Code 72 Quality Review and You
It's one of the times when we know there's risk for patients. Yet, we also know that respecting the patient's autonomy in this situation is absolutely necessary.
Refusal of care or transport is an everyday occurrence. It's the source of ethical dilemmas for paramedics, as well as the source of some very pragmatic issues. We've often seen - and talked about - the documentation problems happening in refusal of care situations.
Inadequate documentation can make it more difficult to assess patient safety in what we call "Code 72." This can be bad for the patient, should more health issues follow, as well as for systemic quality improvement. At its core, it's a patient safety issue.
Now, we've created a feedback loop so that you can consistently know about issues with your Code 72/DMA ACRs.
At last Spring's CME, we talked about the results of a focused audit we did in 2018 on patient refusals following the use of delegated medical acts (DMA). You might recall that the audit showed frequent gaps in documenting things like patient assessments or the patient's understanding of their risks and their care plan following refusal.
We look at every Code 72/DMA ACR to see if patient care was in line with the standards. As part of a new initiative, we're now sending you feedback about the documented care in the key areas that we found were trouble spots during the 2018 focused audit:
- Patient assessment
- Aid to capacity and the informed decision not to consent to additional care
- Patient's ability to understand the situation
- Refusal of service
If you've not documented as needed in these areas and haven't provided a rationale for whythere's no documentation, you'll get an email that shows you where the issue is. These emails are part of a standardized, semi-automated quality improvement process. It's meant to get you feedback on documentation issues so that you know what to watch for in future.
You can still expect to hear from us on the clinical care if we've got uncertainties or think there are issues to address. But, this new feedback specific to documentation on Code 72/DMA ACRs is meant to help us all get the pragmatic issue of incomplete ACRs behind us. That'll be an improvement!
Feel free to reach out if you've got comments or questions.