Regulations, Standards & Documentation

In this article, Dr Elizabeth Hardman of The Royal Flying Doctors Service in Australia discusses how risks of transfer can be reduced through regulations, standards and documentation.

Minimising risks through standards and regulations means setting a required level of quality, and then adhering to that level of quality, and achieving those standards and meeting the requirements of regulations through training and design.

• Standards are often developed and published by central governments, but may come from industry leaders, product developers or medical colleges using a system of risk analysis and evidence bases to make the recommendations in their standards.
• There are similar themes that emerge across many of the set standards from all over the world. Every country has modified standards to meet the requirements of their individual population demographics. As an example, we’ll look at the relevant standards and regulations governing ambulances and transfer vehicles around the world.
• The International Standards For Transfer Vehicles are useful further reading if you’re interested in seeing some differing vehicle standards around the globe.

European Committee for Standardization (CEN) Standards

• These standards apply to road ambulances capable of transporting at least one person on a stretcher (excluding hospital beds).
• The standards cover requirements of the vehicle design and performance including the ergonomics of the patient compartment. They do not cover staff training.
• Complying to CEN standards can avoid injury to the patient and staff.

“All persons and items (e.g. medical devices, equipment and objects normally carried on the road ambulance) shall be restrained, installed or stowed to prevent them becoming a projectile when subjected to acceleration/deceleration forces of 10G in the forward, rearward, left, right and vertical directions” CEN Criteria EN 1789

What Is Regulated?

• You might be surprised on what is included in the regulations! Next to the vehicle specifications, the exterior colour, lettering etc. are standardised.
• For blue lights a 360 visibility increases safety, and the pattern and volume is regulated and very specific for ambulances in each country. Usually you can differentiate police and ambulance by just hearing the siren, all of which increases safety for us and our patients.

Standards specify requirements for ambulance vehicles including design, ergonomics and equipment and exist to protect staff and patients to reduce the incidence of adverse events.

Documentation

• Often the documentation during transfer is viewed as an annoying necessity, but is crucial for many reasons.

• Documentation is important both for medical record keeping and for governance. It is important to keep records in compliance with local security and privacy laws.
• Depending on your team, paper or electronic records may be preferred. Transport team staff should have a clear understanding of what information is expected to be collected, how and where it should be stored, and how it will be used.
• Referring or accepting teams may need access to transport team documentation and it is essential to determine in advance what information will be shared and how this will be done.

Your documentation is the proof of care provided

It’s often a medico-legal requirement to keep patient notes

It allows the receiving team to understand what happened during the transfer

Data is used for financial calculations, research and audit

Driver of quality improvement within a service (learning from incidents)

• The transfer record also helps us understand why adverse events happen – it is through these records that we can learn from and prevent future adverse events, driving quality improvement in service delivery and design.
• For many years various services have tried to facilitate documentation through electronic solutions. Traditionally, the transfer document in an ambulance setting has been in paper form, but in the pre-hospital setting electronic documentation has been trialled in the last few years. These electronic patient records are becoming more popular.
• The most important aspect of documentation is not how it is recorded but the content. It should be a contemporaneous and accurate account of all events and monitoring during a transfer. We will explore documentation in further detail in Week 3.

References

In the next section we’ll be introducing you to human factors and why they are needed to minimise the incidence of not only adverse patient events, but also harm to staff during transfers.