Volume 5 Issue 6

The effect of an integrated approach to care

As the provision of integrated care becomes increasingly adopted into NHS systems, Ian Peate highlights the need for paramedics to be aware of the transition and the implications it has on the profession.

The role of informatics in paramedic practice

Patient safety and understanding informaticsSo, what has informatics got to do with patient safety? The Department of Health says that:‘Improving patient safety involves assessing how patients could be harmed, preventing or managing risks, reporting and analysing incidents, learning from such incidents and implementing solutions to minimise the likelihood of them reoccurring.’This is something that is arguably all the more important in the shadow of the recent Francis report.Patient safety is all about the systematic gathering and intelligent use of information, and implementing systems and technologies to support those activities.Three important developments in health informatics are: implementing electronic patients records (EPRs), providing real-time access to evidence of effectiveness, and increasing the use of information and communication technologies (ICT) in the community.EPRs enables routine recording of patient information that can be automatically coded for secondary uses and facilitate feedback for clinicians. There are two essential pre-requisites: standardised record headings and nationally agreed clinical language.The use of nationally agreed record headings will provide a consistent context across the NHS for each type of data, e.g. care, interventions, or treatments that are provided. The Health and social care information centre (Hscic) is currently looking at working towards ambulance data standards, commencing with discharge summaries.The use of systematised nomenclature of Medicine clinical terms (SNOMED ct) clinical coding system, which is the only system approved for use in the NHS.The implementation of EPRs will provide the technology to support patient information being recorded once and used many times for a multitude of purposes.The routine recording of coded patient information under standardised record headings, by all care providers, will greatly reduce the burden associated with recording high-quality data when carrying out service evaluations, and local or national clinical audit and research, which in turn will lead to improved patient safety.A second informatics component concerns providing access to evidence of effectiveness to support care planning and interventions in real time. Several organisations provide information online to help patients and carers to be better informed, or to support clinical decision making by health professionals.A third informatics component is the use of ICT to enable patients to live in their own homes safely and for longer. Telecare provides monitoring of vital signs and alerts staff when problems arise. Telehealth provides better communication to enable remote consultations and professional support to complement home visits. Both of these components are likely to be significant in the future practice of paramedics and ambulance services with remote access to patient information, to telemedicine support from colleagues at a different location, or to online information to support clinical decision making. Summary Care Record and its future iterations will play a key role in the future.

To alert, or not to alert? That is the question

Pre-hospital alerts provide the emergency department (ED) with time to mobilise specialist teams and prepare essential equipment to ensure the most appropriate care is given to time-critical patients. Providing pre-alerts to EDs is something all ambulance crews have experience of; however, which patients require a pre-alert remains controversial.

Learning auscultation: not for dummies

This American paper is based on a reasonable premise that paramedics are required to be adept at auscultation practices as they are first on scene at emergencies, and also that the skill of auscultation is often poorly taught.

Emergency response driving education within UK ambulance services

Each ambulance trust across the country will have a pool of driving instructors, trained specifically to deliver driving programmes that range from basic driving assessments when new employees start in the service, to full high-speed emergency driving. The driving instructors will have undergone an intense driver instructor programme. The driving instructors are themselves assessed regularly under the new High Speed Driving Act 2009. These new national registers of emergency drivers, which are for all services that include high speed driving as one of their functions, is an attempt to standardise and add a further level of quality to the skill sets of those that drive in emergency situations. Instructors will be reassessed every 3 years and other staff every 5 years.

Is the role of the paramedic lecturer practitioner fit for purpose?

Lecturer practitioners have been in existence in nursing since the late 1980s (Elcock, 1998, Ramage, 2004). Since then the role has been developed and refined, but the overarching concept has remained the same: that is to support students and staff in their workplace (Redwood et al, 2002). Paramedic education has moved into the higher education arena, and with it comes the responsibilities of supervising and managing students in clinical practice. The lecturer practitioner role is currently one of the ways in which this issue is tackled.Within this literature review the role of the lecturer practitioner in the wider health care context is considered, followed by an examination of the successes and problems encountered in the role. An evaluation of future strategies to improve the role then ensues followed by a discussion section that relates the identified literature to paramedic practice. The overall conclusion is that the lecturer practitioner role is suitable for paramedic practice but some adjustments should be made to the nursing model in order to accommodate the peculiarities of paramedic practice.

Exploring paramedic patient assessment

Objective:This study explored the topic of paramedic patient assessment, investigating how they informed clinical decisions, the challenges associated with performing assessments and the perceived effectiveness of current approaches.Methods:Using a Delphi research method, expert participants were independently interviewed which encouraged them to share experiences and views. A thematic analysis approach was then used and the data coded and organised into a series of statements to represent the collective expert views. Statements were then returned to the expert participants for validation and comment.Results:A process of paramedic care delivery was defined, whose activities were largely identified as representing areas of assessment. Protocols and guidelines which are designed to inform paramedic interventions influenced every stage of care delivery. The depth and breadth of a paramedic's patient assessment were found to be limited once indications for a treatment guideline have been satisfied and the main contraindications are excluded. Current formal assessment tools skills being utilised by paramedic staff (including protocols and practice guidelines) were considered only effective for encounters with critically ill patients, and were of limited benefit to the assessment of patients of a lower clinical acuity. There was a direct correlation between the increased paramedic confidence in their patient assessment skills and the more critical the patient's condition. Paramedics were the least familiar or confident with the assessment principles and skills linked with the lower acuity of patient illness.Conclusion:When compared to both national and international ambulance case loads, it is significant that those groups of patient complaints representing the vast majority of ambulance work are the same patient cohorts for whom the paramedic has the least knowledge, preparation and confidence in relation to assessment. Findings relating to the defining of a paramedic's role and process of care distinctly features assessment skills to be both a major component of all pre-hospital activities and integral to the effectiveness of all interventions to follow. This should firmly place

