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jfd347

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Howdy folks. I'm a FTO at a private company in central Indiana. I do a decent job training people except when it comes to naratives. I have one girl now that is really struggling. I know what I need in a report but I have a very hard time explaining it.

Can anyone provide any rescources that I can give her to help her out? Well... and help me out teaching?

Thank you much.
jfd347
 
My company provided me a sample of a written narrative and then a sticker to put on my quick-flip guide with the required elements.

Like everything in life, some people had long run reports, others wrote only a few words. That will be up to you and your service to decide what is write, but it's important to teach the skill correctly.

It went something like:

B123 dispatched priority 1 to 123 main street for a female complaining of chest pain. ATF 38 y/o female sitting upright in chair.

(C) Pt complains of _____________.
(H) Pt history and medications, learned by ________, listed below. Additionally, ______________________
(A) (General appearance of pt noted. Pt. AOx3. Pt. was either + or - for "pain." Then pt. was either + or - for: head pain, neck pain, chest pain, abdominal pain, pain in arms and legs. Pt was either + or - for nausea/vomiting. Pt vitals and condition monitored as noted below. Of course this section could be much more detailed, but this was usually enough for a BLS transfer.
(R) Pt. positioned in position of comfort. O2 via NRB @ 2 LPM. (etc.)
(T) Pt moved to stretcher via sheet drag from hospital bed. Pt secured with straps X3, rails raised. Pt secured in ambulance. Vitals and condition monitored during transport. Pt transported without incident or change in condition. Pt moved to ______ via ____. Pt belongings bag left _____. Full verbal report given to staff.While what I've written looks like a lot, there are a ton of abbreviations for almost all words I've written. Make sure that if you use an abbreviation, it's an accepted medical abbreviation. If you didn't write it down, it didn't happen.
 
I always taught CHART to be a mnenomic to remember an organized hand off report. It hardly covers the territory that a comprehensive PCR should cover.

A comprehensive narrative is pretty much a script of the events, both seen, heard, spoken, and performed, written after the fact. The only help that can be rendered is practice. Short scenarios is all that is necessary. A narrative is just as comprehensive for a short scenario as it is for a complex scenario.

It is sort of like the old computer games. You cannot simply say "grab the key from the closet" (as in the old Kings Quest or similar role playing games.) You must say "See the door, the door is brown, approach door, see the door knob, grasp door knob, turn door knob, pull door towards self, look into closet, the closet is dark, utilize flashlight, see key on shelf, grasp key...."

Get the idea?
 
jfd347 said:
Howdy folks. I'm a FTO at a private company in central Indiana. I do a decent job training people except when it comes to naratives. I have one girl now that is really struggling. I know what I need in a report but I have a very hard time explaining it.

Can anyone provide any rescources that I can give her to help her out? Well... and help me out teaching?

Thank you much.
jfd347
Click to expand...

The DCHART is what a lot of us are taught, and, yes, it's not always enough. The thing is you need to prove in black and white that not only what you did was appropriate, but also every time you moved your patient nothing changed. And if it did, how did it change.

If you intubate a patient, you need to prove you put it in the correct place: with direct visualization, equal chest rise/fall, positive bilateral breath sounds, no epigastric sounds, positive color change on EtCO2 detector (what color change), improved vital signs, ETT mark, and positive waveform on EtCO2 monitor. Chart how you secured it, too. Chart that not just on intubation, but also each and everytime you move that patient.

The same thing goes for MVC pts on LSB's. Every time you splint something, chart Pulse/Motor/Sensory before and after. Also, chart that on each and every time you move that pt. If anything changes, chart how it changed, and what you did to fix it, and what you did if you couldn't fix it.

Expect carpal-tunnel syndrome. The best charters have it, or will.
 
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Our forms are pretty straight forward as they are government regulated.
I always have a thorough PCR because if it isnt there you didnt do it and I get subpoenaed on a regular basis up here. Alwas make sure you cover your *** in everything you do.

