Middleborough Fire Department

[Audio] In this E S O patient refusal presentation, we will discuss the importance of reporting patient refusals of care, how to document refusals in ESO, the legal and ethical implications of patient care refusal, and the required fields to obtain a refusal..

[Audio] It is crucial to report patient refusals of care as it is part of the medical record and provides documentation of the patient's decision. Documentation of refusals can help prevent future liability claims against Fire Department personnel and The Town of Middleborough. Additionally, reporting patient refusals can aid in determining if there are any underlying issues, such as language barriers or cultural differences, that may need to be addressed..

[Audio] E S O allows healthcare providers to document refusals of care easily. To document a refusal of care, healthcare providers should create an electronic record of the refusal within the E S O system. The record should include the patient's demographics and contact information, Vitals, the date and time of the refusal, scene location and information, the narrative section, the specific care that was refused, the providers' signatures, the patient's reason for refusal and the signature of the patient or guardian of the patient. In the event a patient or guardian refuse to sign, have a witness sign if possible. Additionally, providers should document any discussions or attempts to persuade the patient to accept care..

[Audio] Under the heading tabs, begin with the Incident Tab located in the top left of the screen..

[Audio] While working in the Incident Tab, available fields are Response, Scene, Personnel, Disposition, Destination, Times, Mileage, Additional, and Fire Incidents..

[Audio] The first field listed is the Response field. The Response field requests response specific details including responding vehicle information, Run number, and the E M D complaint. Much of this information will be consistent throughout your day if you are using E S O consistently, for incidence, your shift. Information drop down boxes are available throughout the fields by clicking on the triple bar icon to the right of the line item..

[Audio] The next is the Scene field, which includes information on the property type and the address. This may or may not be the contact address of the patient..

[Audio] Personnel fields, as expected, would list the responding personnel. This field also requires the user to input the roles of each provider on scene and the P P E worn by each along with the potential of any exposure issues..

[Audio] This information can be accessed by clicking on the edit fields to the right of each listed provider..

[Audio] When accessed, each line will have a drop down box provided that specific and multiple items may be selected..

[Audio] The disposition field describes what the outcome of the patient was, whether the patient was transported or not. In this case of a refusal, the disposition of no transport auto populates the next line requesting the refusal reason..

[Audio] Because in this case there is a refusal, the destination field is obviously not required..

[Audio] As with any call, times and date must be accurately logged. The only time that is not necessary is the transfer of care time, this may be left blank..

[Audio] As is the case with the destination field, both the milage field and the additional factors fields are not required..

[Audio] The final field under the Incident Tab is the Fire Incident Field. This describes the incident and property types along with actions taken..

[Audio] The next set of fields fall under the patient tab. This documents pertinent information about the patient..

[Audio] Information under the Patient tab that is required are the demographic and contact fields. This includes name, date of birth, and contact address. Note, if the contact address is the actual scene address, this may simply be imported from scene field in the incident tab..

[Audio] The other available fields are History, Allergies, Medications, and belongings. Other than belongings, although not required, history, allergies, and medications fields are part of your SAMPLE history and should be done when possible..

[Audio] The next set of fields are under the vitals tab..

[Audio] The vitals are accessed by clicking Add Vitals..

[Audio] Upon clicking the add vitals icon, the screen will open up to the vitals page. The only required fields are time and date, along with Glasgow coma scale found under the scoring icon and pain scale. Although these are the only required vitals, a full set of vitals should be performed provided the patient consents..

[Audio] The flowchart tab, although not a required field, documents many of the skills that we can perform during patient care and are accessed by clicking the corresponding green tabs at the bottom of the screen. Most of these, if performed, would likely turn out to be a transport. However, there may be some fields within the other green tab, located to the right of the green tab bar, that may be applicable and you may want to consider in your assessment and treatment of the refusal patient..

[Audio] These could include Bandaging, B L S Assessment, or Ice pack..

[Audio] The assessment tab allows you to document a full head to toe assessment on a patient by clicking on the green add assessment icon on the bottom of the screen..

[Audio] Although this tab is also not a requirement, it may better document why you thought the patient should be transported and evaluated at a hospital..

[Audio] The narrative fields further documents the patient complaint, subjective and objective patient assessment information, and the patient care narrative. The associated fields include, impression, signs and symptoms, complaint, injuries, factors, and narrative..

[Audio] The impression field is used to describe what issue and the associated body system is affected. There is also an area to determine whether the incident is a trauma, medical, or a trauma and medical call. Keep this in mind for a later slide, the trauma indication will activate another assessment field..

