Prehospital Care Department UPDATES December 2014

Transcription

1 Prehospital Care Department UPDATES December /5/2014 New Run Review changes for 2015: There will be some changes in requirements and delivery mode for 2015 run reviews. After a lot of discussion with all the local fire chiefs and agency representatives the groups have devised a plan for that will focus more on hands on training and allow for new options for video conferencing. We will be scheduling four skills stations each year spread out one a quarter. Each skills station will be between 4-6 hours long and will include various topics such as: code stations, capnography, airways stations and many other possibilities. The location of these skills labs will be at various locations across the valley with appropriate facilities to host. Each medic will be required to attend one of the scheduled skills stations during the calendar year. We will only be hosting 4 lecture run reviews in Those will also be spread out throughout the calendar year. All 4 will be video recorded and loaded on to the EMS website at: Each paramedic is required to attend one of these run reviews in person. Additionally each medic will be required to watch at least 2 of the other videos and submit the required documentation to the Prehospital office. Agency based run reviews will still be scheduled with each department. You can choose to attend that in lieu of watching one of the video lectures. Breakdown of 2015 requirements 4 Skills labs will be offered annually. (MUST ATTEND 1 ) 4 Run reviews will be offered. (MUST ATTEND 1 IN PERSON) Run Review videos (MUST WATCH MINIMUM OF 2 AND COMPLETE REQUIRED DOCUMENTATION) Agency based (Can attend in lieu of ONE VIDEO) We will be trialing this for Hopefully, this is a more educational and time efficient process for all of the EMS providers. As 2015 comes to a close we will re-evaluate this process and move forward. All ALS providers will be required to read the new Base station policy on continuing education. Attached is an attestation form that will need to be completed by a representative(s) from each agency to ensure that all providers have reviewed the new policy. Please include a roster with each providers initials once reviewed. This is important to insure all providers understand the 2015 requirements.

2 Thank you Tish Arwine, RN, BSN Prehospital/Trauma Coordinator Verde Valley Medical Center 269 S Candy Lane Cottonwood, AZ November /01/14 Prehospital Care Meeting October 14, 2014: Present: David Guth, Steve Trautman, Ed Mezulis, Bill Boler, Tish Arwine, Dave Guth Old Business: Community paramedic committee is continuing to meet regularly to develop a process for the Verde Valley. There are a couple algorhythms that are being reviewed by the committee and Dr. Curtis. More to come. The intent with community paramedicine is to keep the patients out of the hospital by developing a program that will follow the patients after discharge. The next steps are to focus on PCP follow up options. New Business: Ebola The infection control nurse is working regularly with Yavapai Health Department and the CDC to ensure proper ppe and processes are in place. The newest recommendation from CDC included a non permeable suit and a CAPR mask. If EMS encounters a potential patient they will notify on patch and transport to VVMC. VVMC is actively setting up an additional location for long term care of the Ebola patient until they transferred to an Ebola facility. Infection prevention nurse will be briefly speaking at the next run review. Run review changes for Possible changes for next year include the implementation of a 4-6 hour skills lab that will be mandatory for ALS providers to attend. The skills labs will be spread out throughout the year at various locations. The number of run reviews offered will be decreased. All run reviews will be video recorded. Some of the required run review participation will be available through watching the run review videos as a crew. An attestation form will be in place for validation of participation. More information will be released after discussions with the fire chiefs. The committee agreed with the concept of changing run review processes for next year. ITclamp a new EMS tool was presented for the committee to review. The committee and Dr. Curtis did not see the value or have any interest in adding to prehospital care use. Pre-hospital coordinator position- Tish will be resigning from her position in January She will continue to work in the Emergency Department part time. The position is in the process of being posted for applications meeting dates to be posted soon September 2014

