PERFORMANCE IMPROVEMENT (PI) MONITORING

POPULATION OF INTEREST

All patients bitten by snakes.

INTENT (EXPECTED OUTCOMES)

1. All patients bitten by a snake will be managed according to the steps outlined in the Universal Approach to Snakebite Assessment, Diagnosis, and Treatment section, with an emphasis on the clinical syndrome of envenomation, and not on the identity of the snake species.
2. When a broad-spectrum antivenom does not exist for a given syndrome in a given area, the regional algorithms will be used to determine the most appropriate antivenom therapy.
3. Appropriate antivenom will be given at the earliest possible role of care, including in the pre-hospital setting if available, with appropriate documentation of dosage, preparation, administration procedures, and qualified performing provider.
4. Rapid patient assessment and frequent reassessment will be documented.
5. Tetanus prophylaxis will be given to all patients.
6. When antivenom is unavailable, patient will be evacuated urgently to capable role of care, and lack of capability and mitigation strategy is documented.
7. Fasciotomy for suspected compartment syndrome will be avoided unless absolutely necessary (delayed evacuation or depletion of antivenom supply), and DoW ADVISOR Toxicology consultation will be performed and documented prior to fasciotomy.
8. Documented DoW ADVISOR Toxicology telemedicine consult will be performed for any questions, concerns, or unusual manifestations that arise.

PERFORMANCE/ADHERENCE METRICS

1. Patients with clinical syndromes of envenomation who received administration of antivenom at the earliest available role of care.
2. Documentation of antivenom dosage, preparation, administration procedures, and qualified performing provider.
3. Rapid assessment and frequent reassessment is performed, with attention to clinical signs and symptoms of envenomation.
4. Patients urgently evacuated to capable role of care when antivenom unavailable.
5. Tetanus prophylaxis administered.
6. Elevated compartment pressures are managed with repeated administration of antivenom, and fasciotomy is avoided if possible
7. DoD ADVISOR Toxicology telemedicine consultation performed for all questions, concerns, or unusual manifestations that arise.

DATA SOURCES

- Patient Record
- Department of Defense Trauma Registry (DoDTR)

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed. The system review and data analysis will be performed by the Joint Trauma System (JTS) Chief and the JTS PI Branch.

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance and PI monitoring at the local level with this CPG.