scholarly journals ‘Take Ten’ improving the surgical post-take ward round: a quality improvement project

2018 ◽  
Vol 7 (1) ◽  
pp. e000045 ◽  
Author(s):  
Danielle Alice Banfield ◽  
Carly Adamson ◽  
Amy Tomsett ◽  
James Povey ◽  
Tony Fordham ◽  
...  
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Management Plan ◽  
Ward Round ◽  
Nutrition Status ◽  
Surgical Patient ◽  
Improvement Project ◽  
Team Members ◽  
Diagnosis And Management ◽  
Management Plans

BackgroundThe surgical post-take ward round is a complex multidisciplinary interaction in which new surgical patients are reviewed and management plans formulated. Its fast-paced nature can lead to poor communication and inaccurate or incomplete documentation with potential detriment to patient safety. Junior team members often do not fully understand the diagnosis and management plan.AimsThe aims of this project were to improve both communication and documentation on the surgical post-take ward round, influencing patient safety.MethodsThe ward round was deconstructed to identify individual roles and determine where intervention would have the most impact. Ten important points were identified that should be documented in the management of an acute surgical patient; observations, examination, impression, investigations, antibiotics, intravenous fluids, VTE assessment, nutrition status, estimated length of stay and ceiling of treatment. A ‘Take Ten’ checklist was devised with these items to be used as a ‘time out’ after each patient with the whole team for discussion, clarification and clear documentation. Four plan do study act cycles were completed over a period of a year. A retrospective review of post-take documentation preintervention and postintervention was performed, and the percentage of points that were accurately documented was calculated. For further clarification, 2 weekends were compared—one where the checklist was used and one where it was not.ResultsResults showed documentation postintervention varied between categories but there was improvement in documentation of VTE assessment, fluids, observations and investigations. On direct comparison of weekends the checklist showed improved documentation in all categories except length of stay. Junior team members found the checklist improved understanding of diagnosis and management plan, and encouraged a more effective ward round.ConclusionThe ‘Take Ten’ checklist has been well received. Three years on from its inception, the checklist has become an integral part of the post-take ward round, thanks to the multidisciplinary engagement in the project.

scholarly journals Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

2020 ◽  
Author(s):  
Andrew C. Nixon ◽  
Julie Brown ◽  
Ailsa Brotherton ◽  
Mark Harrison ◽  
Judith Todd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Screening Programme ◽  
Management Plan ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

scholarly journals Ward round template: enhancing patient safety on ward rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000170 ◽  
Author(s):  
Niall Gilliland ◽  
Natalie Catherwood ◽  
Shaouyn Chen ◽  
Peter Browne ◽  
Jacob Wilson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Antibiotic Stewardship ◽  
Ward Round ◽  
Early Warning Score ◽  
Improvement Project ◽  
Inpatient Ward ◽  
Improve Compliance ◽  
Safety Parameters ◽  
Ward Rounds

Introduction and aimsConcerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.MethodThe quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.Summary of resultsDocumentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.ConclusionsFollowing introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

scholarly journals P13 Optimising paediatric intravenous fluid management plans: a quality improvement project

2020 ◽  
Vol 105 (9) ◽  
pp. e12.2-e13
Author(s):  
Jenny Gray ◽  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Nursing Staff ◽  
Fluid Balance ◽  
Medical Staff ◽  
Fluid Management ◽  
Management Plan ◽  
Intravenous Fluid ◽  
Safety Alert ◽  
Management Plans ◽  
National Patient

IntroductionIntravenous (IV) maintenance fluids are often prescribed post-surgery when enteral routes are contraindicated. Serious consequences have been documented when poor fluid management has occurred, as highlighted in the National Patient Safety Alert (NPSA) 22; reducing the risk of hyponatraemia; when administering IV fluids to children.1 In response to this, the National Institute for Health and Care Excellence (NICE) published their guidance in December 2015 regarding IV fluids in children.2 Based on NICE recommendations, a pan hospital fluid guidance was produced. Within the NICE and hospital’s own guideline it states that there should be a daily fluid management plan documented. It has been well recognised that this daily fluid management plan was not routinely been completed; hence showing non-adherence to our hospital policy and NICE recommendations.AimsPrimary aim was to improve the documentation of the daily fluid management plan; aimed at the medical staff and the secondary aim was to improve the monitoring requirements of IV fluids and documentation of these; largely aimed at the nursing staff.MethodsA simple sticker was designed and attached to continuous sheets for medical notes which had a checklist of monitoring requirements and a section for fluid balance. Additionally, 2 posters were produced; one aimed at medical staff for documenting a fluid management plan and one aimed at the nursing staff with the monitoring requirements. These posters were displayed on the paediatric surgical ward.ResultsA total of 22 patients who were prescribed IV fluids were identified for a baseline measurement, an equal number of patients were compared after the intervention. Neonates and children receiving total parenteral nutrition were excluded from the data collection. There were 41% of daily fluid management plans completed pre intervention and post intervention there were 56% completed; showing a 15% increase in completion. As regards the monitoring indications; there were increases for nursing fluid balance completed from 19% to 46%, blood glucose taken and recorded from 64% to 83% and the daily weight documented from 10% to 49%.ConclusionsThis short QI project shows that implementation of an intervention did improve outcomes across all indications investigated. The results are not as dramatic as first hoped, but this is largely due to the short time scale of 4 weeks to introduce our change and it coincided with the change-over month of junior medical staff. With further education and champions within the medical and nursing teams; further improvement is very much possible, with the main aim in reducing risk and improving patient safety.ReferencesNational Patient Safety Alert: Reducing the risk of hyponatraemia when administering intravenous infusions to neonates 2007. Available at https://www.sps.nhs.uk/articles/npsa-alert-reducing-the-risk-of-hyponatraemia-when-administering-intraveneous-infusions-to-neonates/ [Accessed 12th June 2019]NICE guidance: Intravenous fluid therapy in children and young people in hospital. Available at https://www.nice.org.uk/guidance/ng29 [Accessed 12th June 2019]

