Gilliland Niall, Catherwood Natalie, Chen Shaouyn, Browne Peter, Wilson Jacob, Burden Helena
Department of Urology, Southmead Hospital, The Severn Deanery, Bristol, UK.
BMJ Open Qual. 2018 Apr 27;7(2):e000170. doi: 10.1136/bmjoq-2017-000170. eCollection 2018.
Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.
The quality improvement technique of plan-do-study-act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.
Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.
Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.
临床管理部门对我们住院查房的安全性提出了担忧，尤其涉及以下方面：临床观察记录和国家早期预警评分（NEWS）、静脉血栓栓塞症（VTE）风险评估中信托机构指南的遵循情况、抗生素管理、姑息治疗以及治疗升级计划（TEP）。开展这个质量改进项目是为了确保在查房过程中考虑并记录这些参数，从而改善患者护理和安全。这些参数基于信托机构的患者安全指南和质量、创新服务支付（CQUIN）目标。
本项目采用了计划 - 实施 - 研究 - 改进（PDSA）质量改进技术。在做出任何改变之前，我们回顾性地检查查房记录，以记录基于上述参数的基线测量值。在此之后，实施的改变是引入一个查房模板，其中包含突出显示的重要基线参数。每月进行PDSA循环，重新检查基线测量值，然后对查房模板进行相关更改。
在引入查房模板之前，基线测量值的记录情况很差；引入标准化查房模板后，情况有了显著改善。经过三个循环，VTE风险评估记录从14%增加到92%。抗生素管理记录从0%增加到100%。TEP表格的使用从29%增加到78%。
引入查房模板后，所有安全参数的合规性都有显著提高。查房时讨论重要的安全措施将提高患者安全性，并提高对信托机构指南以及质量、创新服务支付（CQUIN）目标的合规性。持续的变革实施将专注于提高泌尿外科所有查房中模板使用的合规性。
