CLINCAL ROTATION POLICIES...• CLINICAL ROTATION SCHEDULING AND ATTENDANCE- o Clinical rotations are scheduled one week in advance and at least no more than four weeks in advance

UNIVERSITY OF MISSOURI HEALTH

SYSTEM

EMS EDUCATION INSTITUTE

CLINCAL ROTATION POLICIES

UNIVERSITY OF MISSOURI HEALTH SYSTEM EMS EDUCATION INSTITUTE

UMHS_EMS_ED_Clinical_Rotation_policies_06_2018 Page 1 of 15

Table of Contents CLINICAL ROTATION STRUCTURE & GUIDELINES ................................................................................................... 2

INTRODUCTION: ............................................................................................................................................................. 2

GOALS AND OBJECTIVES: ............................................................................................................................................ 2

• TIMELINES FOR COMPLETION- ........................................................................................................................... 2

• PROFESSIONAL BEHAVIOR- ................................................................................................................................ 2

• STUDENT CODE OF CONDUCT/STANDARD OF CONDUCT- .......................................................................... 2

• SAFE PRACTICE POLICY- ...................................................................................................................................... 2

• CLINICAL ROTATION SITES- ................................................................................................................................ 2

• CLINICAL ROTATION PRECEPTORS- ................................................................................................................. 2

• CONFLICT OF INTEREST- ...................................................................................................................................... 2

• CLINICAL ROTATION DOCUMENTATION- ....................................................................................................... 2

• CLINICAL ROTATION SCHEDULING AND ATTENDANCE- ........................................................................... 3

CLINICAL ROTATION PROCEDURES:......................................................................................................................... 3

SKILLS PERFORMED: ..................................................................................................................................................... 3

OTHER RULES: ................................................................................................................................................................ 3

CLINICAL ERRORS: ........................................................................................................................................................ 4

CLINICAL ROTATION PRE-REQUISITES .................................................................................................................... 4

HOSPITAL CLINICAL ROTATIONS: ............................................................................................................................. 4

AMBULANCE CLINICAL ROTATIONS: ....................................................................................................................... 5

AMBULANCE FIELD TEAM LEAD ROLE (Paramedic Only): ..................................................................................... 5

CLINICAL ROTATION SKILLS & DOCUMENTATION REQUIREMENTS ............ Error! Bookmark not defined.

FISDAP EVALUATIONS .................................................................................................................................................. 7

CLINICAL CONTRACT (STUDENT COPY) PAGE 1 OF 2 ........................................................................................ 12

CLINICAL CONTRACT (STUDENT COPY) PAGE 2 OF 2 ........................................................................................ 13

CLINICAL CONTRACT PAGE 1 OF 2 .......................................................................................................................... 14

CLINICAL CONTRACT PAGE 2 OF 2 .......................................................................................................................... 15



CLINICAL ROTATION STRUCTURE & GUIDELINES

INTRODUCTION: The following policies, rules, and guidelines have been developed in an effort to make your clinical experience a positive one. Realize that it is a privilege to do clinical rotations at University Hospital or at any clinical site. Remember that your actions reflect not only on yourself, but on your class, the program, and even the University of Missouri as a whole. Doing your clinical rotations is a time consuming project. Once you have been approved to perform your clinical rotations, you will be required to complete no less than 24 clinical rotation hours a month.

GOALS AND OBJECTIVES: • Perform all EMS related skills in a patient care setting to become fully competent. • To be exposed to a wide variety of patients in both definitive care and field operation settings. • Hone patient assessment and history taking techniques. • Gain awareness of operations and the role of EMS as an extension of the hospital healthcare setting. • Learn about the role and expertise of other health care providers. • Build professional EMS attributes.

