scholarly journals 367 Improving Handover Documentation in Surgical Inpatients Using Weekend Handover Stickers

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Boyle ◽  
S Chien ◽  
A McCallum
Keyword(s):  
Patient Safety ◽  
Antibiotic Therapy ◽  
Royal College ◽  
Clinical Information ◽  
Relevant Information ◽  
Clinical Situation ◽  
Clinical Governance ◽  
Surgical Patients ◽  
Blood Tests ◽  
Audit Cycle

Abstract Introduction Transfer to the care to the oncoming team is the point at which inpatients are most vulnerable. Effective handover is vital to protect patient safety and clinical governance. The Royal College of Surgery (RCS) Safe Handover guidelines highlight relevant information required for comprehensive handover. This QI project aimed to determine if implementation of weekend handover stickers in surgical patients’ notes improved handover documentation. Method A retrospective records-based audit of patients admitted under general surgery over a 4-week period was performed. Standards were set using the RCS guidelines to determine if sufficient weekend handover was documented. We designed weekend handover stickers to be inserted in notes based on guidelines. A re-audit cycle over a 4-week period was performed to determine if the intervention improved handover documentation. Results 119 patients were in the initial audit. 125 patients were in the re-audit. Documented handover in the notes improved from 43.7% to 89.6% after intervention. Documentation of the following clinical information also improved: clinical situation (43.7% to 92.0%); co-morbidities (14.3% to 89.6%); current issues (71.4% to 94.4%); weekend blood tests (32.8% to 92.0%); antibiotic therapy (21.8% to 92.0%). Conclusions Weekend handover stickers resulted in a significant improvement in handover documentation improving patient safety.

859 Improving Accuracy of Admission Notes Over A Four-Year Period Within an Orthopaedic Trauma Ward: A Four-Cycle Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C McCann ◽  
S Mackenzie ◽  
T White
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Royal College ◽  
Further Education ◽  
Patient Records ◽  
Orthopaedic Trauma ◽  
Contact Number ◽  
Audit Cycle ◽  
Improving Accuracy

Abstract Background Accurate medical notes are essential for effective patient care and safety. The Royal College of Surgeons (RCS) set forth guidelines for standards of documentation. Lack of awareness of these standards can result in inaccurate documentation, compromising patient safety. Method Four prospective audits of admission documents for orthopaedic inpatients were completed, each 1 year apart. For each cycle, 50 admission documents were assessed to determine compliance with the RCS standards. Interventions were carried out between each audit cycle in the following order: educational posters, change from handwritten to online admission forms and optimisation of the online proforma. Results Initially, only two criteria showed above 95% compliance. Implementing educational posters produced significant improvement in one criterion: ‘note signed’ (60% to 96%, p < 0.05). Moving admission documents online improved ‘date stamp’ (66% to 100%, P < 0.05) and ‘contact number’ (0% to 34%, p < 0.05), but decreased documentation of ‘time recorded’ (18% to 0%, p < 0.05) and ‘name and grade’ (74% to 26%, p < 0.05). Further education and modification to the admissions proforma improved documentation of all criteria to over 95%. Conclusions Early cycles of this audit highlighted poor standards of documentation in admission records. Changing to online patient records significantly changed documentation standards. These were further improved with educational measures.

An Automated Clinical Information System

1964 ◽  
Vol 3 (02) ◽  
pp. 45-50 ◽  
Author(s):  
D. Yoder ◽  
R. Swearingen ◽  
E. Schenthal ◽  
W. Sweeney ◽  
J. Nettleton
Keyword(s):  
Natural Language ◽  
Clinical Information System ◽  
Drug Evaluation ◽  
Scientific Information ◽  
Clinical Information ◽  
Clinical Situation ◽  
Field Variable ◽  
Record System ◽  
New Members ◽  
Clinical Terminology

An automated clinical record system must have the following characteristics: as far as the physician is concerned it must operate in natural language on standard sized paper; it must be able to accept information from the physician at a time when he is oriented to clinical terminology and a clinical mode of thinking; it must have an output which is clinically useful for the care and management of a patient; each item of information must be addressable so that it may act as an index for scientific information retrieval; it must be capable of accepting quantative and natural language information.Clinical information constitutes a mathematical set, only a few members of which are applicable to any particular clinical situation, and to which new members are constantly being added. The members of this set are seldom mutually exclusive. An acceptable system which is capable of processing this type of information has been designed utilizing the concepts of self-encoding forms and variable-field, variable-length records. Applications of these principles will expedite hospital automation, the establishment of drug evaluation information systems, and of regional and nationwide medical record systems.

scholarly journals Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

2019 ◽  
Vol 24 (5) ◽  
pp. 431-437
Author(s):  
Krystian Solis ◽  
Walter Dehority
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Information ◽  
Healthy Children ◽  
Osteoarticular Infections ◽  
Younger Age ◽  
Increased Risk ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Time To Onset ◽  
Prolonged Antibiotic Therapy

OBJECTIVES We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC < 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79–0.93; p < 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01–1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01–1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02–1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

scholarly journals Audit of compliance with WHO surgical safety checklist (modified for electroconvulsive therapy including NPSA advice)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S64-S64
Author(s):  
Faisal Alam ◽  
Rizwan Ashraf ◽  
Kyaw Sein ◽  
Terri Feeney
Keyword(s):  
Patient Safety ◽  
Electroconvulsive Therapy ◽  
Time Pressure ◽  
Clinical Situation ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
National Patient ◽  
Service Standards ◽  
Therapy Treatment

