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DEVELOPING STANDARDS OF PATIENT CARE

Standards for patient care:


Patient care of a high quality Patient care of a high quality should be achieved by the hospital through adopting following measures. 1. Provision of appropriate technical equipment and facilities necessary to support the hospitals objectives. 2. An organisational structures the assigns responsibility appropriately and requires accountability for the various functions within the institution. 3. A continuous review of the adequacy of care provided by physicians, nursing staff and paramedical personnel and of the adequacy with which it is supported by other hospital. General standard of patient care: Condition: The general standard of care is applicable: 1. At all times when a paramedic is providing patient care while on duty. 2. To patient care provided by a paramedic where care is general in nature (stated or implied) 3. To patient care pertaining to certain illness or injury categories/situations as specially defined with in a general standard care. 4. Under all environmental conditions, with the provide that personal safety is assured or can be secured without loss of the paramedics life, limb(s) or vital function. Givens: 1. Patients. 2. A partner. 3. An operational ambulance (includes air ambulances)or in special situations such as mass casualty incidents, an emergency first response vehicle. 4. Fully operational patient care equipment as per the MOHLTC provincial equipment standards for Ontario ambulance services.

A. Personal and patient safety and protection: The paramedic will:


1. On receipt of a call, confirm call information with dispatch ensure that patient location and assess information is accurate.

2. Operative the ambulance and utilize ambulance emergency warning devices in a responsible manner. 3. Use an appropriate alternative route selected is impeded due to traffic, weather etc. 4. Secure the environment if assessment indicates there is no danger to self or other. 5. If there is more than one patient and assess the need for additional resources and the need for additional resources and assistance. 6. Use EMS rescuer and extrication techniques as required. 7. Utilize personal protective equipment according to the ambulance service taint care and transportation standard and take appropriate safety measures where necessary. 8. Protect the patient from hazards and exposure to adverse environmental condition. 9. Ensure safe disposal of sharps in an appropriate sharp container. 10. Secure, lift and carry the patient using appropriate methods and devices. 11. Hand wash after each patient contact. General measures: 1. Ensure that other operational procedures which impact directly or indirectly on patient care are carryout on a regular basis specifically. 2. Personal cleanliness, dress, conduct, safety and work performanance. 3. Cleanliness, decontamination, safety, maintenance and routine checks of the ambulance. 4. Educate all patient care related equipment and supplies. 5. Complication and submission of reports. 6. Assistance with familization and orientation of new or less experienced staff. B. Patient commutation 1. 2. 3. 4. Identify and introduce themselves to the patient. Advice the patient that they are there to help. If the patient refuses treatment. Attempt to determine the patients name, gender, age and weight. Treat the patient other at scene with respect and country. Exercise tact and diplomacy. 5. Explain assessments and intervention. 6. Provide verbal and where demand appropriate, tactile comfort and reassurance to the patient and family/friends including unconscious patient.

C. Patient assessment- general principles. 1. On all scene calls, regardless of dispatch priority coding, assume the existence of serious, potentially life-limb-and /or function threatening conditions until assessment indicates otherwise. 2. If a physician is at scene, fallow specific procedures as outlined in the physicians orders standard, in addition to those outlined in the general standard of care. D. Patient assessment-environmental assessments. 1. Make scene observations. 2. Seek medical information tags/jewellery, medication and other forms of patient identification. 3. Collect and transport all patient medications and other relevant identification for review by receiving facility staff. E. Patient assessment-historical assessments. 1. Establish the chief complaint: why did the patient or by standard call for an ambulance. 2. Elicit history of present illness or incident. Utilize as many appropriate methods as required, specifically. 3. Question the patient directly: question others at scene. 4. Seek medical or other identification, e.g. medical information tags/jewelry, medication centres. 5. Observe the patient behaviour. 6. Request/ collect information on allergies, medication and relevant past medical history users prohibited by time and /or the severity of the patients condition or advise scene circumstances. 7. For inter-facility patient transfers, obtain the following information and /or transfer documents. 8. Patient history and case infection. 9. Written treatment order by Doctors. 10. Transfer papers,e.g case summary, lab work, 11. Names of hospital staff and equipment accompanying the patient, where applicable, 12. Name of receiving facility and receiving physician, where applicable. F. Patient assessment-physical assessments. 1. Handle the patient gently. Minimize patient movement and manipulation. 2. Primary patient survey.

3. 4. 5. 6. 7.

Note the patient general condition. Ensure manual C-spin posture if trauma is obvious, suspect or unknown. Check ABCs. Level of condition. Cardiac monitoring. Respiratory arrest; severe respiratory distress Unconscious/decreased level of consciousness Collapse;synocope Chest pain, shortness of breath CVA Major or multiple trauma Hypothermia: heat exhaustion/heart illness Abnormal vital sign. 8. Unless contraindicated, cover the patient with a blanket after the primary survey. 9. Expose body parts only as required to perform appropriate assessments and management. 10. Perform the following secondary physical assessments. Elicit history. Take vital signs. Respiratory rate, rhythm and volume. Skin colour, condition, temperature Pulse rate rhythm and volume Blood pressure Head to toe assessment based on the history, patient condition/scene observations Observe trauma G. Patient management 1. If the patient is vital sign absent and meet obvious death. Note: if the patient has a do not resuscitate order to the DNR standard. 2. If critical finding, 3. To establish improve and maintain airway patency, ventilation and circulation and to control external ward haemorrhage. 4. Ensure appropriate equipment and technique is being applied. 5. To provide advanced life support patient care standard. 6. If the patient is stable and used of specific standards of care. 7. Continue monitor. 8. Ensure the patient comfort and privacy.