Students will complete Clinical Rotations that will train them to take the academic information taught in class and apply the lessons learned to the practical reality of EMS. The requirements (skills and/or total hours) for these portions are listed in the clinical rotation information documents that are handed out during clinical rotation orientation in class. Students may not begin any Clinical rotation time until approved by the Primary Instructor. Students must maintain at least an 80% average to continue doing their clinical rotation time. Students that have less than an 80% average will be required to stop doing clinical rotation time until their average is 80% or higher. If any aspect of clinical rotation performance is substandard, additional clinical rotation time may be added as approved by the Course Coordinator with advisement from the course Medical Director and Course Faculty.

You are here to learn and should function as a student regardless of your past experiences. Do not be critical of hospital or EMS staff while in the student’s role. If you experience frustrations you will have ample opportunity to verbalize your concerns in the form of daily logs and post-conferences. You can instill confidence in the on-duty crew by being professional, helpful and receptive to constructive criticism.

Be sure to partake fully in all activities that normally occur at the clinical site. Your participation and investment in the clinical time will have a significant impact on the quality of the experience. This may include duties which are not related to being a paramedic (eg understanding nursing paperwork requirements and process), or could be non patient-care oriented (eg washing an ambulance), but your participation will help you gain a fuller understanding and comprehensive view of what it takes to be a successful paramedic.

Please review your UMHS EMS Education Student Handbook regarding: • TIMELINES FOR COMPLETION- • PROFESSIONAL BEHAVIOR- • STUDENT CODE OF CONDUCT/STANDARD OF CONDUCT- • SAFE PRACTICE POLICY- • CLINICAL ROTATION SITES- • CLINICAL ROTATION PRECEPTORS- • CONFLICT OF INTEREST- • CLINICAL ROTATION DOCUMENTATION-



• CLINICAL ROTATION SCHEDULING AND ATTENDANCE- o Clinical rotations are scheduled at least one week in advance and no more than four weeks in advance. Clinical

rotation times vary with each agency/unit, shifts are generally in 4 hour blocks. No clinical rotation shall be greater than 12 hours in duration. Clinical rotations are scheduled and documented on FISDAP.net.

CLINICAL ROTATION PROCEDURES: The student should ensure that they work with each unit and obtain an appropriate preceptor. • You will be assigned a preceptor each time you arrive for clinical hours. This assignment should be made by the

Supervisor/Charge RN or Charge Medic on duty. The preceptor will determine what interventions you can do and when they are to be accomplished. You are not to perform any skills until first checking with the preceptor. The preceptor has responsibilities that include evaluating the criteria listed in your skills sheet, as well as those listed with this information.

• Although all clinical sites have been provided with material that delineates your role and the goals/skills etc to be met, each student should still discuss with each preceptor the specific goals and skills for their Scope of Practice.

• Students should participate in all aspects of patient care in each clinical site as part of the team. This means that there will be times when the student is doing other activities that are not directly related to patient care, such as cleaning. This is appropriate as long as these activities are being done by the student’s preceptor and/or coworkers as well.

o Students may not “cherry pick” only those skills or patients that they prefer to complete or participate. They must do all activities that are part of the overall business of delivering patient care.

• The student must log ALL patient contacts, skills, experiences and clinical time. (Even if they have met the total required number for any element).

• Student is responsible for obtaining preceptor evaluation and signature at the end of each clinical rotation.

SKILLS PERFORMED: Skills performed during clinical rotations should be done in such a way as to build confidence and competency in preparation for when the student will be performing them in the field as a practicing professional. The student should take every opportunity to practice all skills at any time, from the most basic such as taking vital signs (such as manual vital signs) up to and including observing those skills that are beyond their scope of practice (such as bypass surgery). Every time a skill is performed, there is an opportunity to learn and build skill competency, and the student should take advantage of these opportunities.

• Students may only perform skills that are commensurate with the scope of practice for which they are training, and only with a preceptor in attendance to supervise the skill and ONLY when on a scheduled clinical rotation. Students may observe skills that are beyond their scope of practice for which they are training.