Students' views of teachers using the Clinical Teaching Effectiveness Inventory

Objectives: The aim of this study was to examine undergraduate students' views of paramedic clinical teachers from a large Australian university.Methods: A cross-sectional study involving a paper-based questionnaire employing a convenience sample of undergraduate paramedic students. Student attitudes towards paramedic clinical in-field teachers were measured using a standardised self-reporting instrument: Clinical Teaching Effectiveness Inventory (CTEI). Participants rate their level of agreement with each item on a 5-point Likert scale (1=never/poor to 5=always/superb).Results: This research indicates that the clinical teachers are able to assist the graduates with the integration of the theory into the practice. There was significant difference between subscale 1‘Learner-centred instructional skills’ and those aged between <20 years and those aged between 35–39 years (p=0.013).Conclusion: This study has provided some insight into this important area. Before any definitive conclusions can be made this study needs to be repeated on a larger scale and across other jurisdictions. To establish a clearer picture we need a greater knowledge and understanding of the levels of education and experience of the clinical teachers. This should assist in building the graduates' epistemology of practice.

History taking, assessment and documentation for paramedics

Paramedic practice is progressing at a more rapid pace now than at any time in its history. Paramedics need to align their method of assessing patients to integrate into the multi-disciplinary team involved in the patient's journey of care and treatment. The review of systems (RoS) approach is widely used and accepted in healthcare, and easily assimilates into paramedic practice. RoS improves patient care by holistically assessing the patient, and can make the inter-professional handover of a patient to another team more professionally acceptable. Documentation using the RoS is more comprehensive and less prone to errors.

Sexually transmitted infections: impact in the remote and overseas environment

Sexually Transmitted Infections (STIs) and remote areas workers have a direct relationship more so than in other workforces. Overseas and migrant workers appear to be affected by these types of infectious diseases in greater numbers than in other workforces (apart from the commercial sex industry) for a differing number of reasons. The relative loneliness and isolation, being away from spouses or regular partners for long periods of time, and relative high disposable income associated with the work all contribute to a large proportion of workers engaging in risky sexual practices whilst away on projects.The contracting of these infectious diseases obviously has a cost to the worker, their families, health services, and also to their employer in terms of family cohesion, treatment, and possible lost productivity/time. It is important that greater preventative measures are required to ease the suffering and cost to all concerned.

Management of patients following cold water immersion

Sudden immersion in cold water results in a number of physiological changes within the human body. This disruption of homeostasis can have a detrimental effect on normal body function and lead to life-threatening consequences including drowning, hypothermia and sudden death. This article will examine the changes in physiology from the point of initial immersion through to rescue or death. Particular attention is given to the profound effects upon the respiratory, cardiovascular and neurological systems as a consequence of cold water immersion. This is then reviewed and observed from the perspective of paramedics practising within the United Kingdom, who may face challenges that arise from this phenomenon. The pre-hospital assessment of immersed patients will be discussed in order to identify and address potential and immediate life threats, with specific focus on rewarming hypothermic patients post immersion.

Book Reviews

This very approachable and concise edition manages to address a number of models of reflective practice and presents the reader with an immediate ‘overview’ of reflection and its worth in paramedic practice. This would hold true for both those with previous exposure to reflection and those new to the practice. Many readers will find the very practical worked examples in chapter 5 helpful, particularly for those perhaps new to formalised reflective practice—they help to make reflection ‘ordinary’ and relevant. The summaries at the end of each chapter are welcome inclusions, being very pithy and succinct.

Book Reviews

If you have a suggestion for a book on pre-hospital or out-of-hospital care that you would like to see reviewed in a future issue of the journal, or if you would like to write a review yourself, contact the Editor, Alistair Quaile. Guidance for book reviewers is available, and first time authors are always welcome.

The road to better patient care

The Francis report (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013) published earlier this year emphasised the need for a cultural change within the NHS. Highlighting the failure of the Mid Stafforshire NHS Foundation Trust to detect poor quality care and to ensure that its services met the standards that the public expects, the 3-volume, 1782-page report called for a patient-centred culture, which has a commitment to serve and protect patients.

Continuing Professional Development: Pain management for paramedic practice

OverviewThis CPD Module will outline the definitions and presentation of the overarching typology of acute and chronic (or persistent) non-malignant and malignant pain, describe the anatomy and physiology relating to pain and review the pharmacology of pain medication in the UK for children and adults. This CPD module is advisory and does not seek to replace any locally agreed policies/procedures within your organisation or national policies and guidelines related to pain management. This module aims to provide you with a background to pain, its various types, some pain assessment tools and the pharmacological action of the common analgesic agents, and therefore a greater understanding of managing patients presenting in pain, their presenting symptoms and underlying pathology.Learning OutcomesAfter completing this module you will be able to:• Outline the history of pain theories to date• Describe the anatomy and physiology relating to pain• Understand different types of pain• Explore some pain assessment tools• Explain the underlying pharmacology of common analgesic agents

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