full clerkings at the n.o.c. ioannis spiliotis, sarah briggs supervisor: dr matt scarborough quality...
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Full clerkings at the N.O.C.
Ioannis Spiliotis, Sarah BriggsSupervisor: Dr Matt Scarborough
Quality Improvement Project
Background
• All inpatients should have full clerking documentation• Most admissions at NOC are elective and clerked in
pre-assessment clinic on paper proforma• Clerking proformas are scanned into EPR, with no
further clerking on arrival• No prompt for past medical history or drug history• If called to see patient on call, this information often
absent• Implications for patient safety
Project aims• All patients admitted to NOC to have full clerking
visible on EPR including:– HPC, PMHx, DHx including allergies, Examination
findings
• Action planning:– What changes can we make that will result in
improvement?• Alter paper proforma to include prompt• SHO education (but should be standard; rotate every few
months)• Electronic proforma
Process Mapping
Action planning
Driver Diagram
Methods
Date 12/10/2011 21/11/2011
full 25 17
partial 34 20
none 7 6
total 66 43
Date 12/10/2011 21/11/2011
% full 38 40
% partial 52 47
% none 11 14
• Cross sectional check of EPR of all current inpatients
• Exclusion criteria: any admitted within preceeding 4 hours
• 40% only with full clerking
• Sticker added to proforma with DHx/PMHx
Data
Date 12/10/2011 21/11/2011 06/02/2012 05/03/2012 26/03/2012 10/04/2012 26/04/2012 Total
full 25 17 44 65 54 24 48 277
partial 34 20 17 13 13 8 14 119
none 7 6 7 1 9 7 3 40
total 66 43 68 79 76 39 65 436
Date 12/10/2011 21/11/2011 06/02/2012 05/03/2012 26/03/2012 10/04/2012 26/04/2012
% full 38 40 65 82 71 62 74
% partial 52 47 25 16 17 20 21
% none 11 14 10 1 12 18 5
Initialpresentation
Percentage of admission clerkings completed
Intervention started
Initialpresentation
Intervention reviewed
Intervention started
Initialpresentation
Intervention reviewed
Absolute numbers of elective admission clerkings completed
Intervention started
Initialpresentation
Intervention reviewed
Percentage of elective admission clerkings completed
Intervention started
Initialpresentation
Percentage of admission clerkings completed
Intervention started
Have we made a difference
• Significant increase in full clerkings• ‘Blip’ in early april – after easter bank holiday• Persistent proportion (15-20%) with partial
clerking– Delays in admission – significant proportion on old
proforma– Need to prompt ‘allergies’?
• No real change in number with no clerkings– Did not attend POAC?– Clerking not scanned?
What next?• Addition of PMHx, DHx and allergies to clerking
proforma• Creation of EPR clerking proforma with prompts
for full clerking information• Targeting of emergency admissions
– SHO/registrar education – what’s expected– Use of an admission proforma?
• Population of existing sections for PMHx and allergies on EPR