3 9/29/14 Sepsis & Treatment Guidelines 2014: All, Please have an assigned representative or your company officers disseminate the recorded video power point from the September run review. Attached is an attestation form indicating that this video was reviewed. The intent is to have this done under the supervision of the company officers or a designated representative. Each medic should sign their own attestation form indicating they have reviewed, understand and are responsible for the content of the video. These then should be delivered to the pre-hospital office for placement in individual files. The video power point (Annual Guideline and Sepsis Alert Video) can be accessed at the following link: The guideline changes can also be accessed here. In addition, each medic is required to review and sign the VERIFICATION OF REVIEW AND UNDERSTANDING OF ORIENTATION MANUAL. (Also attached). Upon review of both the treatment guidelines and orientation manual, each provider is required to sign the form. These then should be delivered to the pre-hospital office for placement in individual files. Finally, attached is a CE form for 1 hour video based training to be completed by the company officer or designated representative. This does not count as a run review for those that did not attend the run review in person. Thank you and let me know if you have any questions. David Guth, Pre-hospital coordinator assistant, Verde Valley Medical Center, Ph ext /27/14 EMT and CEP Refreshers: The EMT and CEP Refresher Classes are posted for the remainder of this year and It is under What s New. 9/24/14 VVMC Guidelines: The new 2014 Treatment Guidelines and Policies & Procedures are out and on the website at under Protocols. August /26/14 Medication Lists: Please make sure that is patients or family provide a list of current medications on an EMS call that the list is brought in and a copy is left with the EMS report. It is a CMS requirement to do a medication reconciliation on patients. We need to document the medication, dose and frequency of all medications. We are regularly hearing that the list was given to the EMS providers at home but nothing is left with patients chart. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center 8/19/14 EMS Court Case: We recently had an agency called to testify regarding an EMS call. The court hearing was not related to EMS care. Please notify the Pre-Hospital Care Department anytime a case is being reviewed within the legal system or by DHS. Remember you work as a medic under the medical directors license. It is better for us to have a heads up regarding the call. Thanks, Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center 8/18/14 IV Solutions: Hi All, As of today, Supply Chain is out of the Baxter SOL INJ 0.9% NACL 1000ML (Lawson# 49953). As an alternative, we were able to get in some from Fresenius. The only difference in the solution is the port has a twist off. You may begin seeing the sub item as early as today on your units. This will be an ongoing sub situation, so there will be times you have Baxter and others when you will have the

4 Fresenius solution. It will be located in the same place on the Pyxis units and is under the same Lawson#. Please let staff know so it does not come as a surprise to them. Thank you and please feel free to contact me with any questions. Thanks, Amy Paynter, Buyer, Verde Valley Medical Center 8/11/14 Linens: This is a reminder again regarding biohazard. Linens with blood on it are not considered biohazard. All linens are sterilized in the same process. The hospital received a large yellow bag labeled biohazard full of lines over the weekend. That is extremely expensive to dispose of, and unnecessary. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center July /17/14 Mag Sulfate: Hi Tish, At this time we are unable to purchase the Magnesium 1gm/2ml vials that are used by the EMT's. We do however have and are able to purchase more of the magnesium 10gm/20ml vial. The EMT's will need to replace their boxes with this larger vial until we are able to purchase the small vials again. I will be unloading the Magnesium 1gm/2ml vials from the VVMC and SMC ER Pyxis until we are able to purchase these vials again. The EMT's will need to come to the pharmacy to receive the larger vials. Thank you, Matthew Gilliam, Lead Pharmacy Tech/Pyxis Tech, Verde Valley Medical Center. June /17/14 New IV Start Kit in EMS Pyxis: Hi ALL, Would like to let you know that sometime this week you will start seeing a new IV Start kit. The new kit has the Tegaderm securement dressing along with the swab pad instead of the SEPP applicator. Please let staff know so they are aware of the changes. Amy Paynter, Buyer, Verde Valley Medical Center May /20/14 Spinal Motion Restriction: This is the link for the spinal motion restriction training. Please designate trainer(s) to get all ALS and BLS crew members trained. I will need a roster of all providers. Please or fax to me. I have attached the powerpoint and the two algorithms to compare. Providers can start utilizing the guideline once trained. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center 05/13/14 Lessons Learned: Interesting article that you may want to forward. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator,Verde Valley Medical Center

