1620 A quality improvement project to improve the handover process in the paediatric department, the royal stoke hospital

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only accurately completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100% of paediatric patients have their regular medications prescribed by mid-day the day after admission. The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using Plan–Do–Study–Act cycles. On average, 40 patients were reviewed each week. The mean reconciliation rate was 79%, and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last 3 weeks of data collection. A repeat audit carried out in September 2018 found the reconciliation rate was maintained at 100%. Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents.

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485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project

British Journal of Surgery ◽

10.1093/bjs/znab134.433 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

P Brennan ◽

D Holroyd

Keyword(s):

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Team Members ◽

Surgical Department ◽

Significant Variability ◽

Standard Operating ◽

Handover Process ◽

Audit Standards ◽

Standard Operating Protocol

Abstract Introduction The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients. Method Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation. Results The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration. Re-audit demonstrated significant improvements in all domains to > 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document. Conclusions A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.

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G103(P) Quality improvement project on handover sessions in the paediatric department of a district general hospital

10.1136/archdischild-2020-rcpch.81 ◽

2020 ◽

Author(s):

C Orazulume ◽

L MacKinnon

Keyword(s):

Quality Improvement ◽

General Hospital ◽

District General Hospital ◽

Quality Improvement Project ◽

Improvement Project ◽

Paediatric Department

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988 A Quality Improvement Project; Improving the Quality and Safety of Handover During COVID-19

British Journal of Surgery ◽

10.1093/bjs/znab259.114 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Chawla ◽

M Said Noor

Keyword(s):

Quality Improvement ◽

Patient Care ◽

Continuity Of Care ◽

Quality Improvement Project ◽

World Health ◽

Junior Doctors ◽

Free Text ◽

Post Intervention ◽

Improvement Project ◽

Handover Process

Abstract Aim The World Health Organisation (WHO) positions effective handover, in its top five patient safety solutions. During our District Hospital Trust’s COVID-19 response, an unprecedented reorganisation of all teams occurred. All surgical and medical speciality junior doctors were re-deployed and split into 4 zones to cover the hospital. In this quality improvement project (QIP), we sought to understand our trainees’ thoughts on this new multi-zonal handover process and aimed to identify risk-reduction measures to aid better patient care. Method The opinions of trainees on the new handover system were obtained using an online Likert scale survey. Following the responses, a new morning and night handover proforma was developed. This was used trust-wide and a post-intervention repeat survey was conducted to assess the new changes. Results The primary survey received 31 responses with feedback illustrating mixed effectiveness of the existing handover process. Free text comments highlighted issues surrounding “safety”, “poor organisation”, “poor continuity of care” with one serious incident reported. Post-intervention of a new handover proforma, a repeat online survey received 25 responses. Results were significantly more positive with >84% of responses being in the “strongly agree to agree” category, including for “continuity of care”, “organisation”, and “safety”. Conclusions This QIP illustrates a good example of a low-cost intervention to create a better handover system and aid hospitals during time of crises. For us, it managed to reform the handover process and ultimately improved our patient care. Forthcoming, we would like to create a national best practice guide for effective handover.

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