Salisbury NHS Foundation Trust, Salisbury, UK.
Great Weston NHS Foundation Trust, Swindon, UK.
Int J Risk Saf Med. 2022;33(S1):S69-S72. doi: 10.3233/JRS-227027.
Advance care treatment escalation plans (TEPs) are often lost between healthcare settings, leading to duplication of work and loss of patient autonomy.
This quality improvement project reviewed the usage of TEP forms and aimed to improve completeness of documentation and visibility between admissions.
Over four months we monitored TEP form documentation using a standardised data extraction form. This examined section completion, seniority of documenting clinician and transfer of forms to our hospital electronic patient record (EPRO). We added reminders to computer monitors on wards to improve EPRO upload.
Initial data demonstrated that 95% of patients (n = 230) had a TEP, with 99% of TEPs recording resuscitation status. However, other sections were not well documented (patient capacity 57% completion and personal priorities 45% completion, respectively). Only 11.9% of TEPs documented consultant involvement. Furthermore, only 44% of TEPs with a do not attempt resuscitation (DNACPR) decision were uploaded. Following this, we added reminders to computer monitors explaining how to upload TEP decisions to EPRO, which increased EPRO uploads to 74%.
Communication of TEPs needs improving across healthcare settings. This project showed that the use of a physical reminder can greatly improve communication of treatment escalation decisions. Furthermore, this intervention has inspired future projects aiming at making communication more sustainable through the use of discharge summaries.
在医疗机构之间，高级医疗护理治疗计划（TEP）经常丢失，导致工作重复和患者自主权丧失。
本质量改进项目审查了 TEP 表格的使用情况，旨在提高文档记录的完整性和入院期间的可见性。
在四个月的时间里，我们使用标准化的数据提取表格监测 TEP 表格的文档记录情况。这检查了部分完成情况、记录医生的资历以及表格是否转至我们医院的电子病历（EPR）。我们在病房的计算机监视器上添加了提醒，以改进 EPRO 的上传。
初步数据表明，95%的患者（n=230）有 TEP，99%的 TEP 记录了复苏状态。然而，其他部分记录不完整（患者能力记录完成率为 57%，个人优先事项记录完成率为 45%）。只有 11.9%的 TEP 记录了顾问的参与。此外，只有 44%的有不进行心肺复苏（DNACPR）决定的 TEP 被上传。在此之后，我们在计算机监视器上添加了提醒，解释如何将 TEP 决策上传至 EPRO，这将 EPRO 的上传率提高到了 74%。
需要改善医疗保健环境之间的 TEP 沟通。该项目表明，使用物理提醒可以大大改善治疗升级决策的沟通。此外，这一干预措施激发了未来的项目，旨在通过使用出院小结使沟通更加可持续。
