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HomeMy WebLinkAboutSFRF Review CriteriaBEAUMONT FIRE -RESCUE QUALITY ASSURANCE PROGRAM STANDARD FIREHOUSE REPORT FORM (SFRF) REVIEW CRITERIA General Information 1. Run Number 2. Unit Number 3. Date in MM/DD/YY format AND time in AM/PM or military time. 4. Name of EMT in charge. 5. FD ID Number of EMT in charge. 6. Additional EMTs -If there are more than four write them in above #7. 7. Check off as reviewed and complete the form. 8. Priority- This is only if the priority was recorded, not if it was correct. 9. Nature of Call -Not what the call was dispatched as but what it really was. 10. Subtract "Responding" from "Dispatched" times -This is how long it took until the unit went enroute. 11. Subtract "Leave Scene" from "On Scene" -This is how long the unit was on -scene. 12. If any of the times are excessive and there is an explanation in the narrative, check "Yes", otherwise check "No". 13. If you check "Yes" to #12 write the explanation here. 14. Age of Patient. 15. Gender of Patient. 16. Check the highest level of care provided. 17. Check "Yes" if the patient was transported, "No" if not. If "No," explain why. (i.e. "refusal", "no patient found") Section A -Documentation O II4.vk^;'� 1`�11u1r I:[mis sccf'1iuuim iiiirviiiul cs �v lx'11l1c111' 11iuui' 1111)1. I.lmcrun 1`�1iwi1111 � w'I�,�f,nd, lll°III'�,�.�,31 liild IIIA µw111 111 µS = the item was documented completely, correctly and legibly. I the item is incomplete, unclear or illegible. A. = the item is missing altogether. N/A = the item is not applicable for this call. 18. Was the date recorded? 19. Were the Patient's Name, Home Address, Town, State, and Incident Address filled out correctly? Was Responsible Party/Employc fill out or marked N/A? Were the Priori1y, Age, DOB, Gender and Local MD filled out correctly? 20. Was the crew with EMT #s filled out correctly? Were all times listed? 21. Was the Reason for Call filled out correctly? Does the Clinical Impression accurately reflect the patient's condition? 22. Does the Allem box have either a check mark or listed allergies? 23. Does the Medications box have either a check mark or listed medications? Is the spelling close enough so that other medical professionals will know what the medications are? 24. Does the History box have either a check mark or listed history or N/A? If there is a listed history, is it clear and complete? 25. Does the narrative clearly record the patient's history of therp esent illness or injury? 26. Does the narrative clearly record the results of the physical exam? 27. Does the narrative clearly record all treatment given? 28. Does the narrative clearly record the outcome and/or results of all treatmentig ven? 29. Does the narrative clearly record that the patient was continually observed and what those observations were? 30. Is an accurate Glasgow Coma Scale and Revised Trauma Score recorded or marked N/A? 31. Were Vital Si ns recorded? Where they repeated every 5 minutes for critical patients and every 15 minutes for other patients? 32. Were all Medications and Procedures listed in the "Medication and Treatment Therapy" box including 02, IV, medications, ETT, blood glucose? 33. Did the Medical Control Physician sign the form if orders were requested? 34. Did the EMT that completed the form, the AIC and the RN or MD that received the patient sign the form? 35. Is there anything else absent such as Data Collection, Communications, Disposition or anything else? 36. Comments—Clarify any items that received an "I" or a "U" rating. Attach extra sheets if necessary. Section B—Clinical Audit ()A u c.vk�'�v 1`�11u1r iallmiiis scx,011iuuim iiurvi�i lllvcc s �vIIat am:lxltfllllllY i.wiicm i.1cl ct llllll h) gc' 111im(.o11dl iallmc. fii,flllll111u�viiuilg °�vflllll ���III�III�III fir; A = the actions taken for the selected topic were acceptable or appropriate according to industry standards, statewide protocols or service policies. u = the item was performed but should be reviewed for circumstances or could be improved. 11 = the actions taken for an item were outside of industry standards, statewide protocols or service protocols. This would include omission of an action that should have occurred. RFT = there is not enough information on the run form to make a determination. N/A = the item is not applicable. 