[Audio] The two fields signs and symptoms along with complaint describe what the patient's main complaint is and any associated objective and subjective data gained from your assessment..

[Audio] The injuries field gets into more detail about any injury to the patient. In this case where there was no documented injury, there is nothing more to submit..

[Audio] Factors relate to any Sensory, Cognitive, Psychological, or physical barriers that prevent the effective communication between the provider and patient. This field opens questions regarding pregnancy..

[Audio] The final field for the narrative tab is in fact the narrative field. This is the providers narration of the response to the scene, survey of the scene, initial patient presentation, patient assessment, care rendered, and patient outcome. In the case of any call, even a refusal, it is important to document thoroughly about the above observations and actions..

[Audio] The forms icons are special studies and specific questioning further associated with a specific topic whether stroke, C P R, or a motor vehicle collision. These fields are designed to help prompt the provider in thorough documentation. In the case of this particular refusal, in the impression field, under the narrative tab, trauma was indicated. Although very minor, it was a trauma incident. If the woman fell to the floor because she felt faint, it would have been a medical/trauma indicated in the impression field. Indicating any trauma event will automatically bring up the trauma icon form to be filled out..

[Audio] The more specific questions associated with the traumatic event help to indicate in this case that this particular patient does not qualify for a trauma point of entry facility because the incident was in fact so insignificant..

[Audio] The billing tab is a section that Middleborough Fire Department personnel do not have to fill out. Because we are a non-transporting entity, we can not bill for our services. The contracted E M S provider must complete this section in order to obtain payment for services..

[Audio] The signature tab has sections on authorization for transport, facility signature pages, and the controlled substances waste page; all of which Middleborough Fire Department personnel do not have a need for. The remaining two icons, provider signatures and refusals will be the focus. First the provider page will open 4 fields for provider signatures. The refusal page will open fields for the lead provider signature; then a section for the patient, parent, or guardian signature; and in the event that you can not obtain a patient, parent, guardian signature; there is a field for a witness signature..

[Audio] Here, the provider signature clearly shows the provider printed name and signature. In this example, there is only one signature, the lead provider's signature is on the refusal page in this example, however, if needed, there is room for four provider signatures as you scroll down..

[Audio] The refusal icon page has multiple areas. Capacity assessment is the first section in the refusal consisting of assessment of legal, conscious, and medical competency to sign..

[Audio] The medical command section is there in the event you contact medical control to help persuade a patient to seek transport and treatment at a hospital. An example of a time when this would be used is when you are confronted with a chest pain patient, in the denial phase, with clear signs and symptoms consistent with a myocardial infarction..

[Audio] The patient notifications is the area specific for the lead provider to document the concerns of the refusal of the patient and an area for the patient signature..

[Audio] The patient refusal section lists exactly what is being refused by the patient and their reason for refusal should be entered. Following this is the legal statement releasing liability from the providers..

[Audio] Scrolling past the legal release statement, there is a section for the patient, parent, or guardian to sign with the typed name above..

[Audio] Sometimes there are patients that simply signed with an x mark or are not compliant with the request for their signature of refusal. In this case you may scroll down further for a witness signature. This could be another family member or friend on scene, a bystander, or a police officer on scene. If there is no other person available, the last resort should be a Middleborough Fire Department crew member..

[Audio] To ensure the run report has the minimum required information, click on the check mark in the upper right hand corner of the report. Any critical areas that are not complete will be listed..

[Audio] The unfinished critical criteria will be listed with a description of the issue. Upon clicking on the red critical bar, you will jump to the area that requires information..

[Audio] In this case, the time was entered incorrectly. The correct time was inserted and the check mark was depressed..

[Audio] The completed run report is shown. At this time, if you are comfortable with your report, press lock report to close the report. Once the report is locked, it can not be edited any further..

[Audio] When a patient refuses care, it is important to respect the patient decision, but it is also important to ensure that the patient is fully aware and understands the potential risks and consequences of refusing care. Healthcare providers have an ethical and legal obligation to ensure that the patient is fully informed of the risks versus benefits of any treatment or procedure. Providers should also document the informed consent process thoroughly..

[Audio] In conclusion, reporting patient refusals of care is essential for providing accurate and complete medical records. ESO allows healthcare providers to document refusals easily and provides a comprehensive record of the patient's decision. Proper documentation of refusals can help prevent future liability claims, aid in addressing any underlying issues, and ensure that patients are fully informed of the risks and consequences of their decisions. Thank you for watching our presentation on ESO patient care refusal reporting..