National Patient Care Report (PCR)
The PCR was developed in order to assist in the measurement and management of ambulance service information from a national perspective. It has been implemented as follows:
- HSE ambulance service (except HSE South East)
- Dublin Fire Brigade
- All PHECC-Recognised Institutions
- All CPG-approved organisations includingstatutory, private andauxiliary/voluntaryambulance service providers.
All PCRs are stored accordingto the PHECC Clinical Record Management Guidelines(available from info@phecc.ie or download from www.phecc.ie). These guidelines define the storage requirements which ensure that records are maintained, managed and controlled effectively in accordance with the legal, operational and information needs of the prehospital emergency care practitioners, responders and ambulance service.
Cardiac First Response Report(CFR Report)
The CFR Report meets the requirements of the international ‘Utstein Template’ which was developed to summarise a specific set of survival rates and outcomes post-cardiac arrest.
The CFR Report has been deployed as follows:
- Community responder programmes, both those coordinated by the regional ambulanceservices and the standalone responder programmes
- Numerous fire services nationally
- An Garda Síochána
- Various colleges, schools e.g. IT Colleges
- Occupational Health Departments of large manufacturing companies/organisations e.g. Intel, Millipore, Burger King.
Concerns regarding the handover process of the CFR Report exist, particularly in regions where the community responders programmes are not coordinated by the ambulance service. PHECC advise that where a CFR Report is completed it should always be handed over to the practitioners who arrive at scene and it will be part of the handover documentation at the hospital/destination facility. The next edition of the PCR will include a CFR Report tick box which will indicate that there is also CFR Report completed.
This handover process applies to all users of CFR Reports.
Patient Transport Report (PTR)
The PTR was developed in response to feedback received from some services who were planning to record patient transport information on the PCR. The PTR’s recommended use is in circumstances where the transport is planned and where care is limited to the administration of oxygen or stretcher requirements. The practitioner may make a decision to commence a PCR enroute if patient condition necessitates.
The PTR has been implemented in the following statutory ambulance service areas:
- HSE West
- HSE Mid West
- HSE Midlands
- HSE North East
HSE South use the PCR for patient transport journeys.
HSE North West and HSE Eastern Area are currently using their own PTR.
Ambulatory Care Report (ACR)
The ACR is being developed in response to requests for a report which will record minor injury patient details and treatments. A DRAFT data set has been developed and is currently being reviewed. PHECC propose the use of Digital Pen technology for use with the ACR. This technology was deployed in the past in a Cork City ambulance station. The trial time was 6 weeks and the conclusion was that this technology was not suitable for front line emergency ambulances and would be more suited to the entry of minor injury information. Based on this recommendation we are going to proceed with the deployment of Digital Pen Technology for the recording of minor injury information on the ACR. We are currently liaising with our paper suppliers regarding the specialised paper requirements for use with the technology.
Electronic Data Capture
ePCR tablet PC
The electronic Patient Care Report (ePCR) is an advanced electronic patient care recording system that enables clinical and incident information to be captured at scene or as close to the incident as possible. The patient information is captured by the practitioner on a tablet PC and then transferred real time, via GPRS/SMS technology, to the destination hospital.
The associated system integrations are
- Computer Aided Dispatch (CAD) from Control Centre; and
- LP 12 integration.
The primary outputs from the system are
- ePCR Reporting Module; and
- eTriage module.
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The ePCR integrated system has been implemented in the HSE North East. During the implementation there have been many issues both from a connectivity and a device perspective and user training perspective. These problems have been addressed as far as possible but nonetheless from time-to-time device issues do occur. At all times, if the fault cannot be fixed by the practitioner immediately, the fall back procedure is to revert to a paper PCR. Following patient handover the practitioner should always check the Trouble Shooting Guides/User Manual for a solution before returning the device for repair. From July,a pre-labelled ePCR Repair box will be available in all stations in addition to a fault sheet which should also be completed prior to return of the device.
The implementation of the ePCR integrated system nationally remains a vision for PHECC and we are working closely with the HSE to keep this important channel of communication open for the future to enable this roll out to occur.
Dublin Fire Brigade plan to implement the ePCR integrated system later this year. Significant progress has been made with regard to the installation of the back end systems and successful testing of these has occurred. Consideration is currently being given to tablet PC type for deployment and this stage will be followed by a communications exercise in Dublin City and County Emergency Departments (EDs).
ePCR data entry
The ePCR data entry programme is available for implementation in all PHECC-approved organisations and CPG-approved service providers.
What does it do?
The ePCR facilitates the retrospective entry of PCR information on the ePCR national data base. This can be carried out following the installation of the ePCR CD on to a designated internet enabled PC.
See the ePCR data entry User Manual and associated PHECC Gateway Guides for all data entry and data transmission instructions.
ePCR data entry has been implemented as follows:
- Order of Malta
- Civil Defence
- Irish Red Cross
- Private ambulance service providers - Needford, HeartER, Murray, Beaumont and Cara
- St John Ambulance in the planning phase.
If you are interested in implementing ePCR data entry in your organisation contact jacqueline@phecc.ie
Out of Hospital Cardiac Arrest Register (OHCAR)
OHCAR is a project established to create an outof-hospital cardiac arrest registry which will facilitate research into out of hospital cardiac arrest (OHCA) in Ireland. This data will allow us to describe and analyse the OHCA population, case management and patient outcomes in the pre-hospital environment. It will provide an Irish evidence base for pre-hospital resuscitation service planning. The first national data headline from the data of the first 200 cases show that 6.5% (13) patients survive to discharge.
The OHCAR project is funded by PHECC and run in cooperation with the Department of General Practice, NUI Galway and the Department of Public Health Medicine HSE North West.
OHCAR collates cardiac arrest information on patients who had witnessed arrests and were attended to by the emergency services where resuscitation was considered or attempted.
The patient data is retrieved, primarily from the PCR with supplementary data extracted from the ambulance control logs. Patient outcome data is gathered from the admitting hospitals allowing calculation of survival rates and assessment of neurological function at discharge.
To date OHCAR has been implemented in the HSE North West, Midlands and North East. Initial meetings have taken place with HSE South, Eastern and South Eastern Regions; follow up meetings are planned for HSE West and HSE Mid West regions. Initial contacts have been made with Auxiliary and Voluntary providers.
Current Data Projects
1. Development of Edition 3 PCR with particular emphasis of a requirement for further space for the recording of medications, care management, vital observations and out-of-hospital cardiac arrest information.
2. Development of the PHECC Information Standard. This will include the data elements from all pre-hospital patient reports including the new edition 3 PCR, the CFR Report, PTR and ACR.
3. Revision of current Glossary of Terms. This will now reflect the EMS Priority Dispatch Standard and the Inter Facility Patient Transfer Standard.
4. Following evaluation of the SWID (Strengths and Weakness IDentification) model of Clinical Audit we look forward to further deployment of same nationally. We will have a SWID overview and report in the next PHECC newsletter. (If you are interested in implementing the SWID model in your ambulance station contact jacqueline@phecc.ie).
5. Continue discussion with the HSE regarding national roll out of ePCR and associated system integrations.
6. Implementation of ePCR in Dublin Fire Brigade.
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