R426-10-2100. Continuous Quality Improvement (QI) Program

  (1) Licensed air ambulance providers shall establish a quality management team and a program implemented by this team to assess and improve the quality and appropriateness of patient care provided by the air ambulance services.

  (2) The program shall include:

  (a) development of protocols, standing orders, training, policies and procedures;

  (b) approval of medications and techniques permitted for field use by service personnel in accordance with regulations of the Department;

  (c) direct observation, field instruction, in-service training, or other means available to assess the quality of field performance; and

  (d) Participation in local and regional performance improvement activities.

  (3) All licensed air ambulance providers shall have a written policy that outlines a process to identify, document, and analyze sentinel events, adverse medical events, or potentially adverse events with specific goals to improve patient medical safety and/or quality of patient care.

  (4) Policies shall include the following:

  (a) review of events should address the effectiveness and efficiency of the organization, its support systems, as well as that of individuals within the organization;

  (b) when a sentinel event is identified, a method of information gathering shall be developed, and shall include outcome studies, chart review, case discussion, or other methodology;

  (c) findings, conclusions, recommendations, and actions shall be made and recorded including follow-up which also shall be determined, recorded, and performed; and

  (d) training and education needs, individual performance evaluations, equipment or resource acquisition, patient medical safety and risk management issues shall be integrated with the continuous quality improvement process.

  (5) All licensed air ambulance providers shall have a written policy outlining a utilization review process.