Team training program's impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol

INTRODUCTION

Medication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing safe and effective patient care, especially in a time-sensitive, high-risk environment such as the ambulance services. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme that, to our knowledge, has not been studied in the ambulance services previously. TeamSTEPPS is based on the five principles: team structure, communication, leadership, situation monitoring and mutual support. This study aims to advance the knowledge of the medication administration process in the ambulance services and study the impact of a team training programme on the frequency of MAEs, and the perception of teamwork, and patient safety culture.

METHODS AND ANALYSIS

This study uses a longitudinal multimethod design to evaluate medication administration and the implementation of the team training programme TeamSTEPPS in an ambulance service. A review of electronic patient journals 6 months prior to the intervention, and 12 months after the intervention will provide data on the frequency of MAEs. Focus group interviews and questionnaires will be carried out before and after the intervention to describe the perception of teamwork and patient safety culture among ambulance professionals. Observations, individual interviews and a review of guidelines will be conducted in the first and second quarters of 2022 to study the medication administration process in ambulance services.

ETHICS AND DISSEMINATION

The study protocol was reviewed by the Regional Committees for Medical and Health Research Ethics Central Norway and approved by the Hospital Trust data protection officer, and the head of the Prehospital Division at the Hospital Trust. The data material will be managed confidentially and stored according to regulations. The results will be disseminated through scientific papers, reports, conference presentations, popular press, and social media.

TRIAL REGISTRATION NUMBER

NCT05244928.

Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study

Background

The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need.

Methods

A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms.

Results

Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor.

Discussion

This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process.

Conclusions

This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.