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Sunday, November 1, 2009: 4:15 PM
Learning Objective 1: state why on-scene (or on-site) observational research is important to improve quality.
Learning Objective 2: state the most common reasons for protocoldeviation by ambulancenurses and to adapt this in their own practice.
Protocoladherence amongst ambulancenurses: an on-scene observational study.
Background:
Ambulance care in the Netherlands has a high standard of quality. Ambulance nurses in the Netherlands are allowed to perform various advanced medical procedures. These procedures and their indications are documented in protocols, developed by the national ambulance protocol council.
Aim of the study:
The purpose of this quantitative observational study was to investigate the degree of protocol adherence amongst ambulance nurses and to examine the main deviation points.
Methods:
This study addresses the protocol adherence on-scene and is, as far as known, unique in this design. Other investigators studied protocol adherence, but the value of their results was limited by the fact that they were retrospective reviews of written documentation.
The investigator observed 237 ambulance trips. Deviations from the protocol were divided into groups, for instance deviations in medical treatment and physical examination. We also investigated the relation between the deviations and years of experience, the specialist nursing background, and motivation for deviation.
Results:
The total percentage of deviations was between 40% and 60%, which is comparable with the international literature.
Analysis of the percentages of deviations showed that ambulance nurses who had worked as an ambulance nurse for 10 years or more, deviated from the protocol more often than less experienced colleagues. Most deviations occurred during physical examination, sequence of the protocollary assessment and treatment, and medication errors. Using an univariate analysis these deviations showed statistical significance in relation to years of experience. After logistic regression analysis however, no significance could be found.
Conclusion:
Protocol adherence in the Dutch ambulance system is similar to that of other countries. It remains however far from optimal. Therefore, further research is recommended to explore the underlying causes and motivations for deviating from the protocols. With a better registration-, feedback- and control system, protocol deviations could be analyzed and subsequent training needs could be adequately determined.