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==Section 2 - EMERGENCY OPERATIONS==
===220.14 Quality Assurance Program===

===PURPOSE:===
To establish the review of EMS incident reports and on scene care to identify and continually measure the quality of emergency medical care being provided by Maitland Fire Rescue personnel. It is the intent of these guidelines to meet and/or exceed the requirements of Florida Statute 401 and FAC 64-E (section 8).<BR>

This review will be used to enhance training and Practice Parameter development/revision through the direction of the Medical Director. This process will improve the overall quality of service provided by the Maitland Fire Rescue Department. Maitland Fire/Rescue Department respects the privacy rights of patients as well as all EMS system providers and will to the greatest extent possible; protect individually identifiable information from public disclosure consistent with Federal HIPAA guidelines. This QA plan details the first four phases of the Maitland Fire/Rescue Department’s medical services QA plan:
* Patient Care Report (PCR) documentation standards.
* In-house PCR QA reviews within each provider agency
* EMS Medical Director QA Patient Care Report reviews
* In-house training as follow up to PCR review
 
===PROCEDURE:===
===Documentation Standards===
Maitland Fire/Rescue Department has developed a minimum documentation standard for over 50 different categories of patient encounters. Each category has specific documentation guidelines to assure complete documentation of the patient’s condition, as well as the treatments provided by the EMS providers.<BR>

A copy of the Maitland Fire/Rescue Department’s QA Documentation Criteria can be found at the end of this document, and is incorporated into the QA plan. Every PCR reviewed by the agency’s EMS representative or EMS Medical Director shall be evaluated based on these standards.
===Patient Care Report Review Standards===
Patient Care Report (PCR) reviews shall be conducted on an on-going basis to provide feedback to the individual providers and the EMS system as a whole. PCR reviews shall be completed internally within Maitland Fire Rescue Department EMS and externally by the EMS Medical Director.

===Internal Agency Review:===
* Maitland Fire/Rescue Department EMS Agency representative (Engineer/OIC/Preceptor – in the absence of the Engineer/OIC/ Preceptor the Lieutenant will be responsible) will conduct reviews on every PCR completed as logged and filed within the agency per calendar shift.
* Maitland Fire/Rescue Department EMS shall also conduct PCR reviews for the following types of patient encounters and present the most critical at the next scheduled Medical Director meeting.
* QA’s are to be completed on all reports entered prior to 1700hrs. on the day of the call.
* MFRD Lieutenant/OIC shall be responsible for checking the completion of all QA’s monthly to ensure no missing reports. **Cardiac arrest
**Trauma Alert Activated
**Stemi Alert Activated
**Stroke Alert Activated
**Hazmat Alert
**Advanced Airway Intervention
**Pediatric patients
**Refusals

All QA sheets shall be reviewed by the EMS Director/Coordinator (on duty Battalion Chief) and if any discrepancies or deviations from standing protocols are noted the QA sheet will be forwarded to the Fire Chief or her designee and if need be to the Medical Director for review and evaluation.<BR>

The EMS Medical Director will identify specific focus care areas for review each calendar month. Examples could include chest pain, diabetic emergency, allergic reaction, unconscious, refusals, etc. Up to ten (10) PCRs of these call types shall be provided to the Medical Director for review each month.

===Medical Director Review:===
The Medical Director shall review the selected PCRs during the monthly Medical Director meeting and issue a written summary of specific and general findings if deemed necessary. This documentation shall be utilized for the agency to provide additional feedback to the individual providers, as well to address agency wide issues. Medical Director Documentation shall become part of the agency’s QA files.

===Method of Review:===
All in-house PCR reviews shall be documented using the Maitland Fire Rescue Department QA advisement sheet, which is made a part of this program and included at the end of this document. The QA sheet will be completed according
to the QA program guidelines. Once the PCR review is completed, the EMS Agency representative (Engineer/OIC/Preceptor in the absence of the Engineer/OIC/Preceptor the Lieutenant is responsible for the completion) completing the review shall forward the QA sheet and provide feedback to the designated report author, who will then provide, either in person or by written summary, the report findings or corrections made. If trends are noted in patient care or treatment the information gathered in
the QA program will be used to guide company- wide continued education. The individual provider will have the opportunity to provide written comments regarding the review of the care rendered on the call. If a questionable pattern of behavior is identified in an individual provider, the Medical Director or a designee may choose to do direct clinical observation of the care of that provider in the field. Such reviews are not punitive, but aimed at improving the providers care.

===Summary:===
The goal of the EMS QA process is to improve patient care through the use of prospective training on documentation standards, retrospective PCR reviews and direct clinical performance observations by Maitland Fire Rescue Department Emergency Services. The cooperation of all EMS System stakeholders in establishing benchmarks and opportunities for improvement is vital and valuable. Finally, this plan outlines the basic, minimum requirement for EMS QA activities for Maitland Fire Rescue Department EMS. All members are strongly encouraged to exceed the standards identified here to assure the highest quality patient care possible.