Pittsburgh EMS Chest Pain Audit
Trip sheet Review Draft – 1/31/01
CCR #______Date______Medic Unit______
1. Interpreting the history and physical on the trip sheet (excluding interventions), the documentation supports that the etiology of the patient’s chest pain was:
Non cardiac Unsure Definitely cardiac
1 … 3 … 5
2. The interventions performed by the crew suggest that the etiology of the patient’s chest pain was:
Non cardiac Unsure Definitely cardiac
1 … 3 … 5 Use of NTG = 5
3. The documentation of the history on the trip sheet includes PQRST (provocation, quality, radiation, severity, timing), Meds, Allergies:
Disagree Neutral Agree
1 … 3 … 5
4. The documentation of the physical exam on the trip sheet included at least 2 sets of vital signs, vital signs taken after vasoactive med was given, lung sounds, and other pertinent findings as directed by the history:
Disagree Neutral Agree
1 … 3 … 5
5. The following interventions were performed:
Response time______min Scene Time______min Transport Time______min
Intervention / Performed / Use NA for not indicated, allergy, etc.If patient took own ASA that day , ASA is optional
Oxygen / Done Not done NA
EKG monitor / Done Not done NA
12 lead EKG / Done Not done NA
ASA / Done Not done NA
Nitroglycerin / Done Not done NA
Command contact / Done Not done NA
6. Was the use of the Chest Pain protocol specifically documented Y N
7. Was the chest pain protocol performed in order Y N NA (O2, Monitor, 1 NTG, saline lock, command , ASA)
8. Does the trip sheet suggest how the patient was transferred to the truck? Y N - Walked Carried Other
9. The reviewer believes that the chest pain was:
Non cardiac Unsure Definitely cardiac
1 … 3 … 5
10. If NTG was administered in a male patient was the use of Viagra documented? Y N NA
On EMS Letterhead
The Pittsburgh EMD Continuous Quality Improvement Committee (CQI) has initiated a process to evaluate and improve the care of chest pain patients in our service. The committee has chosen to use a system wide chart review to look at cardiac care.
Chest pain patients make up a significant proportion of patients transported by Pittsburgh EMS. In addition, Pittsburgh paramedics have several therapeutic modalities to offer chest pain patients including, nitroglycerin, aspirin, 12 lead EKGs, etc.
Attached is a review of the enclosed trip sheet by one of the members of the CQI committee. The review is primarily for your education. System totals are included so that you may compare your performance with the service as a whole. You are encouraged to discuss this audit with one of the members of the CQI committee. Additional reviews of chest pain charts will continue over the next several months.
Sincerely,
Ron Roth, MD
CQI Executive Committee Members
Doug Garretson, Norm Auvil, Roy Cox, Scotty Everitt, John Soderberg, Robert Hrabar,
Bryan Kuszajewski, Mark Pinchalk, Michael Robinson,
CCR#______Trip Sheet Author______
Review of your Trip Sheet
1. The chart reviewer felt that your documentation of the history and physical suggested that the patient’s chest pain (was cardiac, was noncardiac, was of unclear etiology).
2. The interventions that you initiated were felt to be directed towards chest pain of (a cardiac, noncardiac, an unclear etiology).
3. Documentation of the history for chest pain should address the PQRST (provocation, quality, radiation, severity, timing), Meds, Allergies as noted in the Chest Pain Protocol 301. The reviewer felt that your documentation was (limited, adequate, very good).
4.The following interventions should be performed on the majority of patients with “cardiac” chest pain:
InterventionOxygen / Documented Not documented NA
EKG monitor / Documented Not documented NA
12 lead EKG / Documented Not documented NA
ASA / Documented Not documented NA
Nitroglycerin / Documented Not documented NA
Command contact / Documented Not documented NA
5. For medicolegal purposes it is important to specifically document when you use a protocol or invoke standing orders. You (did not, did) specifically document the use of the Chest Pain Protocol.
6. The Chest Pain Protocol (was, was not) performed in order. (O2, Monitor, 1 NTG, saline lock, command , ASA)
7. You (did not, did) document how the patient was transferred to the Medic unit.
8. The Chest Pain Protocol requires you to ask male patients if they have taken Viagra recently. You (did not, did) document this in the trip sheet. Remember, the combination of Viagra and nitroglycerin can cause profound and sometimes fatal hypotension.
System WideCompliance
69% -adequate
86%-documented
54%-documented
54%-documented
35%-documented
93%-documented
96%-documented
24%-documented
48%-in order
41%-documented
4%-documented