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Community Paramedic FLEX Grant CP Program VisitationWho: Jessica Mathews, ParamedicWhen: August 22, 2019Where: Eagle County Paramedics – Avon, Colorado with Kevin Creek, Community Paramedicine Program Coordinator (3 years in this position)TopicInformation/Lessons LearnedHistoryProgram is in its 11th yearInitially a conditional home health license (hired home health nurse to help with guidelines and regulations)2017-2018 obtained Community Integrated Health Care Services license ()Initially provided: INR, lab work, post discharge follow-ups, medication reconciliationHave an advisory board that meets at least quarterly to discuss the forward focus of the programAdministration1 coordinator and 3 CP specific positions24-7 coverageSUV (see more information below)Based out of their Avon, CO station which is the middle of their coverage area. Administration is located in Edwards, COCurrent focusAmbulatory detox. Alcoholism is the major addiction focus in Eagle County. With this program, patients are provided with 2 days’ worth of medications. CP checks in the patient to see if they are being complaint and can request additional medication. Patient is also set-up with mental health. 4-week programs (2 visits a week for the first two weeks, then 1 visit a week for the next two weeks).Crisis calls. CP responds on all 911 mental health calls. This includes calls that only the PD is sent and/or ambulance. CP and a member of the Hope Center’s mental health staff respond to the call. The CP and Hope Center staff are able to provide medical screening, medication (PO Ativan is CP SUV), referral, and follow-up. Currently this service is preventing 78% of patients needing to be seen in the local emergency rooms. FundingInitially was grant fundedCP is now multiple line items in the budgetCurrently in negotiations with Anthem and other payer sourcesReferralsReceived through a secure faxColorado requires a physician signature, diagnosis and plan for what they want the CP to do. Majority are 1x visits, but they have at least 2 patient’s they have been seeing for 9 yearsThey do have a protocol in place for a nurse practitioner to refer911 crew internal referral form. Once returned from a call the crew can complete a referral form and the CP program director will work to get a home visit through either their PCP or the CP’s medical director.CP Program Director calls each patient to discuss program, patient has option to refuse, and then appointment made. Ambulatory detox patients are most likely to refuse.Home VisitsTypically, 30 minutes to 2.5 hoursCrisis calls tend to be longer – if PO Ativan given the CP must stay with the patient for at least 1 hourDocumentationUtilize about 1/3rd of their Zoll PCR with the majority of their charting being the narrativeThey fax a “Physician Referral Summary” back to the physician within 24 hours of a CP visit. They modeled it after typical doctor H&P forms for consistency. Found that providers were confused by the EMS PCR.Each patient has a folder that has each PCR, Physician Referral Summary, and a Patient Chronological that is like a running nurse note. Helpful for all the CP’s to keep up-to-date and a place for information that does not need to be in the PCR, but needs to be documented. Especially helpful for telephone communication, messages and if a patient refuses service.StaffingHad a discussion about managing CP personnel. Kevin stated that he does not recommend a brand-new medic, that they need to be well rounded and it truly comes down to the person. One of his best CP’s is a 60 y/o female that connects well with the home visits and does extremely well with crisis patients. HurdlesInitial hurdles included nursing associations (thinking CP was taking over home health), funding, and internal paramedic hurdles (taking away 911 calls)Current hurdles are getting physicians to remember to refer. Working with the care coordinators to increase referrals. Having to work to build relationships with the care coordinators.Who has all social determinants of health referral information – someone has to be the keeper of “the book”FutureDo they need 2 CPs on 24-7 – increase in crisis callsShould CPs be used for transportation to alternative destinations (doctor visits, urgent care, dentists, etc.)?More outreach (mobile clinics, more exposure in the community, what other resources to pair up with)More/better/stronger involvement with their hospitalSUVHas a police-like barrier between the front and back seat for safety during patient transportBase radio – they call e n-route, on-scene, and clearLocked narcotic box that has 1mg Ativan PO x2 for crisis callsSee CP Bag/Supplies for more comments CQI100% CQI on reports by the CP medical director – CP medical director is a primary care physician.ProtocolsCPs are able to utilize any of Eagle County’s 911 protocols and the CP protocols are in addition (they did not want to reinvent the wheel)I have an emailed copy of their CP protocols (sent to June and Dr. Childers).CP Bag/SuppliesHave a LifePak 15, but going to be putting an AED in their stat bag because they do not bring the LifePak in on every call.Adult and pediatric scaleStat pack that includes IV supplies, basic O2 supplies, trauma dressings, and 1st line ACLS drugs (looking to not carry because if a code focus will be CPR and AED knowing 911 response coming)CP bag includes INR supplies, lab/blood draw supplies, stethoscope, BP cuff, pulse oximeter, otoscope, glucometer, thermometerTwo of the CPs carry a tote bag with what they need for each patient and leave the majority of the equipment in the SUVVisitLessons LearnedDiscussion with KevinMy goals for the visit, questions and answersHome visitMedication reconciliation and fall safety. Very much how my community health worker visits have been going. They do perform a set of vital signs (P, BP, RR, & LOC), lung sounds and heart sounds on all patients. Tour of Area/Eagle County EMSMore discussion of their coverage area, demographics, access to healthcare, social determinants of health, etc.Continued discussion/Protocol reviewContinued the discussion which is outlined aboveRead through their protocols with a copy emailed to my PVHC emailClarification and rationale discussion about their paperwork and protocolsCrisis callNo crisis calls during the shift ................
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