what happens when you deviate from protocol?

DrParasite

DrParasite

The fire extinguisher is not just for show
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Question for providers of all levels....

if you deviate from your protocols, the ones that were approved by your medical director and operational supervisors, what happens?

If your deviations did not negatively impact the patient in any way, or were actually appropriate (but still contrary to what your protocols say to do), what happens?

This is assuming that it gets flagged in a random QA/QI list (which can happen to any call), or someone in the ER asks why you deviated from agency protocol.

Looking for how other places do things before I give more information about why I am asking.
 
If we deviate without permission it is punishable by suspension up to termination.

Even if its something like doing a procedure that is post radio, without calling med control first.
 
Current job and last job? Write it up as a variance (mainly why you varied), it will be QA'd and if appropriate you'll get an "attaboy good job" if not non-punitive correction will be initially applied.
 
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usalsfyre said:
Current job and last job? Write it up as a variance (mainly why you varied), it will be QA'd and if appropriate you'll get an "attaboy good job" if not non-punitive correction will be initially applied.
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Pretty much the same here.
 
firing_squad_2.jpg
 
Our standing orders state:

Standing orders are not intended to provide definitive treatment, but are intended to stabilize the patient prior to transport to the hospital for definitive treatment. Deviation from standing orders may be undertaken only by direct order from an approved medical control physician serving as Medical Command within an approved facility.
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We also have to write a variance and be able to defend our actions in the chart review process.
 
Same as usals. QAd, be able to back it up, get an attaboy. Helps to be on real good terms with your med director, though.
 
We generally have to write up why we deviated from protocol, and then talk to our medical director about it. It will inevitably come up at QA and we'll have a group discussion about it.
 
Generally if you can explain it, and it seems like you did what any logically thinking person trained to your level would do, then you are alright... even if the pt. outcome is not positive.

For example: our protocols state that if you put someone on a long board, you HAVE to put on a cervical collar. I've been on a number of calls where the only way we were going to get the person out of the house was on a long board. There was no suspected spinal injury, and so the collar was left off. This would be explained to hospital staff and documented in the chart. I've not heard of a single case where that has come back to bite someone.
 
Call the doc let them know what's up bounce your idea off of them and 9/10 times they say well whatever you think needs to be done then do it. And if you do deviate from protocol it's not the end of the world.
 
And if you do deviate from protocol it's not the end of the world.
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This depends on where you work. Some places are very strict and you will be suspended while they investigate the deviation, and may be fired even if what you did was logical. Some services are very like the military, if the rules say to do A you do A or suffer.

There is almost nothing that I can think of that one would do that is both in violation of your protocols AND you don't have time to call in and ask.

I'd also point out that there is a big difference between sins of omission and sins of commission. It is much more defensible to not do something your protocols say you should, ie by arguing that the protocol doesn't really apply to the situation, than it is to explain why you actively did something that wasn't in protocols or that is specifically prohibited.

So you are much better off being in the situation where you didn't give nitro for chest pain because you felt the patient had a borderline BP of 101/60 than you would be if you gave nitro to a patient with a BP of 90/60 if protocols say the BP must be at least 100 systolic.
 
Our medical director trusts us to use good clinical judgement and use critical thinking. We're allowed to deviate from protocol as long as it makes sense and is in the best interest of our patients. Our protocols are more often referred to as "guidelines." That said, if you do something stupid you'll get a phone call.
 
The reason I asked this question is I am current assigned to EMS communications, and field providers (particularly ALS providers both where I work and some on EMTLife) absolutely LOVE to complain about dispatch, and how calls are usually overtriaged and a medic is going for the 20 year old with toe pain who isn't breathing, or some other call where (following dispatch protocol), the call is handled a particular way, that is either upgraded or downgraded by protocol, not necessarily how I would handle it.
ally question).

I know I can take a call, have a 99% confidence that the call will be an ambulatory BLS patient, but because my approved protocols (based on the answers the caller gives me, whether accurate or not) say I must code a response a certain way, I have to do what my bosses as.

so i was curious how other agencies handle it when their ems personnel deviate from the protocols they are given. It can be as simple as not backboarding a person because there is no scientific evidence to show it does any good, or the afore mentioned (are they breathing norm
 
Dispatch protocols are a whole different kettle of fish, and closely linked to what EMD has to say.
 
DrParasite said:
The reason I asked this question is I am current assigned to EMS communications, and field providers (particularly ALS providers both where I work and some on EMTLife) absolutely LOVE to complain about dispatch, and how calls are usually overtriaged and a medic is going for the 20 year old with toe pain who isn't breathing, or some other call where (following dispatch protocol), the call is handled a particular way, that is either upgraded or downgraded by protocol, not necessarily how I would handle it.
ally question).

I know I can take a call, have a 99% confidence that the call will be an ambulatory BLS patient, but because my approved protocols (based on the answers the caller gives me, whether accurate or not) say I must code a response a certain way, I have to do what my bosses as.

so i was curious how other agencies handle it when their ems personnel deviate from the protocols they are given. It can be as simple as not backboarding a person because there is no scientific evidence to show it does any good, or the afore mentioned (are they breathing norm
Click to expand...

+1 on the idea that dispatch protocols are different. I would argue that if you are working from a script/protocol on the phone, you really aren't supposed to be applying any HCP judgement. My understanding is that half the reason MPDS exists and is so widely used is specifically because having a trained person asking questions can go pretty pear shaped sometimes.

If you're a properly educated HCP, why are you sitting in a call centre reading scripts? On the other hand if you're not, why are you questioning the script? It kind of seems like you're in some kind of grey area between the two, which begs the question as to why.
 
A BS working dispatch, we must truly be in a depression. Kinda a bummer.
 
At my old services you had to be able to explain to medical director: a couple of times I would see him in the ED and when I went to explain myself he told me not to worry about it, he trusted me too much to question me.

Here it has to be documented: half of our coverage area we have no cell or radio coverage.
 
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