scholarly journals Introducing an electronic tracking tool into daily multidisciplinary discharge rounds on a medicine service: a quality improvement project to reduce length of stay

2018 ◽  
Vol 7 (3) ◽  
pp. e000174 ◽  
Author(s):  
Nicholas Meo ◽  
Evan Paul ◽  
Christopher Wilson ◽  
Janice Powers ◽  
Marinette Magbual ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Average Length ◽  
Multidisciplinary Care ◽  
Coordinated Care ◽  
Improvement Project ◽  
Team Members ◽  
Electronic Tool ◽  
Medicine Service ◽  
Daily Discharge

BackgroundInefficient coordination of care around discharge can increase length of stay, lead to ineffective transitions and contribute an unnecessary cost burden to patients and hospital systems. Multidisciplinary discharge rounds can improve situational awareness among team members leading to more efficient and better coordinated care. This project aimed to standardise the daily discharge rounds occurring on a medicine service to reduce length of stay. Participants included physicians, nurses and social workers.MethodsA key driver diagram was developed to understand drivers of length of stay. Improving multidisciplinary care coordination was targeted as an initial area of focus. Stakeholder interviews were held to understand current participants challenges with the daily discharge rounds process. Baseline assessment included a review of discharges for 6 weeks before the initial intervention. A Plan Do Study Act quality improvement framework was used to implement change.InterventionAn electronic tool was developed which highlighted critical information to be captured during discharge rounds on each current inpatient in a standardised fashion. Information was reviewed and solicited from care teams by a facilitator, then edited and displayed in real time to all team members by a scribe.ResultsThe average length of stay decreased by 1.4 days (p<0.05), an improvement of 21.1%. There was no measured increase on readmission rate during the intervention period.ConclusionAn electronic tool to standardise information gathered among team members in daily discharge rounds led to improvements in length of stay. Multidisciplinary discharge rounds are an important venue for discharge planning across inpatient care teams and efforts to optimise communication between team members can improve care.

A patient-centred check sheet improves communication on the trauma ward round

2019 ◽  
Vol 80 (8) ◽  
pp. 472-475
Author(s):  
Oliver S Brown ◽  
Teri HH Toi ◽  
Pedro R Barbosa ◽  
Patra Pookarnjanamorakot ◽  
Alex Trompeter
Keyword(s):  
Patient Survey ◽  
Management Plan ◽  
Ward Round ◽  
Improvement Project ◽  
Orthopaedic Department ◽  
Number Of Patients ◽  
Surgical Ward ◽  
Ward Rounds ◽  
Transfer Of Information ◽  
Initial Results

Background: Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient. Methods: A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one. Results: Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%. Conclusions: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.

scholarly journals 1702 A Proforma To Improve Documentation of Surgical Ward Rounds

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Armstrong ◽  
M Koronfel
Keyword(s):  
District General Hospital ◽  
Ward Round ◽  
Post Intervention ◽  
Improvement Project ◽  
Vte Prophylaxis ◽  
Surgical Ward ◽  
Management Plans ◽  
Ward Rounds ◽  
Assess Quality

Abstract Aim The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety. Method Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into: A re-audit was performed following introduction of a ward round proforma using the same criteria. Results The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%. Conclusions The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.

Are we really good to go? Can we do better?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 251-251
Author(s):  
Katie Magni ◽  
Janet Bagley ◽  
Jeffrey Durney ◽  
Rachel A Wolfberg ◽  
Melissa Perna ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intervention Program ◽  
Team Approach ◽  
Improvement Project ◽  
Team Members ◽  
Training Video ◽  
Chemotherapy Administration ◽  
Pharmacy Intervention ◽  
Phone Calls ◽  
Pharmacy Interventions

