EP.TU.270Improving Treatment Escalation Plan (TEP) Completion Rate for General Surgical Patients

Aims Treatment Escalation Plan (TEP) is essential for recognition of patients’ ceiling for care in the event of clinical deterioration. It should be clearly documented to ensure continuity of care, especially during Covid-19 pandemic. This audit aims to evaluate and improve the TEP filling rate for general surgical patients. Methods A prospective data collection was performed for one week in July 2020 in general surgical wards. Data on patients’ gender, age, presence of DNACPR form and date of TEP completion were collected from patients’ clinical notes. Data was analysed using SPSS statistic software. Educational posters were displayed in the ward and presentation was done to emphasise the importance of TEP documentation. Second audit cycle was done in August 2020 to assess for improvement in TEP filling rate. Results In the first cycle, 60 patients were included with a mean age of 60. Only 11.7% patients had TEP form filled in with a mean delay of 2.7 days since admission. In the second cycle, 57 patients were included with a mean age of 66. 28.1% patients had TEP form documented with a mean delay of 1.7 days. This has shown a 140% improvement in completion rate of TEP form and 59% reduction in the delay in TEP documentation. Conclusions TEP is essential to ensure that patients received optimal care when their condition deteriorate. Simple intervention such as educational posters will help to improve the TEP completion rate. However, continuous auditing is required to ensure improvement in TEP documentation for surgical patients.

How internal audit can champion continuous monitoring in a business operation via visual reporting and overcome barriers to success

Many auditing professionals would contend that continuous monitoring is a function of management and not internal audit. However, effective continuous auditing is highly dependent upon a strong continuous monitoring system. Further, by integrating technology of these two systems, continuous assurance can be achieved, and audit efficiency and effectiveness can be improved through the reduction of costs and effort. This paper discusses how internal audit can collaborate with a business operation to develop a continuous monitoring application utilizing visual reporting and overcome the potential barriers to success. The specific business operation selected for modification was the procurement card program at a large public university. Following an introduction of the scenario, an overview of the ProCard™ program is provided, highlighting the program risks and controls. Third, a four-phased approach used to develop the continuous monitoring tool is described, including specific steps taken to ensure effective use of the real-time data by auditors. Fourth, challenges the internal function encountered when implementing the system are described, including how those challenges were addressed. Fifth, the paper provides concluding comments and future initiatives planned. Finally, the paper provides additional examples for continuous auditing and monitoring and suggests future research topics in this area. Keywords: Continuous auditing, continuous monitoring, visual reporting, internal audit, procurement card.