5

6

7 April /25/14 Prehospital Care Committee Minutes: Prehospital Care Agenda April 15, 2014 Minutes: Stroke EMS Education- EMS4Stroke- Please Tish when all providers have completed the training. The website is Community Para-medicine Third meeting is schedule with AZDHS today to look at future of community paramedicine across the state. More to come as each agency and the state determines their level of involvement. FOB The FOBs that were previously ordered for EMS agencies had to be distributed to the Sedona law enforcement officers. The old number keypad at SEC had to be replaced after some recent security concerns. New FOBS have been ordered and will be distributed to each agency once they come in. NTG/Morphine for chest pain- there has been some discussion with the cardiologists regarding the use of Morphine and Nitro for acute MI patients. Dr Peek expressed concern that the use of Morphine for acute MI s does not impact the pain associated with the MI, but rather the preload. The benefits of preload reduction max out at 8 mg. Additional discussion is occurring with the cardiologist and any changes to protocols will be discussed later. New Business AZDHS Drug Box DHS has changed the minimum quantity list for drug boxes. DHS Table 5.2 Minimum Supply requirement was distributed along with the current VVMC drug box inventory list. Each member was asked to review the list to determine if there were any drugs that should be changed or removed to be fiscally responsible. The cost to stock the drug box has increased greatly over the last couple years. The cost to fill each box with the current list is $ There are additional costs for RSI medications, Epi-pens, and Rocuronium. The VVMC Administration has ensured that the cost for drug boxes will not be increasing from $ for this upcoming fiscal year. Protocol Review- please forward recommendations for protocol changes to Tish or Dave. We are in the process of doing the annual review of protocols and policies. Spinal Motion restriction training- each agency will have their agency based run review scheduled either in April or May. Each agency will need to designate a couple trainers to train all BLS and ALS providers that were not at the agency based run review. Go live date with spinal motion restriction is planned for June 1st. Rosters once complete will need to be ed to Tish Arwine. This new protocol will be included in the 2014 protocol revisions. ED Physicians and ED Nurses are being trained as well. Chain of custody- drug/etoh panels- Discussion regarding possible options for drug panels for providers either if there is a suspicion or need after an accident. Currently Nextcare has limited times. Southwest Lab is a facility that VVMC Lab has used. Tish will get more information and forward to each agency. This would be agency specific, but would allow a process for providers to come to VVMC if necessary to have the specimens obtained and the proper chain of custody followed. Run Review G60 (Ground level fall/over 60 BT/F1-6(ie w)-7oc( l)o ruines

8 April 16 th at 0830Conference Room B and C at VVMC Airway Skills Lab April 28 th and 29 th at Cottonwood Public Safety building March /25/14 Advanced Airway Lab: Guardian Air & Prehospital Care are hosting an Advanced Airway Management Lab on April & another one on April You must Tish Arwine to reserve a spot. Tish.Arwine@nahealth.com. 3/25/14 NS & LR Shortage continues: We received another regarding the shortage of NS and LR from the distributors. As we have put out before unless the patient is in obvious need of fluids please do not hang or spike an IV bag. You can start an IV to administer medications or if you think the patient may need one in the future. Example- chest pain patient or respiratory distress protocol indicates IV. Patient may not need fluids but may need for mediations. Let the ED physician determine if they need fluids. It may only require a smaller fluid volume such as 500ml or 250ml. There are saline flushes in the Pyxis at both facilities. Make sure you have a stock within ambulance to prime line and flush any medications. Baxter is continuing to experience an unprecedented demand for IV fluids throughout the country. In order to better serve our customers during this ongoing, nationwide short supply situation Baxter is going to be implementing a weekly allocation schedule starting on March 24 th, Customers will be allocated somewhat less than their current monthly allocation (it will be consistent with current customer shipments) and those allocations will now be divided up into weekly allotments. This means that customers will have to place weekly orders based on the allocations they are allotted. Weekly allocations will roll over into the next week but will not rollover after each four week window. Customers must continue to order through the same channels that they have in the past. Baxter has made the decision to implement a weekly allocation process in an attempt to provide a more efficient shipping and delivery method to get customers the products they need more quickly. Baxter also believes that by implementing this weekly allocation schedule that they will be able to catch up to normal inventory and supply much faster than through the current method. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center February /27/14 VVMC Pharmacy Hours: Pharmacy is now closed from There is a pharmacist on call if needed. I don t believe that there is generally issues during these late night hour but I wanted you to be aware. If there are any issues with medications in the evening hours. Please send me an ASAP so I can correct in the morning. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center, 269 S Candy Lane, Cottonwood, AZ 86326, , arwinet@nahealth.com 2/06/14 LR and NS 1000ml shortage: As I have already mentioned to you in a previous there are critical shortages of NS and now LR. The additional shortage of LR has come since nationally

