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Treatment Guidelines: The next evolution in patient care

Treatment Guidelines: The next evolution in patient care. Karen Wanger MDCM, FRCPC, FACEP Clinical Associate Professor, UBC Medical Director, Whistler Fire Rescue Service. Eagles/ACEP October 14, 2011. Are protocols a problem?. Protocols work just fine

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Treatment Guidelines: The next evolution in patient care

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  1. Treatment Guidelines:The next evolution in patient care • Karen Wanger MDCM, FRCPC, FACEP • Clinical Associate Professor, UBC • Medical Director, Whistler Fire Rescue Service Eagles/ACEP October 14, 2011

  2. Are protocols a problem? • Protocols work just fine • Indirect oversight requires linear practice to succeed • Worry about the “lowest common denominator” • We can QI protocols so better for patient safety

  3. What’s the problem? • All of that is incorrect

  4. Protocols force: • Lock-step procedure • Fear of being caught “out of protocol” • Shoe horn of patients into the protocol

  5. “Do what’s right........ • write what’s correct”

  6. There has to be a better way

  7. Goals • Need to allow paramedics to use their critical thinking skills and do what the patient needs in the moment • Need to provide good tools for the paramedics to do the job • Need to support paramedics through education • Need to identify misses, near misses/good catches....and....

  8. Time to raise the bar...

  9. What does this mean to paramedic practice? • New “guided flexibility” in making choices or decisions about the care they provide their patients • “all....some...or none”

  10. Patient Safety

  11. Treatment Guidelines • Ask paramedics - surveys and email campaign • Chose broad and tighter topics - what to keep, what to add • Plan of action and implementation strategy

  12. TG creation • Topics divided among the 4 Regional Medical Directors • Teams of volunteer paramedics facilitated by community EMS physician. One topic/team • The LMC worked with the team to find evidence and best practise in other services and discuss as a group

  13. TG creation • Each team submitted recommendations to Regional Medical Director • RMD edited and summarized • PMLC ranked in order of importance for implementation • Project Manager edited further to insure consistency of language

  14. TG Rollout • Three phases to rollout: • “no change” + TG-1course • existing topics with some changes • new topics + TG-II course

  15. Medical Principles } Treatment Guideline Intervention Guidelines

  16. Reaction • Most loved it • Some had/have difficulties making the leap - maintained access to protocols for reference

  17. Challenges • Understanding “scope of knowledge” vs. “scope of practice” • The dreaded nitro issue.....

  18. Next iteration • Feedback from paramedics ++++(+++!) • All info in single document with newly arranged flow to intervention guidelines • “TG-0” • “There’s an app for that.....”

  19. Lessons • Yes we can, and we should • Long prep and run in • Be ready for avalanche of questions • Be ready to see what’s really happening • Be ready with support

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