Page 12
initiated on the floor Documentation requirements: · Implementation of the Medical Directive must be documented on the chart under physician orders · Vital signs pre and q15 to 30 minutes post medication · Response to bronchodilator medication must be documented in the RRS note Review/Evaluation Process (how often/by whom): every 2 years by Medical Department -Emergency Medicine and Critical Care Council. Related Documents: Canadian Asthma Consensus Report – Canadian Medical Association Journal 1999; 161:S1-S12. ORNGE Medical Directives and Standing Orders. Airway-Airway Protocol – Crash. April. 2005. Pg. 33-34. MEDICAL DIRECTIVE Rapid Response System (RRS) – Respiratory Distress Approved by/Date: February 26, 2013 (For LHB Pilot Only) Lakeridge Health Page 7 of 9 Ontario Provincial Primary Care Paramedic Medical Directives - Bronchoconstriction Medical Directive. Waterloo Region, Ontario, Canada. Base Hospital Program Jan 1, 2007 pg. 8-9 Ontario Provincial Primary Care Paramedic Medical Directives – Sever Asthma Exacerbation Medical Directive. Waterloo Region, Ontario, Canada. Base Hospital Program Jan 1, 2007 pg. 10. Ontario Provincial Primary Care Paramedic Medical Directives – Pulmonary Edema Medical Directive. Waterloo Region, Ontario, Canada. Base Hospital Program Jan 1, 2007 pg. 13. Lakeridge Health Corporation. Emergency Medical Directives: Adult Asthma. Sept 2009. Lakeridge Health Corporation. Emergency Medical Directives: Adult COPD. Sept 2009. APPENDIX A: LAB REFERENCES “BIO10.08F Testing Menu for Vitros Analyzer at all Lakeridge Sites Version 1.0” in the Laboratory QMS MEDICAL DIRECTIVE REFERENCES 1. Garrard, C, Young, D. Suboptimal care of patients before admission to an Intensive care us caused by a failure to appreciate or supply the ABCs of life support. BJM 1998; 316:1841-1842. 2. Buist MD, Jarmolowski E, Burton PR, et al. Recognizing clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care: a pilot study in a tertiary care hospital Med J. Aust. 1999; 171:22-25. 3. Berwick, DM. Redesigning hospital care. JAMA. 2006; 295:324-327. 4. Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomized controlled trial. Lancet. 2005; 365:2091-2097. 5. Bellomo R, Goldstein D, Uchino, S et al. A prospective before and after trial of a medical emergency team. Med J Aust. 2003; 179:283-287. MEDICAL DIRECTIVE Rapid Response System (RRS) – Respiratory Distress Approved by/Date: February 26, 2013 (For LHB Pilot Only) Lakeridge Health Page 8 of 9 6. Bellomo R, Goldstein D, Uchino, S et al. Prospective controlled trial of effect of a medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004; 32:916-921. 7. Buist MD, Moore GE, Bernard SA, et al. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: a preliminary study. BMJ. 2002; 324:387-390. 8. Kenward G, Castle N, Hodgetts, T, et al. Evaluation of a medical emergency team one year after implementation. Resuscitation. 2004: 61:257-263. 9. DeVita MA, Braithwaite RS, Mahidhara R, et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004; 13:251-254. 10.Jolley J, Bendyk H, Holaday B, Lombardozzi KA, et al. Rapid Response Teams: do they make a difference? Dimens Crit Care Nurs. 2007; 35:2076- 2082. 11.Jones D, Opdam H, Egi M, et al. Long term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation. 2007; 74:235-241. What is RRT • Why RRTs • Organization of RRTs • A hospital’s Experience with RRT • Costs and Benefits of RRTs • Needed Action The first of the six interventions of “Save 100,000 Lives” Campaign of the Institute for Healthcare Improvement (IHI-2004) “Deploy Rapid Response Teams at the first sign of patient decline” Joint Commission’s National Patient Safety Goal # 16 introduced in 2008 “Goal 16: Improve recognition and response to changes in a patient’s condition”