• At no time should you administer blood or blood products. • At no time on your clinical rotations should you take verbal orders for your preceptor.

• EXCEPTION: You may take verbal orders if you are in consultation with medical control, but this is solely at the discretion of the preceptor, and your preceptor must be able to hear both sides of the conversation with Medical Control, eg when using the radio.

• AT NO TIME should a student ever do a skill with which they are unfamiliar, use a piece of equipment with which they are unfamiliar, or falsify information/give misleading information when performing assessments or skills. THE PATIENT COULD DIRECTLY BE HARMED in these situations. You are not expected to know everything right away. You ARE expected to ASK when you don’t know and ADVISE when you are not sure. EGOTISTICAL PRIDE HAS NO PLACE IN YOUR CLINICAL ROTATIONS.

• The criteria listed in the skills sheet are the minimum expectations. A professional strives to exceed this. Also, remember that a number of skills can be checked off with each patient contact.

OTHER RULES: • Use caution while using hospital equipment. Do not cause harm to yourself, others or the equipment. • Return any hospital or EMS equipment used during your clinical experience. • Do not disturb personal property of others without their permission.



CLINICAL ERRORS: It is reasonable to expect that there will be occurrences where clinical errors will occur. While this is expected to be infrequent, the student should be aware that they have a duty to report any errors. Errors will include items such as incorrect administration of a drug, improper patient assessment (eg incorrect vital sign), completion of a skill in a non-approved manner (eg failure to clean an IV site prior to IV initiation), or similar. It is impossible to list all possible errors that might occur, so the responsibility falls on the student to be aware of all of their actions, and to perform all activities to the standards of performance set forth by the EMS Education program, the Bureau of EMS, the National Registry of EMTs, and the National Highway Transportation and Safety Administration, as well as any other regulatory bodies.

• Should any clinical error occur, the student must IMMEDIATELY report this to their preceptor. • The student should assist the preceptor, as required by the preceptor, to complete any procedures or

documentation that are needed as a result of the error. • The student should report the error to their Primary Instructor and/or the Clinical Coordinator at the first

reasonable opportunity, but no later than within 24 hours after the event has occurred. • The student must submit written documentation to the Primary Instructor and/or the Clinical Coordinator as to the

sequence of events. Further, it must include a self-evaluation and self-remediation plan as to how the student will attempt to prevent this event or similar events from occurring in the future.

CLINICAL ROTATION PRE-REQUISITES Paramedic and EMT Students must meet the following criteria prior to participating in the Clinical and Internship:

o In good academic and administrative standing. o Signed confidentiality agreement is on file. o Signed clinical agreement is on file. o Proof of Personal Medical Liability coverage on file with EMS Education o All pertinent Immunization records maintained current and on file with EMS Education. o BLS certification maintained current and on file with EMS Education. o Laboratory skills completed and documented as follows:

• All NREMT skills sheets completed successfully and documented in Fisdap. • 20 sample patient contact forms completed and on documented in Fisdap (as part of the in course

class work and grade). o Paramedic Only-

• MO EMT-B licensure maintained current and on file with EMS Education. • ACLS passed and maintained on file with EMS Education. • PALS passed and maintained on file with EMS Education prior to doing L&D or Pediatric Unit clinical. • 20 NREMT Adult airway management skills completed (mix of ETTs, Combitubes, and LMAs, using at

least 3 different adult airway mannequins). This includes completing the ventilation portion. • 20 NREMT Pediatric airway management skills completed (all ETT, using at least 2 different peds airway

mannequins). This includes completing the ventilation portion. • 20 sample patient contact forms completed and on file with EMS Education (as part of the in course class

work and grade).

HOSPITAL CLINICAL ROTATIONS: • Student Handbook Page 13

o Goals/Objectives for Hospital Clinical: • Perform all EMS related skills in a patient care setting to become fully competent. • To be exposed to a wide variety and significant quantity of patients in a definitive care setting. • Hone patient assessment and history taking techniques. • Gain awareness of hospital operations and the role of EMS as an extension of the hospital

healthcare setting. • Learn about the role and expertise of other health care providers. • Build professional EMS attributes.