251 Background: ASCO/ONS (2016) stated that health care continues to see errors regarding chemotherapy administration. ASHP (2015) recommends that institutions establish checkpoints to ensure that chemotherapy orders are correct. These critical safety checks involve stakeholders on the frontline. The institute uses the pharmacy intervention program to combat this critical need. Pharmacy interventions are reviewed monthly and defined as any medication order that pharmacy reviews and recognizes a discrepancy, requiring follow up. An interdisciplinary workgroup of pharmacists and nurses was established to address pharmacy interventions identified. Methods: The workgroup met over two months to revise the existing medication administration criteria and developed a standardized Good to Go worksheet. A mandatory training video was assigned to infusion nurses. The worksheets were piloted over three weeks and reviewed for completion and notes. Pharmacy interventions were collected prior to and during implementation to track compliance and improvement to patient safety. Nurses and pharmacists were identified as team members. Daily debriefing huddles were held during implementation with feedback incorporated and revisions made to the worksheet for the following day(s). This project was approved by the DFCI IRB as a Quality Improvement Project. Results: The pilot unit had a pharmacy intervention rate of 8.8 % for one week prior to implementation. During week one of the pilot the pharmacy interventions decreased to 4.1% and one month after pilot the rate was 4.6% and 4.7%. The most recent pharmacy interventions were communicated to staff. May data showed a further reduction to 2.8%. Nurses reported feeling better organized and more focused, while pharmacists report less phone calls to infusion. Statements from frontline staff and leadership including the positive results of the pilot were added to the training video. Conclusions: With the positive impact on patient safety, the Good to Go project will be implemented throughout the institute in the summer of 2018. Team members will include infusion nurses and pharmacists from all units. A standardized team approach to chemotherapy administration has the potential to minimize medication errors.

scholarly journals Accuracy of periocular lesion assessment using telemedicine

2021 ◽  
Vol 28 (1) ◽  
pp. e100287
Author(s):  
Swan Kang ◽  
Mohammad Dehabadi ◽  
Dawn A Sim ◽  
Peter B M Thomas ◽  
Doris Appiah Ewusi ◽  
...  
Keyword(s):  
Case Series ◽  
Management Plan ◽  
Kappa Coefficient ◽  
High Rate ◽  
Series Data ◽  
Nurse Specialist ◽  
Face To Face ◽  
Diagnosis And Management ◽  
Management Plans ◽  
Eyelid Lesions

ObjectivesTo assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics.MethodsIn this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant.ResultsComplete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s.ConclusionsThis study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.

569 Improving the Urology Post Take Ward Round with Best Clinical Practice and A Governance Checklist. Quality Improvement Project Within Belfast Health and Social Care Trust 2020

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P McLoughlin ◽  
A McAdam
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Royal College ◽  
Management Plan ◽  
Ward Round ◽  
Quality Improvement Project ◽  
National Guidelines ◽  
Improvement Project ◽  
Ensure Patient Safety ◽  
Health And Social Care

Abstract Introduction The post take ward round (PTWR) is a vital element to ensure patient safety. Although well established as a necessity, often documentation is poor and does not accurately reflect a clinical assessment or generated management plan. This quality improvement project aimed to assess the pitfalls of the PTWR and improve these were possible in-line with best clinical practice. Method Audit standards were established using national guidelines, including those by the Royal College of Physicians, Royal College of Surgeons, GAIN guidelines and NICE. An initial audit was carried out against these guidelines. Following this, three distinct interventions were implemented namely, Junior Doctor Education Sessions, a Urology Consultant Email Circular, and the development of a Urology PTWR Checklist. After each intervention, a re-audit was carried out. Results Compliance with guidelines improved across all standards set. Overall compliance improved from 19.0% to 70.4% after our three interventions were implemented. Conclusions The results of the initial audit outlined that PTWR documentation is often very poor or severely lacking. Fortunately, this QIP demonstrates how the urology PTWR can be significantly improved with relatively simple measures.

scholarly journals OR and ICU teams ‘running in parallel’ at the end of cardiothoracic surgery improves perceptions of handoff safety

2021 ◽  
Vol 10 (1) ◽  
pp. e001001
Author(s):  
Safraz Hamid ◽  
Frederic Joyce ◽  
Aaliya Burza ◽  
Billy Yang ◽  
Alexander Le ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Safety Culture ◽  
Positive Response ◽  
Improve Patient Safety ◽  
Health Care Research ◽  
Response Rates ◽  
Patient Safety Culture ◽  
Improvement Project ◽  
Surgery Patient

The transfer of a cardiac surgery patient from the operating room (OR) to the intensive care unit (ICU) is both a challenging process and a critical period for outcomes. Information transferred between these two teams—known as the ‘handoff’—has been a focus of efforts to improve patient safety. At our institution, staff have poor perceptions of handoff safety, as measured by low positive response rates to questions found in the Agency for Health Care Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS). In this quality improvement project, we developed a novel handoff protocol after cardiac surgery where we invited the ICU nurse and intensivist into the OR to receive a face-to-face handoff from the circulating nurse, observe the final 30 min of the case, and participate in the end-of-case debrief discussions. Our aim was to increase the positive response rates to handoff safety questions to meet or surpass the reported AHRQ national averages. We used plan, do, study, act cycles over the course of 123 surgical cases to test how our handoff protocol was leading to changes in perceptions of safety. After a 10-month period, we achieved our aim for four out of the five HSOPS questions assessing safety of handoff. Our results suggest that having an ICU team ‘run in parallel’ with the cardiac surgical team positively impacts safety culture.

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