South Denver Prehospital Services 2014 Overview of 2014 BACKBOARD EMS PATIENT OUTCOMES EMS Pain management MED RECONCILIATION Attention! BACKBOARD DRILL!! BEFORE AND AFTER PROTOCOL CHANGE Measure: Injury: Change in incidence of cord injury Time management: Scene time and ED time? Utilization of expensive imaging: Reduced patient costs? PAIN RELIEF IN THE PREHOSPITAL SETTING http://emsteam.org 1
PAIN RELIEF IN THE PREHOSPITAL SETTING PROCESS Goal of Pain Management: DMEMSMD protocols Removal of all pain? NOT! Make the pain tolerable for assessment, treatment and transport Caution to prevent respiratory depression especially in children and elderly 195 PATIENTS c/c pain from October 2013 thru February 2014 Age and weight Vital signs Repeat doses? Initial EMS Pain Evaluation (0-10) Patient pain at ED arrival recorded by EMS Patient pain at ED arrival recorded by ED triage Patient Pain at ED 1 st dose administration Time from ED arrival to 1 st ED dose SAMPLE STATISTICS 1 2 3 4 Initial Pain ED arrival ED triage pain Pain at ED 1 st dose Minutes Mean Median SD Age 59.5 62.0 21.4 EMS initial pain 8.5 9.0 1.76 EMS ending pain 4.3 4.5 2.6 ED triage pain 5.6 6.0 3.2 Pain at ED drug 6.1 6.0 2.7 Arrival to Pain Drug (min) 58.3 50.0 38.8 Time From ED Arrival to ED Medication GUESS? EMS patient pain level on arrival Time to ED pain medication What is # 1 reason for EMS pain medication delivery? http://emsteam.org 2
. Total equals more than 195 because of combination of some chief complaints For example: Fall with lower extremity injury, or fall with hip/pelvis injury Fall 75 Hip/Pelvis Injury 56 Abd/Flank/GI Pain 54 Back Pain/Injury 32 Lower Extremity Injury 30 Upper Extremity Injury 23 Chest Pain/Respiratory 17 CHI, Headache, Seizure 15 Neck Injury 7 Seeking 1 http://www.boredpanda.com/ EMS Effect on Patient Care More to study from EMS perspective Patients DO experience significant pain relief We Plan On Studying If EMS Pain Management Impacts MEAN 8.5 TO 4.3 After patient arrival: time to 1 st dose in the ED lengthened SO WHAT???????? Patient satisfaction LOS Healing? PATIENT PAIN REDUCING MEDICATION ERRORS DRUGS PATIENT SAFETY MED ERRORS ARE A SIGNIFICANT RISK TO PATIENTS http://emsteam.org 3
Med Reconciliation: SIMPLE Tool to Keep Patients Safe Med Reconciliation: Why? Patient Safety Initiative WITHOUT Medication reconciliation RESULT Risk of doubling in mortality: Adverse drug events Prevent medication errors such as: Omissions Duplications Dosing errors Drug interactions Wrong medications WITH Medication reconciliation RESULT 75% reduction in medication errors and drug discrepancy related adverse drug events Massica,A Richter,K. Convery P Linking Joint Commission impatient core measures and National Patient Safety Goals with evidence: Baylor University Medical Center 2009 Med Recon Process Example of a med rec problem 1. Med Rec is a Meaningful Use Measure for the ED, and a JCAHO requirement 2. Applies to all patients admitted or discharged home 3. A med list including dosages, frequency, and times (OTC and supplemental meds included) verified on each visit, preferably prior to any meds being given in ED 4. The process is more accurate and faster if the staff has the medication bottles or weekly pill containers Dosages and frequency are known Pharmacy and physician names are known and can be called if detective work is needed Medications can be identified by their size, color and numbers if pill containers are all that is available 75 F transport by EMS: remembers a few of her meds Arrival at ED: handoff includes verbal list of three meds to RN Hx: HTN CHF DM Requires metroprolol: but no record of dose Med given, but will begin at lowest dose because dose is not known After admission BP will not stabilize Patient actually was on a dose 4 times higher than what she was being given during admission Another example of med rec problem A Collaborative Approach 92 M brought in with syncope vs. seizure, confused EMS report pt. confirms he is taking Detrol, Prevacid, Atenolol, Coumadin and Atrovent Meds the same as 2007 admission for this pt., so he was admitted and the same meds were ordered Pts. BP dropped to 80 systolic, needed IV bolus to improve his BP Daughter arrived and reports that pt. no longer takes Atenolol it was discontinued years prior 46 year old female patient admitted for acute appendicitis, with a history of glucocorticoid deficiency Taking hydrocortisone Med rec that was done showed patient taking hydrochlorothiazide which was ordered upon admission Somewhere in the process if the medication bottle was present, the error could possibly have been prevented http://emsteam.org 4
EMS Influence Monitoring Vital and important link in getting medication information to the ED staff Bring medications into the hospital Plastic bag and label supplied The practice will increase throughout the Denver area % of Med Rec Completion for all patients Monthly report Looking for increased compliance and consequently increased patient safety ED staff will be responsible for the medications (patient s personal property) Monitoring of med loss or other occurrences by the hospital Quality Department http://emsteam.org 5