9 providers have adjusted the fluid administered to LR. According to a statement issued by the Food and Drug Administration (FDA) and the drug manufactures, the increased demand from a harsh flu season and temporary shutdowns at some manufacturing plants are the cause of the shortage. At this time there is no expected date that supply will be corrected. I have spoke with Dr. Curtis in regards to protocols. The recommendation is to place a IV heplock for medications and only hang a fluid bag if clinically indicated ie, hypotensive, obviously dry(been down for awhile) and possibly septic. The Emergency Department greatly appreciate when EMS starts IV s as it helps the whole patient care process move faster. So if you think the patient may have further treatment with IV medications or fluids we would like you to consider placing a heplock. This can easily be explained to the patients as an access site for medications and fluids if the physician determines necessary after assessment. We may need to increase your quantity of IV flushes. Those are in your EMS pyxis. Reminder: If you are administering pain medications through the heplock remember to either dilute in 10 cc syringe with 9cc of fluid or push the medication and flush slowly. Let me know if you have any questions. Tish Arwine, RN, BSN 2/01/14 Fentanyl: Please have each ALS provider review the Fentanyl powerpoint. Please focus on dosages and last couple of slides related to using ampules. Complete a signed roster and forward to Prehospital Office. I have already asked VVMC Pharmacy to place an order for all agency drug boxes. I will let you know when available. One provider from each agency will be responsible for obtaining the necessary Fentanyl from pharmacy and stocking in the drug boxes. Each drug box will be required to carry 200mcg (2 ampules) per DHS. Let me know if you have any questions. Tish Arwine, RN, BSN. January /21/14 Prehospital Care Committee: We covered a lot of items at the meeting. Thanks for those that attended and your participation. Please make sure that your agency is updated on the information. A few bullet comments to remind you. Please have providers complete the online stroke education EMS4Stroke at Paul Honeywell is the new NAH Educator. He has a new concept in distance learning for future EMT to Paramedic classes. Next class starts March 4 th. See NAH website on training for more information In the process of annual protocol/policy review. Ask providers if they have any recommendations. Fentanyl will be placed in drug boxes. Still no carpojets available. Will be using the glass ampoules. Refresher training on drug profile will need to be signed off my each medic. Also must use a filter needle. AZDHS is going to an online recert process. There will be train the trainer series starting sometime in January. More to come from DHS. All providers will eventually have to do their state recert online.

10 There has been some changes to scope of practice in the recent AZDHS rules published December Some additional medications have been added to the interfacility scope of practice. Insulin, Propofol and Levophed. Those will not be added until VVEMS determined a training program for those. There has also been some changes to the equipment requirements in the ambulance. All of this is listed on the AZDHS website for more information. Community Paramedicine sub committees have been established across the state in an effort for DHS to get a better idea of what each region/agency would like to see in the future. Each agency will be starting to use some new prox fobs for access to the Emergency Department. A couple agencies trialed these and had great feedback. These are more expensive than the cards but we hope to minimize the need to replace them so often because of breaking. All agencies need to report back by end of month with the ambulance names. Each ambulance will get two badges. There needs to be an accountability on these badges. After discussion with the committee if there are badges lost there will be a $5 charge to replace. Broken FOBs will not be charged. I need the list of the month that each agency wants to conduct their agency run review training by end of month. Schedule some early in the year please! Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center, 269 S Candy Lane, Cottonwood, AZ 86326, , arwinet@nahealth.com December /17/13 CPR Instructor Renewal Classes for 1 st Quarter 2014 are under What s New 12/1/13 VVMC Run Reviews for 2014: January 21 st Tuesday 1900 Conference Room B and C February 19 th Wednesday 0830 Conference Room B and C March 18 th Tuesday 1900 Conference Room B and C April 16 th Wednesday 0830 Conference Room B and C May 20 th Tuesday 1900 Conference Room B and C June 18 th Wednesday 0830 Conference Room B and C July 15 th Tuesday 1900 Conference Room B and C August 20 th Wednesday 0830 Conference Room B and C

11 September 16 th Tuesday 1900 Conference Room B and C October 22 nd Wednesday 0830 Conference Room B and C November 18 th Tuesday 1900 Conference Room B and C December 17 th Wednesday 0830 Conference Room B and C