As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPs?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address transfer of care.
4.2 Transfer of Care
A regulated member transferring full or partial responsibility for a patient’s care to another healthcare provider(s) must:
- Provide the healthcare provider(s) with a timely, written summary that includes the following information:
- Identification of the roles and responsibilities of the regulated member and other healthcare providers involved in patient’s care up to the point of transfer
- Pertinent clinical information
- ECG or other test results
- Treatment plans and recommendations for follow-up care
- Communicate clearly to the patient the roles and responsibilities of the regulated member and other healthcare providers involved in the patient’s next steps for care.
- Ensure any referral or alternate care plan or release of care by a paramedic to another regulated healthcare professional is communicated to the patient, family and receiving healthcare provider.
Scenario:
Cole and Kristy, both ACPs, are working together on an ambulance in the community of Westlock, located just outside Edmonton. Early in their shift, they are called to a 68-year-old female, Mrs. Linda Parker, who has fallen outside her residence and sustained an open tibia fracture. Upon arrival, they find Mrs. Parker sitting on the ground, visibly distressed, with an open wound on her right leg and the bone protruding. She is alert but in significant pain.
Cole quickly assesses the patient and instructs Kristy to manually stabilize the fracture and apply a sterile dressing to the wound while he obtains vital signs and prepares to manage the pain. Cole follows his employer’s medical control protocols and proceeds to administer a loading dose of 5 mg of morphine IV for pain relief (patient weight is 60 kg). They proceed to stabilize Mrs. Parker’s leg for transport and apply the appropriate dressings while continuously monitoring her vitals and condition.
As they prepare to transfer Mrs. Parker to the hospital, Cole ensures that the following steps are carried out in compliance with 4.2 Transfer of Care standard.
1.Written Summary (i.e. electronic patient care record) provided to receiving healthcare providers which includes the following information:
a) Roles and Responsibilities of the regulated member:
- Paramedic crew: Cole (ACP) led the call, assessed the patient and administered morphine, while Kristy (ACP) assisted with wound care and stabilized the fracture.
b) Pertinent Clinical Information:
- 68-year-old female with an open tibia fracture and exposed bone.
- Vital signs: BP 130/80 mmHg, HR 100 bpm, SpO2 98%, Respirations 22 per min
- 5 mg morphine IV administered with stable post-administration vitals.
c) ECG or other test results:
- Sinus tachycardia
- Blood glucose level (BGL) 4.1 mmol
d) Treatment Plans and Recommendations for Follow-Up Care:
- Immediate X-rays for fracture assessment, possible surgery, and ongoing monitoring for infection or complications.
2.Communication with the Patient:
Before transport, Cole explains to Mrs. Parker the care she has received and the next steps in her care plan: “We’ve stabilized your leg and given you medication to help with the pain. You’ll be transferred to the hospital like you requested, where doctors will take X-rays and decide if surgery is needed.” Cole also speaks with Mrs. Parker’s daughter (with permission) on the phone to let her know the care plan: “Your mother has an open fracture. We’ve stabilized her leg and given her pain relief. She’ll need X-rays and possibly surgery, but she’s stable for now. If you’d like, you can meet us at Westlock Hospital as we should be there in about 15 minutes.”
3.Communication with the Receiving Healthcare Provider:
Upon arrival at the hospital, Cole provides the following verbal report to the ED team: “This is Mrs. Linda Parker, a 68-year-old female with an open tibia fracture, treated with 5 mg morphine IV. Her vitals are stable: BP 130/80 mmHg, HR 100 bpm, SpO2 98%, Respirations 22 per min, BGL 4.1 mmol, ECG – Sinus tachycardia. We’ve applied a sterile dressing and splinted her leg. Recommend X-rays and orthopedic consultation for possible surgery.”
Cole and Kristy assess if they have adequate time to complete their documentation now or if they will need to perform only a verbal report and submit their written report later, in a timely matter. Noting that the submission of a written report is what formally constitutes the transfer of care, Cole and Kristy decide to finish their documentation prior to leaving the hospital. They complete the handover, ensuring all necessary information is communicated clearly to the patient, family, and the receiving healthcare providers/team. The hospital team assumes responsibility for Mrs. Parker’s ongoing care while the paramedics finalize their electronic patient care report.
In this example, Cole and Kristy both demonstrate their knowledge and adherence to the Standard 4.2 Transfer of Care, where a regulated member transferring full or partial responsibility for a patient’s care to another healthcare provider(s) must:
1.Provide to the receiving healthcare provider(s) a timely, written summary that includes the following information:
- Identification of the roles and responsibilities of the regulated member and other healthcare providers involved in patient’s care up to the point of transfer
- Pertinent clinical information
- ECG or other test results
- Treatment plans and recommendations for follow-up care
2. Communicate clearly to the patient the roles and responsibilities of the regulated member and other healthcare providers involved in the patient’s next steps for care.
3. Ensure any referral or alternate care plan or release of care by a paramedic to another regulated healthcare professional is communicated to the patient, family and receiving healthcare provider.