Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan.

2020 ◽  
pp. 1-17
Author(s):  
Mohammad Ashraf ◽  
Syed Shahzad Hussain ◽  
Usman Ahmad Kamboh ◽  
Mehreen Mehboob ◽  
Saman Shahid ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit Quality ◽  
Wound Care ◽  
International Standards ◽  
Neurosurgical Department ◽  
Post Intervention ◽  
Improvement Project ◽  
Audit Cycle ◽  
Patient Note ◽  
Operative Notes

Abstract Objective: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. Methods: The prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 219 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patient-notes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. Results: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care: monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in ‘use of antibiotic prophylaxes’. Conclusion: Regular audits are needed to monitor and improve, Continuous..

scholarly journals Improving patient diary use in intensive care: A quality improvement report

2019 ◽  
pp. 175114371988529
Author(s):  
Asya Veloso Costa ◽  
Olivia Padfield ◽  
Sarah Elliott ◽  
Paul Hayden
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Psychological Symptoms ◽  
Time Constraints ◽  
Guidance Document ◽  
Improvement Project ◽  
Patient Diary ◽  
Patient Note ◽  
Team Engagement

Background Patients surviving critical illness are at risk of developing psychological symptoms that affect quality of life and recovery. Patient diaries may improve psychological outcomes by reducing gaps in memory and contextualising what has happened during admission. Factors including lack of guidelines, lack of awareness and time constraints may lead to poor diary use. Aims This quality improvement project aimed to increase diary provision and overall multidisciplinary team engagement with diaries for all patients admitted for over 72 h to an intensive care unit. Methods Trialled changes implemented via the ‘Plan-Do-Study-Act’ method included adding alerts to the online patient note system, providing education sessions and introducing a guidance document to facilitate entry completion. Results A ‘diary provision’ target of 100% was achieved (from a baseline of 26.1%). Simple changes have proven effective in establishing routine engagement with diaries, and lessons may be used to improve diary systems elsewhere.

scholarly journals Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

2018 ◽  
Vol 17 (3) ◽  
pp. 137-143
Author(s):  
Priya Patel ◽  
◽  
Natalie King ◽  
Keyword(s):  
Quality Improvement ◽  
Elderly Patients ◽  
Skin Care ◽  
Quality Improvement Project ◽  
Psychological Consequences ◽  
Post Intervention ◽  
Improvement Project ◽  
Care Bundles ◽  
Trust Hospital ◽  
Acute Admissions

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Edd Maclean ◽  
Shreena Patel ◽  
Olaminposi Joseph ◽  
Daniella de Block Golding ◽  
Samantha Maden ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Best Practice ◽  
Stroke Risk ◽  
International Standards ◽  
Quality Improvement Project ◽  
Management Decisions ◽  
Improvement Project ◽  
Management Algorithm ◽  
Arrhythmia Management

Objectives: In response to a serious incident involving an atrial fibrillation (AF) associated stroke, a quality improvement project was established to examine and abrogate unnecessary thromboembolic risk in patients presenting with acute AF to London’s North Middlesex University Hospital (NMUH). Methods: The presenting complaint was examined for 2,105 consecutive medical admissions to identify 100 patients (4.7%) with acute AF. For each patient, 36 indices and performance indicators were collected and analysed against international standards and the collective best practice of the local Cardiology team. Deficiencies were identified throughout the inpatient experience, including documentation, risk stratification, anticoagulation and arrhythmia management decisions. With cross-specialty collaboration, a single-page AF management algorithm was subsequently established using sequential PDSA methodology, and following its introduction a further 100 consecutive patients with acute AF were analysed prospectively. Results: Algorithm implementation significantly reduced the proportion of patients exposed to unnecessary stroke risk (30% -> 4%, p<0.0001); improved identification and documentation of thromboembolic potential (50% -> 88%, p<0.0001), reduced incorrect drug decisions (12% -> 2%, p=0.01), reduced contraindicated rhythm control (8% -> 0%, p=0.007), and increased direct oral anticoagulant (DOAC) prescribing (38% -> 86%, p<0.0001) over warfarin. There was a trend towards reduced mean inpatient stay (4.7 -> 3.5 days, p=0.11). Conclusions: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit.

Poster 117: Pain Assessment Survey (PAS) for Assessing Physical Pain in Post-Cerebrovascular Accident (CVA) Patients Post Intervention: Quality Improvement Project

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S172-S172
Author(s):  
Kirill Alekseyev ◽  
Nikhil Verma ◽  
Swathy Sreekumar ◽  
Amarin Suriyakhamhaengwongse ◽  
Malcolm Lakdawala ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Assessment ◽  
Cerebrovascular Accident ◽  
Quality Improvement Project ◽  
Physical Pain ◽  
Post Intervention ◽  
Improvement Project ◽  
Assessment Survey

3 Peer-Produced Induction Material for Foundation Year One Doctors in Plastic Surgery – A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Dwyer-Hemmings ◽  
L Salfity
Keyword(s):  
Quality Improvement ◽  
Plastic Surgery ◽  
Quality Care ◽  
Smooth Transition ◽  
Junior Doctors ◽  
Free Text ◽  
Post Intervention ◽  
Improvement Project ◽  
One Year ◽  
Surgery Department

Abstract Introduction Induction programmes are recommended for all junior doctors starting new posts and are mandatory for foundation year one doctors (FY1s). Constraints on time and staff mean these guidelines are not always met. This project aimed to improve the efficiency, effectiveness, and timeliness of care by designing and distributing peer-produced induction material to FY1s starting placements in plastic surgery. Method A quality-improvement methodology was utilised. Online questionnaires assessed FY1 experiences in several domains using five-point Likert scales and free-text answers. This information was used to design induction material. Material was distributed to incoming FY1 cohorts, the questionnaire was repeated, and material updated and redistributed. Results Three quality improvement cycles were performed over a one-year period. Four FY1s were surveyed pre-intervention, and four post-intervention. Post-intervention, there was a statistically significant improvement in understanding of responsibilities (+2.2, p &lt; 0.01) and departmental structure (+2.0, p = 0.018). FY1s felt confident in starting (4.75±0.5), prepared for on-calls (4.75±0.5), and satisfaction was high (4.75±0.5) Conclusions Peer-produced induction material for FY1s can improve understanding of responsibilities and structure within a plastic surgery department. This will increase confidence of new starters and facilitate smooth transition of staff, enabling the provision of high-quality care by enhancing its efficiency, effectiveness, and timeliness.

scholarly journals Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S38-S39
Author(s):  
Fraser MacNicoll ◽  
Mong Sun Tung ◽  
Brion McGowan
Keyword(s):  
Quality Improvement ◽  
Old Age ◽  
Quality Improvement Project ◽  
Assessment Process ◽  
Early Warning Score ◽  
Post Intervention ◽  
Improvement Project ◽  
Physical Deterioration ◽  
Increased Risk ◽  
Old Age Psychiatry

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

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