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Welcome

In this newsletter:

  • Find out the plan for Spring CME
  • Clinical guidance you need to know
  • ACR tips for patient safety advocates

What's New

There is so much happening in Eastern Ontario paramedicine! How to keep up?! At the RPPEO, we asked paramedics - and ourselves - if we should communicate more with those practicing about all these happenings. While clinical issues, patient safety information or practice guidance are constantly in motion, we don't want to give you motion sickness by churning too much info! But, one thing kept coming up front and centre: paramedics want to be informed. So here we are, offering up a few choice nuggets from the region for your information. We will keep it focused on what's important for you to know from us and we hope you find it useful. As always, if you've got any questions or comments on what you hear and see feel free to reach out by phone, email or social media.

Paramedic Care

Clinical Guidance on COVID-19

We're all starting to get more familiar with the latest coronavirus to emerge, COVID-19. Like it's cousins SARS and MERS, the first few months after its arrival were noisy. The Ministry of Health's guidance for paramedics acted like sound padding, though, and now you should be able to hear yourself over the noise.

The Ministry of Health guidance is simple yet it manages to speak to patient assessment, treatment, notification and documentation. Take a quiet moment to read the most recent Training Bulletin No. 120 put out on February 28, 2020. If you've been wondering where to find the COVID-19 Screening Tool, it's now a stand-alone document on the MOH Paramedic Practice page.

While you're on a reading jag, have a look at the memo from the Medical Advisory Committee (MAC). The take-home from MAC is that they know - and now you know - that you may need to adapt your care plan for a patient who screens positive using the COVID-19 Screening Tool.

The Medical Directives in your BLS and ALS Patient Care Standards apply to all of your patients, including those who screen positive to the COVID-19 Screening Tool. The ALS PCS recognizes that in extenuating circumstances paramedics may not be able to provide all the treatments that they’ve considered. MAC considers a positive screen on the COVID-19 Screening Tool as an extenuating circumstance.

The Ontario Paramedic Clinical Guide working group added MAC's Considerations for COVID-19 clinical care to the app on March 6. You'll see a button embedded in the protocols where COVID-19 considerations might apply.

The RPPEO shared the current paramedic guidance for COVID-19 with Base Hospital Physicians. When you're patching, the physicians should be familiar with the COVID-19 Screening Tool and your treatment guidelines.

Education

Spring CME

With the need to slow the spread of COVID-19, the RPPEO is suspending classroom CME until further notice. We will, however, provide an online Spring CME learning package for paramedics. At this time, your annual CME requirements have not changed. Watch your inbox and social media for the release of virtual Spring CME.

Have you seen the Institute for Safe Medication Practices' Safety Bulletin Multi-Incident Analysis of Incidents Involving Paramedicine? The authors give us portraits of medication safety incidents that seem truly authentic to paramedic practice. That's because the incidents in the report come from voluntary reports of medication safety incidents that actually happened somewhere in Canada.

The good news is that the Safety Bulletin identifies factors that contributed to the medication errors. These are often factors that we can systematically fix.

Enter Spring CME. One of the themes for this round of RPPEO continuing education is medication safety. We're taking a closer look at the ways medication error happens for paramedics and the concrete things that we can do to decrease these errors.

We'll also take time to talk about what ECGs can tell us and look deeper at 12 lead interpretation. These are tools we use often, yet there is always more to learn about them. The upcoming CME topics are listed in the graphic you see here.

Make sure to hop on MedicLEARN for the pre-class online content. We have new content in your Spring 2020 pre-learning all packaged and waiting for you right now!

Spring CME topics are chosen by looking at patient safety and quality data and educational needs of paramedics

Quality & Patient Safety

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.

Upcoming Events

March 30: Spring CME Launch

About Us

The Ontario Base Hospital is a fictitious base hospital. This site is used for demonstration, development and testing purposes only.

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