37. Response time: (the amount of time from dispatch to the ambulance signing on) EMT on duty in the station: A = <1 minute I = >1 minute but < 3 minutes 11 = >3 minutes EMT on duty not in the station: A = <8 minutes _ >8 minutes but <12 minutes 11 = >12 minutes EMTs not on duty in the station: A = <10 minutes I = > 10 minutes but <14 minutes 11 = >14 minutes 38. Scene time: (the amount of time the ambulance is on -scene– not EMTs) Trauma – A = <5 minutes I = >5 minutes but <10 minutes, without extenuating circumstances 11 _ >I 0 minutes, without extenuating circumstances. Extenuating circumstances may he anything from a difficult extrication to an uncooperative patient but must he documented. Medical A = <15 minutes (<10 minutes, if only BLS or ALS -I is present) _ > 15 minutes but <25 minutes, without extenuating circumstances (>10 minutes but <20 minutes, if only BLS or AL S-1 is present) 11 = > 25 minutes (>20 minutes, if only BLS or ALS -I is present) Rate depends on whether or not paramedic level care was delivered on scene. Extenuating circumstances are the same as for trauma. 39. Dispatch of BLS/ALS: A = based on the "Reason for Call" the call was BLS and dispatched as BLS or was ALS and dispatched as ALS, or as soon as sufficient information was obtained ALS was requested or cancelled appropriately. u = AL S was requested when the call did not fit AL S dispatch criteria or was dispatched later than it should have been. 11 = ALS should have been dispatched based on ALS dispatch criteria but was not. 40. Utilization of BLS/ALS: Based on who performed the skills listed in the Narrative, Vital Signs box, and Medications and Treatment box. A = appropriate division of tasks, including driving, based on EMT level and the patients condition (For example if there was a B, an I and a P in the back of the ambulance on an ALS run, the B is doing vitals, the I the IV and the P the meds). u = tasks are not divided evenly but care is delivered appropriately according to EMT level. I = care is not delivered appropriately according to EMT level (Le. A medic drives with only a basic in back on an ALS call). 41. Assessment: A = the scene and the patient were assessed promptly, thoroughly and appropriately. The documented vitals and other findings support the diagnosis (or at BLS level support the treatment). u = the assessment was delayed or incomplete without extenuating circumstances. l = an assessment was not performed or a BLS assessment was performed when ALS was present and an ALS assessment should have been performed. 42. Trauma Team Activation: A = the Trauma Team was activated appropriately and timely. u = the Trauma Team was activated later than it should have been or was activated when the call did not fit the criteria for activation. I = the Trauma Team was not activated when the call fit the criteria for activation. 43. Treatment/Procedures: A = the treatment/procedures were complete, performed correctly and appropriately based on the patients condition, BFR Protocols and EMT level. The appropriate medications were given in the appropriate dose. Medical Control orders were followed. u = treatment/procedures were provided that were not according to BFR protocols but did not harm the patient (i.e. collared and boarded a patient that did not meet the criteria for c -spine immobilization). Minor treatment was omitted that should have been provided but the omission would be unlikely to harm the patient. I = treatment/procedures/medications were provided that were not according to BFR protocols and could have harmed the patient or were omitted when they should have been provided and the omission could have harmed the patient. Even if the patient was not actually harmed, an incident that meets this criteria should still be marked as "U". 44. Policy Adherence: A = service and Region policies that would apply to the run were adhered to. u = minor policies were not followed but the omission would be unlikely to harm the patient or be detrimental to the service. I = service or Region policies that should have been follow were not and the omission could have harmed the patient or have been detrimental to the service. 45. Overall Documentation: A = the overall documentation was sufficient to become an reliable part of the patient's medical record and correctly indicates information and language needed for billing purposes. u = the overall documentation should be reviewed for circumstances or improved. I = the overall documentation is not complete enough to become a reliable part of the patient's medical record. 46. Overall Performance: A = the overall performance of EMS was consistent with industry standards, Statewide protocols, Region V and service policies. u = the overall performance should be reviewed for circumstances or could be improved. I = the overall performance was not consistent with industry standards, Statewide protocols, Region V and service policies. 47. Other: Used to assess the performance of EMS as the result of any unusual occurrences. 48. Other: Used to assess the performance of EMS as the result of any unusual occurrences. 49. Comments: Clarify any items that received an I or a l rating. Attach extra sheets if necessary.