaining the first blood pressure manually.  Please note that the REMAC endorses that the first BP should be done manually
  • Manual BP’s were documented in odd number?
  • Continuation forms not used when medication is administered. You must document any medication administration on a continuation form and it should include the dosage of the medication given
  • Many of the PCR’s had incomplete vitals
  • Treatment section of paper PCR does not match the narrative.  Make sure that if you fill in the circle under the treatment section of the PCR if it applies even if it is in your narrative.

November 9, 2010

PCR Review - 5 cardiac arrest charts were reviewed. 2 of which were the same patient, BLS unit on scene started care and linked up with ALS enroute to the hospital

PCR Review Findings

  • Lack of documentation to an IV attempt prior to IO access
  • Notification of the hospital is essential when bringing a patient to the ED and should be done ASAP, we noted that notification of the hospital should have been sooner in one case. Keep in mind that it may be beneficial to your patient to notify the hospital on your way to the call when dispatched to a potentially serious patient.
  • Vital signs not taken per BLS educational standards
  • One PCR was documented in a narrative style which created an unclear timeline and brought forth questions in regards to proper medication administration with a changing heart rhythm. Medications and times should be clearly documented with Heart rhythm and vitals identified  if a narrative format is going to be used. The best course of action is to use the medication areas on the continuation forms to document the medications. Unclear as to the number of shocks given
  • Noted lack of documentation on what size  endotracheal  tube was used
  • Great job done by BLS crew who linked up with ALS on the way to the hospital

February 8, 2011

PCR Review - 17 Cardiac Related (potential) calls were reviewed
PCR Review Findings
  • The time that vital signs were taken was missing on many PCR’s, pulse and respiration quality was also missing on vital signs documentation.
  • Many of the PCR’s  reviewed were missing documentation of skin color, condition, and temperature
  • Noted incorrect dose of ASA being given and no nitroglycerin being given to patient with complaint of chest pain, no documentation as to why protocol was not followed
  • Documentation of Blood glucose by an agency not approved to do BLS Blood Glucometry. It is possible this treatment was done by ALS after they linked up.  Reminder that BLS should only document what they do and no ALS procedures should be documented on a BLS PCR when an ALS link up occurs
  • Overall, very poor documentation of initial, focused or detailed assessments of the patient.   Also very weak documentation of “OPQRST” or history of presenting illness.   No documentation of patients’ response to treatment.
  • One chart showed BLS as in charge, when ALS procedures were done. If a patient warrants any ALS procedure the ALS provider must be in charge!
  • BLS aspirin administration should have been considered on 2 of the 17 charts
  • In one chart patient appears to be suffering from Pulmonary Edema, no treatment given, no ALS taken to the patient.
  • Non-compliance without supporting documentation of NYS BLS protocol for O2 administration.
  • Charts documented medication list attached, it was not. Medications should be documented on your chart as part of the legal patient care record.  7 of the 17 charts were missing one or more of the following items: Medications, past medical history or allergies.
  • Many of the charts contained nonmedical approved abbreviations, making it difficult to understand chart.

EMS - Lewis County General Hospital
Continuous Quality Improvement

Joint effort between Lewis County EMS Council Committee and Lewis County General Hospital Quality Council Committee

3rd and 4th Quarters 2009

PCR Review – 15 PCRs from 3rd Quarter and 15 PCRs from 4th Quarter 2009 were reviewed

PCR Review Findings for 3rd Quarter 2009

  • Average PCR documentation compliance of 90% with no PCRs falling below the 75% standard indicator compliance.
  • 80% past medical history
  • 73% allergies
  • 53% skin color
  • Everything else above 85%

PCR Review Findings for 4th Quarter 2009

  • Average PCR documentation compliance of 89% with one PCR falling below the 75% completion standard.
  • 73% allergies , respiratory quality, skin color and ALS interface
  • 68% pulse quality
  • Everything else above 85%

1st and 2nd Quarter 2010

PCR Review – 17 PCRs from 1st Quarter and 20 PCRs from 2nd Quarter 2010 were reviewed

PCR Review Findings for 1st Quarter 2010

  • Average PCR documentation compliance of 94%, an increase from previous quarter. 2 PCRs fell below the 75% standard indicator compliance.
  • 76% meds and CUPS
  • 71% allergies
  • 82% pulse quality, vital signs every 15 min. and skin color

PCR Review Findings for 2nd Quarter 2010

  • Average PCR documentation compliance of 87%, a decrease of 7% from previous quarter. 2 PCRs fell below the 75% standard indicator compliance.
  • 76% meds, pulse quality and CUPS
  • 71% allergies
  • 53% skin color
  • 81% skin condition
  • Everything else above 85%

3rd and 4th Quarter 2010

PCR Review – 20 PCRs from 3rd Quarter 2010 and 20 PCRs from 4th Quarter 2010 were reviewed

PCR Findings for 3rd Quarter 2010

  • Average PCR documentation compliance of 88%, an increase of 1% from previous quarter.
  • 75% allergies
  • 80% pulse quality and respiratory quality
  • 83% vital signs every 15 minutes
  • 65% skin color
  • Everything else above 85%

PCR Findings for 4th Quarter 2010

  • Average PCR documentation compliance of 84%, a decrease of 4% from previous quarter. 1 PCR fell below the 75% standard indicator compliance.
  • 65% past medical history, pulse quality and respiratory quality
  • 75% meds
  • 80% allergies
  • 20% skin color
  • Everything else above 85%

1st and 2nd Quarter 2011

PCR Review – 18 PCRs from the 1st Quarter 2011 and 16 PCRs from the 2nd Quarter 2011 were reviewed

PCR Findings for 1st Quarter 2011

  • Average PCR documentation compliance of 87%, an increase of 3% from previous quarter.
  • 68% meds
  • 78% allergies and skin color
  • 83% pulse quality
  • 23% ALS interface
  • Everything else above 85%

PCR Findings for 2nd Quarter 2011

  • Average PCR documentation compliance of 88%, an increase of 1% from previous quarter. 1 PCR fell below the 75% standard indicator compliance.
  • 62% meds
  • 69% allergies
  • 81% pulse quality and vital signs every 15 minutes
  • 69% skin color
  • 38% ALS interface
  • Everything else above 85%

3rd and 4th Quarter 2011

PCR Review – 15 PCRs from the 3rd Quarter 2011 and 49 PCRs from the 4th Quarter 2011 were reviewed

PCR Findings for 3rd Quarter 2011

  • Average PCR documentation compliance of 93%, an increase of 6% from previous quarter.
  • 72% past medical history & skin color
  • 60% meds
  • 80% allergies & vital signs every 15 minutes
  • Everything else above 85%

PCR Findings for 4th Quarter 2011

  • Average PCR documentation compliance of 96%, an increase of 3% from previous quarter.
  • 85% vital signs every 15 minutes & pupils
  • 75% skin color
  • Everything else above 85%

 


of Jefferson, Lewis & St. Lawrence Counties
Comments/Suggestions: mailto:ncems@canton.edu
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