Agha Riaz, Edison Eric, Fielder Camm Christian, Cheng Lisa, Gajendragadkar Pushpaj, Borland Colin
Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, PE29 6NT, United Kingdom.
UCL Medical School, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
Ann Med Surg (Lond). 2012 Aug 9;1:34-8. doi: 10.1016/S2049-0801(12)70011-0. eCollection 2012.
Parkinson's disease can progressively affect daily function and multidisciplinary teamwork is essential to provide high quality care. The National Institute of Health and Clinical Excellence (NICE) issued guidelines regarding diagnosis, follow-up, and multidisciplinary care. This quality improvement project sought to measure and improve the compliance of service provision against the guidelines. In total, 3 audit cycles were completed. Each audit involved reviewing notes of patients attending a Parkinson's disease outpatient clinic against the PD NICE guidelines audit criteria. The first and second audits showed compliance was high for the criteria relating to initial diagnosis and referral but poor for those criteria relating to multidisciplinary referral. A pro forma stamp was recommended to be placed in the notes at each regular Parkinson's outpatient review by a specified date (October 2009), with re-audit occurring in June 2011 as part of the official hospital audit plan. Compliance to the NICE criteria improved to 100% on all criteria measured. However, it was evident from the notes that the pro forma that had been recommended by the previous audit had been in use but was not at present. In fact the pro forma had been so successful that the clinicians had made each of the criteria a routine part of their consultations and so did not need to rely on it. Use of a checklist can have a lasting improvement on compliance with NICE guidelines, even if the intervention itself is transient.
帕金森病会逐渐影响日常功能，多学科团队协作对于提供高质量护理至关重要。英国国家卫生与临床优化研究所（NICE）发布了关于诊断、随访及多学科护理的指南。这个质量改进项目旨在衡量并提高服务提供符合指南的程度。总共完成了3个审核周期。每次审核都对照帕金森病NICE指南审核标准，查阅帕金森病门诊患者的病历。第一次和第二次审核显示，与初始诊断和转诊相关的标准合规率较高，但与多学科转诊相关的标准合规率较低。建议在2009年10月这个指定日期前，每次帕金森病门诊定期复诊时在病历中放置一份预印表格，2011年6月进行重新审核，作为医院官方审核计划的一部分。所有衡量标准的NICE标准合规率都提高到了100%。然而,从病历中可以明显看出，之前审核推荐的预印表格曾被使用，但目前已不再使用。事实上，预印表格非常成功，以至于临床医生已将每项标准作为会诊的常规部分，因此不再需要依赖它。使用检查表可以对符合NICE指南的情况产生持久的改善，即使干预本身是短暂的。
