Hutton Joe, Gingell Megan, Hutchinson Lisa
Gloucestershire NHS.
BMJ Qual Improv Rep. 2016 Apr 4;5(1). doi: 10.1136/bmjquality.u204172.w4017. eCollection 2016.
Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97.7%). The EPCs support the management of unwell patients, are relevant to the workload of modern doctors practice and may improve patient care. This improvement measure could be applied to other NHS trusts and medical specialties.
开始基础年（FY）培训的医生面临着诸多压力和挑战。FY医生常常是病情严重且不断恶化患者的首要接触点。信托机构的指南用于辅助急性病医疗管理。获取指南往往充满障碍。有证据表明，备忘卡能让获取指南和管理路径变得更加容易。我们旨在通过改善格洛斯特郡信托机构指南的获取途径和易用性，提高FY医生对急性病的处方准确性和效率。向FY医生发放问卷，以确定纳入急诊处方卡（EPC）的急性病。制作了两张双面小卡片，上面包含针对以下病症的要点式信托机构指南：高钾血症/低钾血症、癫痫持续状态、糖尿病急症、心律失常、心肌梗死、急性哮喘、肺水肿、过敏反应以及查房清单。在发放之前，利用反馈意见对EPC进行了改进。FY医生完成了干预前（N = 53）和干预后（N = 46）的书面问卷。这些问卷评估了急性临床管理情况，包括指南的使用、管理信心、开处方速度以及EPC的“易用性”。为评估处方准确性，对急性病的处方在干预前（N = 8）和干预后（N = 12）进行了审查。EPC受到广泛好评（80%认为相当/非常有用），且被认为“易于使用”（83%）。EPC的引入增加了指南的使用（干预前为58.8%，干预后为71.7%），增强了信心（干预前为79%，干预后为89%），并显著提高了开处方速度（p = 0.05）。信心与开处方速度之间存在显著相关性（p = 0.023）。处方剂量的准确性有所提高（干预前为62.5%准确，干预后为87.5%准确），给药途径/其他所需信息的详细程度也是如此（干预前为75%，干预后为97.7%）。EPC有助于对病情不佳的患者进行管理，与现代医生的工作量相关，并且可能改善患者护理。这种改进措施可应用于其他国民保健服务信托机构和医学专科。