AMBULANCE CLINICAL ROTATIONS: • Student Handbook Page 14

o Students may not begin the Ambulance Clinical rotations until ALL of the hospital clinical time is completed. Clinical logs for in-hospital time must be reviewed before being approved for ambulance clinical time.

o Goals/Objectives for Ambulance Clinical rotations: • Integration of knowledge gained in class and in hospital clinical rotations into the primary EMS

setting on an ALS ambulance service. • Demonstrate competency at taking care of patients in respective role as part of a team. • Demonstrate preparedness to take on the role of team leader. • Build professional EMS attributes.

NOTE: Ambulance time total MUST be AT LEAST 350 hours (Paramedic); 96 hours (EMTB). If the student completes the Ambulance Clinical Skills in less time, then they MUST continue Clinical Rotations until all required hours have been completed.

AMBULANCE FIELD TEAM LEAD ROLE (Paramedic Only): o Student performance as evaluated by the service and or preceptor will dictate if the student is allowed to

function in the team lead role. The EMS Program Director or Clinical Coordinator may override the decision of the service or preceptor based on student academic and skill performance in the classroom, in which case the student may be required to perform more orientation time in the internship phase.

o Goals/Objectives for the Ambulance Field Team Leader: • Demonstrate the ability to lead a team of health care providers in taking care of a patient in the

EMS emergency setting. • Demonstrate the ability to create a list of differential diagnoses for a patient, and make critical

thinking decisions in directing the patient’s care. • Demonstrate the ability to communicate with all individuals involved in any part of an EMS call. • Build professional EMS attributes.

• The types of runs that qualify as having the potential for team leading are defined as: 911 calls (unscheduled) with patient contact and a full ALS assessment by the student that is

either ALS or BLS in nature (regardless of transport status). Complicated transfers with multiple drips or other elements that are deemed by the preceptor

to be appropriate for the student to demonstrate high level skills and team-leading traits. Scheduled runs (routine transfers and long-distance transfers) DO NOT qualify for team

leads unless they meet the complicated transfer criteria above. Presence of EKG monitoring or a simple IV infusion does not qualify as a complicated transfer.

The student MUST be able to perform the duties of the team leader in order for the call to be counted as a “team lead”.

• Team leader responsibilities o Initiates and performs the initial, primary and detailed assessment of the patient. o Demonstrate the ability to create a list of differential diagnoses for a patient o Plans and initiates the management plan. o Communicates effectively to assign or direct team members to carry out duties in the

management of the patient. o Demonstrates competent leadership. o Demonstrates professional behaviors o Demonstrates competent clinical decision making.

If the student does not do the interview/assessment or lead the call, then it cannot be counted as a team lead. Student must do both!



CLINICAL ROTATION SKILLS & DOCUMENTATION REQUIREMENTS



FISDAP EVALUATIONS











MU HEALTH CARE EMS EDUCATION

CLINICAL CONTRACT (STUDENT COPY) PAGE 1 OF 2

I, __________________________________, (Print Name) have received or acknowledge the following conditions of the EMS Education Clinical Rotation Program:

Please Initial

_________ I have received, read, and understand the Clinical Rotations, Rules & Guidelines and Student Handbook and will abide by all the information contained in these documents.

_________ I have submitted all items that are required to participate in clinical rotations, and will submit items necessary to keep those requirements current.

_________ I understand and will strictly comply with the EMS Education dress code and personal hygiene policies.

_________ I understand that I must attend all scheduled clinical rotations or follow appropriate call-in methods if I am unable to attend.

_________ I understand that I must complete documentation in a timely manner according to policy. To do otherwise could lead to my dismissal from the program or could lead to voiding of previously complete clinical shifts and repeating of those shifts at the Clinical Coordinator’s discretion.

