How ems can improve with newest patient safety recommendation
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How ems can improve with newest patient safety recommendation
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How ems can improve with newest patient safety recommendation
- 1. How EMS Can Improve Care With Newest Patient Safety Recommendations Dr. Soumar Dutta. Consultant and Coordinator- Emergency Medicine Patient Safety Officer Narayana Superspeciality Hospital, Guwahati
- 2. EMS – Emergency Medical Service To providing out-of-hospital acute medical care, transport to definitive care of patients with illnesses and injuries
- 4. Terminologies in EMS “Patient” is used to describe the casualty, victim, caller, or ill or injured person to whom EMS personnel responds and no age is excluded. Patient safety is defined as the reduction and mitigation of unsafe acts within the healthcare system. Excluded from this definition are discussions of best practices for specific diseases.
- 5. It’s a Tough Job…
- 6. Introduction There is inadequate information about the scope and character of adverse events in prehospital care. Patient safety issues in pre-hospital care are poorly investigated Most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting.
- 7. Errors in healthcare Healthcare is not as safe as it should be. Evidences points to medical errors as a leading cause of death and injury. Two large studies done in US: Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle accidents, breast cancer or AIDS.
- 8. First report on patient safety norms November 1999
- 9. Types of Error Error or delay in diagnosis. Failure to employ indicated tests. Use of outmoded tests or therapy. Failure to act on results of monitoring or testing. Diagnosis Error in the performance of an operation, procedure, or test. Error in administering the treatment. Error in the dose or method of using a drug. Avoidable delay in treatment or in responding to an abnormal test Inappropriate (not indicated) care. Treatment
- 10. Types of Error Failure to provide prophylactic treatment. Inadequate monitoring or follow-up of treatment. Preventive Failure of communication. Equipment failure. Other system failure. Others
- 11. Second report on patient safety norms years after ….. To Err is Human 15
- 13. Recommendations
- 14. Recommendations
- 15. Recommendations
- 17. Haddon matrix framework Developed by William Haddon in 1970, The Haddon Matrix is the most commonly used paradigm in the injury prevention field.
- 18. Paradigm shift “Scoop and Run” and not to “Stay and Play” A critical injured patient cannot be stabilized in field
- 20. Host • Patient • EMT • Locomotive operator Agent • Energy during injury. • Unrestrained equipment inside ambulance Physical Environment • Roadway • Design of ambulance Social Environment • Social • Legal • Cultural norms Haddon matrix framework
- 21. Haddon matrix framework Post event During event Pre event Timing of factors also plays a role in the event occurrence
- 22. Host • Conceptualizing the EMS professional as the host in Haddon matrix Health & Fitness Alertness at work Education Knowledge Skill Capability
- 23. Host factor solutions Although high rate of occupational injury among EMS provider, but lacks standard reporting methods of such injuries. Non sharing of data outside a single agency/jurisdiction. Decisions made by local groups no centralized organization and national leadership. EMS provider injury can be reduced through focused and creative efforts, rigorous scientific testing to develop ergonomic equipment specifically designed to meet the challenges of providing patient care in the pre hospital environment
- 24. Host factor solutions Technology making significant in roads assistance to drivers. Driver monitoring and feedback systems to help change dangerous driving behavior. Patient’s comorbid and acute medical conditions also makes the patient susceptible to injury or decline in health status as a result of ambulance transport or a crash.
- 25. Agent Energy exerted during the course of an injury Unrestrained equipment Ambulance design and maintenance are of primary consideration Audible and visual warning signs
- 26. Agent factor solution Newer design ambulance rear compartment Advance technology of patient care Restraint of both provider and patient for maximum safety. If EMS professionals were able to remain in a stable, seated position for longer periods of time, this intervention could cut the risk of falls and subsequent injury significantly.
- 28. Physical environment solutions Policy to enforce speed limits Situational awareness at the scene of an EMS response Develop hands-free devices to provide patient care and for communication while maintaining seated and restrained position.
- 29. Social environment Vehicle Use Personal management Behavioral response Response time Light & Siren use Call prioritization Seat belt usage Driver training Notion of speed at all cost Personal accountability Error recognition Self reporting
- 30. Social environment solution The reliance on response time should be considered as a performance indicator rather than the speed of the vehicle. “Safety dispatch” – information - accurate & informative. Acceptable use of light and siren. Call prioritization will help replace of “rush” culture of EMS and will provide a safe culture of transport/care VehicleUse
- 31. Social environment solution Develop and provide ergonomically effective seating positions within the ambulance that allow EMS professionals full access to the patient and allow the providers to care for the patient while seated and restrained. Screening of drivers at entry level, retraining and evaluation. PersonalManagement
- 32. Social environment solution BehavioralResponse Situational awareness: recognizing hazard, decision making Develop a culture of self-reporting Discourage the “blame and shame” paradigm of criticizing or punishing professionals who disclose adverse events.
- 33. Haddon Matrix
- 34. Conclusion Regulations are needed for a uniform and centralized national reporting network for all minor and major safety related issues. Ambulance design – safety measures, patient, EMT & equipment restraints Innovative equipment designed to meet the challenges during pre hospital patient care
- 35. Conclusion Real-time driver monitoring and feedback systems and event data recorders (EDRs) Research projects in pre hospital safety Rigorous standards for EMT & driver recruitment. Reference from past employees.
Editor's Notes
- An adverse event is an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a “preventable adverse event