D/T(dispatched to) - always put this because dispatch is always wrong..not their fault but they are
O/A(on arrival) - how I found the patient and if there are people there and C/C(chief complaint of patient unless uncx then I ask bystanders if they know) Also get any other information that may be pertinent.
O/E(on exam) - Pt Uncx/Cx A/Ox3/4 A - aiway B - breathing C - circulation Skin - presentation, feel, temperature
HEENNT(head, ears, eyes, nose/neck, throat) - JVD, Trachea M/L, N/V, Discharge
CHEST - chest pain, sob, air entry
ABD - palpation of 6 quadrants..and tenderness...soft ridgid
PELVIS - is it stable and instact
EXT - grip strengths, PMS
BACK - presentation..pain?
L/M (last meal)
BM/Urination - frequent, normal, odor
PMHX
MEDS - if taken or not with a list of dosage and frequency

If it is a transfer I would also write here in the O/E IV size of cathlon, fluid and rate...how much infused prior...catheter..size..and output..etc..

Then we have a spot for TX(treatment)
I go step by step with what I did
Pt Hx & Assessment
V/S
Pulse Oximetry
Oxygen
Glucose Testing
Pt extremity lift onto stretch -> Unit #123
Reassessment - (write here if any changes or improvements with anything)
V/S (again)
Pulse oximetry
Any other TX I might do
Pt Sheet life from stretcher to hospital cot
Care of Pt transfered to (name)RN

If medications or procedure are done then I would insert them in the appropriate order in my TX section.

There is a spot on PCR's to put who you made your report to over the radio as well.

Dunno if this helps at all for anyone who has a problem with writting there stories.

MDKEMT
 
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Remember though, you have to make sure your narrative fits your PCR. A lot of new PCRs are now covering findings that used to go in the narrative. It is bad practice to fill out all those options (usually checkboxes or 1-2 line sentences) and then repeat all that information in your narrative. You would be setting yourself up for a discrepancy in your own chart that a lawyer would tear you up for if it ever came to it.

At this point, all my findings on the pt are covered in my ePCR. There's a section for the head to toe, a chief complaint section (including OPQRST and a small narrative box for the pt's complaints), there is an initial findings page that covers most of the bases as well as a much more in-depth treatment and response page which is where I put all my neuro/ETT/etc. rechecks during pt movement and other treatments.

Basically my narratives are now just a short paragraph telling the story of what I found. I teach people to write them so any layperson reading them could understand what happened on the call. Usually starts out "Medic 261 dispatched priority 1 to a residence/SNF/Airport and arrived to find a patient in care of FD complaining of non-traumatic lower back pain." I don't go on to describe the pain because that's already been done before in my PCR. All I do is tell the story of what happened. I'm always sure to end it with where the pt requested to be taken and that transfer of care was handed off upon arrival (especially since RNs don't sign for pt's here anymore).

Granted if you are teaching them to write a full narrative then you do need to include the items listed in the above posts.
 
Ours make us do a narrative. No choice hehehe

MDKEMT
 
I worked for an ambulance service that we had to do hand written run reports. Sucked!!! They just always took too long. They have since moved to an ePCR system.

One of the many advantages we get from our system is if you've seen the patient once, the laptop stores all their information (allergies, medications, and past pertenant history) for all time. So I can actually start to gather this information prior to even hitting the scene.

Also, as I'm filling out the run report on the toughbook laptop in the field (or hospital) it is storing all the vital signs, OPQRST, associated signs and symptoms, MSI, and medications/interventions (based on the times entered for each). It compares the times for each entry to my "on scene" "leave scene" and "at hospital" times and actually formats my narritive for me (in SOAPIE-A format). From there I simply click into the narritive field and write what I personally want to say around what the narritive generator made for me.

Hope this helps.

Good luck everyone.
 
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We were taught SAMPLE and OPQRST.

S-Signs/Symptons
A-Allergies
M-Medications/Med Hx
P-Provocations
L-Last Oral Intake
E-Events Leading to 911 call

O-Onset
P-Pain Type
Q-Quality of Pain
R-Radiation of Pain Y/M
S-Severity 1/10
T-Time pain started

Don't know how different it is from everything else.
 
The best way to learn is to get a subpoena. Your charting will get a whole lot better the very next day!
 
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