AimsThis audit aims to evaluate the compliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment in ECT clinic at Greater Manchester Mental Health Bolton Directorate. The audit is based on WHO surgical safety checklist modified for ECT including National Patient Safety Agency advice. The goal is to improve the compliance and in turn improve clinical outcomes.BackgroundThe WHO surgical safety checklist (modified for Electroconvulsive therapy including NPSA advice) is devised to promote patient safety, improve teamwork, reduce errors/adverse events and improve overall quality of care. An audit was completed regarding the compliance with the safety checklist at the Bolton ECT clinic and to assess how this could be improved.MethodFollowing approval from the clinical audit department, GMMH NHS Foundation Trust, 20 checklists from randomly selected patient ECT files were included in this audit. We looked at whether the checklists were completed, signed and dated. Our current WHO surgical safety checklist is as per the Electroconvulsive therapy accreditation service standards.ResultA total of 20 WHO surgical safety checklists were reviewed. 95% of the checklists (19/20) were completed by the duty Psychiatrist. 1 form was not completed. 25% (5/20) were not signed rendering them invalid. A total of 75% checklists were complete and valid. Checklists were present in all the case notes.ConclusionCompliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment can be challenging due to various reasons ranging from time pressure to difficult clinical situation. This audit has highlighted that the overall compliance with the set standards (100% completion) was not achieved. A repeat audit will be important to further improve the compliance and overall clinical outcome.

scholarly journals Data-driven approach to Early Warning Score-based alert management

2018 ◽  
Vol 7 (3) ◽  
pp. e000088 ◽  
Author(s):  
Muge Capan ◽  
Stephen Hoover ◽  
Kristen E Miller ◽  
Carmen Pal ◽  
Justin M Glasgow ◽  
...  
Keyword(s):  
Patient Safety ◽  
Early Warning ◽  
Early Recognition ◽  
Clinical Information ◽  
Patient Characteristics ◽  
The Elderly ◽  
Early Warning Score ◽  
The Right ◽  
The Impact ◽  
Alerting Systems

BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

The role of diagnosis in medical practice and society

2019 ◽  
pp. 17-33
Author(s):  
Ahmed Samei Huda
Keyword(s):  
Clinical Practice ◽  
Medical Practice ◽  
Clinical Information ◽  
Relevant Information ◽  
Access To Healthcare ◽  
Social Effects ◽  
Health Statistics ◽  
Social Functions ◽  
Teaching And Research

Organization of knowledge is needed to help doctors learn and recall information in their clinical practice. Diagnostic constructs help, providing prototypes against which doctors can diagnose patient conditions. They then seek to confirm or disprove this diagnosis by searching for relevant information. Attached to these diagnostic constructs are information such as causes, prognosis, and treatment. Diagnostic constructs are provisional and should be changed if information suggests they are incorrect. They also aid communication between professionals for teaching and research, and have important social functions such as providing access to healthcare, determining eligibility for welfare, offering administrative and payment functions, and collecting health statistics. Some social effects of diagnostic constructs can be harmful, such as stigma. Diagnostic constructs are included in broad diagnostic formulations including relevant clinical information.

scholarly journals Communication and access to information in assessing the quality of multiprofessional care of patients

2010 ◽  
Vol 8 (3) ◽  
pp. 303-307
Author(s):  
Leny Vieira Cavalheiro ◽  
Paola Bruno de Araújo Andreoli ◽  
Nadia Sueli de Medeiros ◽  
Telma de Almeida Busch Mendes ◽  
Roselaine Oliveira ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Healthcare Professionals ◽  
Clinical Information ◽  
Relevant Information ◽  
Cross Sectional Study ◽  
Model Group ◽  
Cross Sectional ◽  
Multiprofessional Team ◽  
Under Performing

ABSTRACT Objective: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case). Methods: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. Results: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%), appropriate use of the Plan of Care form (97.0%), and formalized discussions with physicians (88.2%). In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. Conclusions: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.

scholarly journals LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S62-S62 ◽  
Author(s):  
L.B. Chartier ◽  
S. Vaillancourt ◽  
M. McGowan ◽  
K. Dainty ◽  
A.H. Cheng
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Patient Safety ◽  
Quality Improvement ◽  
Needs Assessment ◽  
Residency Training ◽  
Royal College ◽  
Assessment Tool ◽  
Postgraduate Medical Education ◽  
Clinical Scenarios

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

scholarly journals The use of operationalised criteria for inclusion on a Care Programme Approach register

2001 ◽  
Vol 25 (5) ◽  
pp. 172-174 ◽  
Author(s):  
M. Phipot ◽  
H. Hales ◽  
B. Sheehan ◽  
S. Reeves ◽  
M. Lawlor
Keyword(s):  
Clinical Practice ◽  
Clinical Audit ◽  
Clinical Governance ◽  
Clinical Implications ◽  
Policy Feedback ◽  
Retrospective Case ◽  
Care Programme ◽  
Minimum Standards ◽  
Audit Cycle ◽  
Service Policies

Aims and MethodTo determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.ResultsConsultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.Clinical ImplicationsHealth service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.

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