_________ I understand that my attitude must be professional at all times. I must treat my fellow students, faculty, peers, preceptors and patients with the highest degree of courtesy and respect.

_________ I understand that I may NOT leave a clinical assignment early, change clinical areas, schedule my own clinical rotations, and I may not have my paperwork signed before the end of the shift.

_________ I understand that I will be evaluated every shift in the clinical setting.

_________ I will conduct all clinical rotations with due regard to the principles of scene safety in order to ensure my own safety, the safety of those I am working with, and the safety of the patient.

_________ I understand that failure to comply with any of the above or with any of the policies, rules & guidelines can lead to my dismissal from the program.

___________________________________________________________________________________ Name (Print) Signature Date ___________________________________________________________________________________ Witness Name (Print) Signature Date




CLINICAL CONTRACT (STUDENT COPY) PAGE 2 OF 2


Please Initial

_________ I understand that I must complete an accurate Patient Care Report on each patient using appropriate medical terminology, spelling, and adhering to principles of documentation in FISDAP during the rotation. To do otherwise could lead to my dismissal from the program or could lead to voiding of previously complete clinical shifts and repeating of those shifts at the Clinical Coordinator and/or Program Director’s discretion.

_________ I understand that at the end of each clinical rotation I am required to have the preceptor

1) review the shift documentation I have entered,

2) complete site evaluation

3) complete Preceptor Evaluation of Student,

4) complete Student Evaluation of the Preceptor,

5) Preceptor has signed and student has lock the shift. (Must be done within 12 hours of shift completion.

To do otherwise will void the shift and I will need to repeat that rotation.






CLINICAL CONTRACT PAGE 1 OF 2


Please Initial

_________ I have received, read, and understand the Clinical Rotations, Rules & Guidelines and Student Handbook and will abide by all the information contained in these documents.

_________ I have submitted all items that are required to participate in clinical rotations, and will submit items necessary to keep those requirements current.

_________ I understand and will strictly comply with the EMS Education dress code and personal hygiene policies.

_________ I understand that I must attend all scheduled clinical rotations or follow appropriate call-in methods if I am unable to attend.

_________ I understand that I must complete documentation in a timely manner according to policy. To do otherwise could lead to my dismissal from the program or could lead to voiding of previously complete clinical shifts and repeating of those shifts at the Clinical Coordinator’s discretion.

_________ I understand that my attitude must be professional at all times. I must treat my fellow students, faculty, peers, preceptors and patients with the highest degree of courtesy and respect.

_________ I understand that I may NOT leave a clinical assignment early, change clinical areas, schedule my own clinical rotations, and I may not have my paperwork signed before the end of the shift.

_________ I understand that I will be evaluated every shift in the clinical setting.

_________ I will conduct all clinical rotations with due regard to the principles of scene safety in order to ensure my own safety, the safety of those I am working with, and the safety of the patient.






CLINICAL CONTRACT PAGE 2 OF 2


Please Initial

_________ I understand that I must complete an accurate Patient Care Report on each patient using appropriate medical terminology, spelling, and adhering to principles of documentation in FISDAP during the rotation. To do otherwise could lead to my dismissal from the program or could lead to voiding of previously complete clinical shifts and repeating of those shifts at the Clinical Coordinator and/or Program Director’s discretion.

_________ I understand that at the end of each clinical rotation I am required to have the preceptor

1) review the shift documentation I have entered,

2) complete site evaluation

3) complete Preceptor Evaluation of Student,

4) complete Student Evaluation of the Preceptor,

5) Preceptor has signed and student has lock the shift. (Must be done within 12 hours of shift completion.

To do otherwise will void the shift and I will need to repeat that rotation.



Documents

CLINCAL ROTATION POLICIES...• CLINICAL ROTATION SCHEDULING AND ATTENDANCE- o Clinical rotations are scheduled one week in advance and at least no more than four weeks in advance