H. patient refused of treatment and transport 1. The patient refused treatment and transport explain the possible consequences of such refused. 2. Provide appropriate documentation. 3. Carryout emergency treatment and transport if the paramedic determines J Patient care reroute to the recovery facility. 1. 2. 3. 4. Responsible for attending to the patient. Complete the history. Maintained appropriate management. Maintained communication with patient and family.

K. Radio reporting of patient care to receiving family. Complete the radio report within 2 minutes optimally within 1 minute for most cells. L. Documentation of patient care Record the patients general condition medication and vital sign. Keep patient infection confidential.

Emergency department nursing care Standards


The nursing staff in the emergency department supports and maintenance the nursing care standards of the department of nursing. In the spirit of those standards, the nursing staff in the emergency department is expected and required to adhere to the following standards. At triage 1. Introduce yourself and extend words of caring and concern regarding the patients injury or illness. 2. Listen to the patient. 3. Do not respond as robot, but respond as caring person. Minimum requirement is one personnel comment to each patient and family. 4. Maintain eye contact with the patient. 5. Explain the registration and bed placement process. 6. Never leave triage untreated. 7. Be sensitive to gender issues when placing patient in semi private treatment room.

At the beginning of treatment 1. For ambulatory triage patients, primary nurses should introduce themselves to the patients within minute of a room assignment. 2. Once demographic information is available, refer to the patients by his her name. Do not continue to refer to the patient as a bed number or a diagnosis through his/her treatment. 3. Throughout treatment, do not use the name of patients or family members without permission. 4. Do not refer to the patients as honey, sweetie or dear at any time during his or her treatment. 5. Be sure to ask the patient. Is anyone with you? Or is there some you would like us to call for you/ 6. Briefly review the visitation policy with the patient and their family. During treatment 1. Announce yourself and your title when entering the exam room. 2. Explain every intervention and procedure before you being in that in that procedure, and verify the patient and family understandings. 3. Continuously communicate the process of care and the expected treatment of the patients. Make sure that the patient knows what to expect next. 4. Ask the patient do you have any questions or needs every time you interact with the patients. When question are asked about delays or treatment.. 1. Avoid telling a patient i am not your nurse or i dont know. Advice the patient that you will have to check on that report and follow up with the patients. 2. Responds to delays in a cooperative and responsible manner, and be sure to emphasis for any delay. 3. Do not blame other departments or colleagues for delays; do not make excuses be positive and proactive. Admitting and discharging patients 1. Call report and admit the patient within 30 minutes of a bed assignment. Document any delays. 2. Discharge the patient within 20 minutes of instruction availability and completion of treatment. Patient-focused treatment standards. 1. Wear your nametags at all times.

2. Ensure that every patient has a functioning call light at all times. 3. Respond to the call lights immediately. 4. Evaluate every patient for nourishment, and provide food and beverages as appropriate. 5. Make proactive rounds Minimum requirement is to back the patient every 45 minute (more frequently if there is a change in patient condition) with documentation of check; VS assessment and documentation. 6. Check and document the pain status of the patient and the effectiveness of medication within 30 to 60 minutes of medication, depending on the route of administration. Team-focused treatment standards. 1. Communicate the process of care and expected treatment internally so that physicians, nurses, and other care providers are aware of any testing and changes in care. when patient verbalize. 2. Anticipate your co- workers need for assistance without being asked. 3. Limit the use of the intercom to patient emergencies and physician calls. DO NOT uses the intercom in the following situations. 4. To page staff to the desk. 5. To announce that the paramedics are in an exam room waiting for a nurse. Emergency department protocols When questions are asked about delays 1. Listen and respond with empathy and concern. 2. Acknowledge and apologize for the delay. 3. Briefly explain the reason for the delay, communicate a realistic and liberal time frame, and do not blame other departments or colleagues for the delay. 4. Confirm the patient understands of his or her plan of care. When questions are asked about treatment. 1. Listen and respond with empathy and concern. 2. Clarify the question(s) answer and the question confirms the patient understands of your response. 3. If you do not know the answer, advise the patient that you will have to check on that information or request that information or request and then follow up with the patient. When patients verbalize that they are leaving without being seen

1. Immediately communicate to the charge nurse that the patient if going LWBS.patients leaves the emergency department. 2. The charge nurse should evaluate the situation and intervene with the patient as appropriate. 3. Document the patient 4. Intervention and the results When patients verbalize that they are leaving against medical advice. 1. Immediately communicate to the charge nurse and the physician that the patient is going to AM. 2. The physician should evaluate the situation and intervene with the patient as appropriate. 3. Document the patient intervention and the results and complete the appropriate forms. When patients use threats and profanity. 1. If the patient uses profanity state the following: in order or me to be able to help you need to stop using profanity. 2. Immediately notify the charge nurse of the situation. 3. Implement the security management plan as needed. Identify patients who are at high-risk for dissatisfaction. It is important to identify patients who may be high-risk for dissatisfaction in order to use proactive behaviours (such as those outlined in section 1and 2 above) to keep the patients dissatisfaction from escalating to the point where the patient goes LWBS or AMA. Proactive behaviours on the part of the emergency department staff may also prevent high risk patients escalating to out-of bounds behaviours such as yoking and using profanity. Keep in mind that the following patients are a high risk for dissatisfaction. 1. Patients who have waited over 45 minutes in the lobby. 2. Patients who have waited over 30 minutes to see a doctor. 3. Patients who have spent over 3 hours in the emergency room. BIBLOGRAPHY: 1. Ontario. Emergency Health Service Branch Ministry of Health and Long-term Care. Basic life Support Patient Care Standards, January 2007; page 1-18.

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