Improving the Surgical Ward Round.

Transcription

1 Postr Sssion HRT1317 Innovation Awards Novmbr 2013 Brisban Improving th Surgical Ward Round. Prsntr(s):J. Lin, G. Thompson, M. Pitchr, S.Chan

2 KEY PROBLEM -Ward Round Issus 1. Tim constraints 2. Staff changs Diffrnt consultant vry 24 hours (Acut Surgical Unit) Diffrnt rgistrars admitting & lading ward round Diffrnt nursing staff 3. Complxity of tam mmbrs Avrag of 1 consultant, 3 rgistrars, 2 intrns, mdical studnts & nursing staff. Communication in a crowd 4. Patint factors NESB, non communicativ, th sick patint 5. Taching

3 AIM OF THIS INNOVATION Obsrv and rcord complianc of ky aspcts of th ward round procss, bfor and aftr th us of a chcklist. Mdical studnts attachd to th unit wr ducatd to rcord ths obsrvations ovr two tim priods. Phas 1- surgical tam unawar of purpos of study & natur of obsrvations Phas 2 -surgical tam wr promptd to omission(s) against chcklist

4 BASELINE DATA - Currntly no data had bn collctd on using a chcklist to Improv th Surgical ward around.

5 Outcoms So Far Bfor and Aftr study dsign. Sampl siz rquird for statistical significanc = 12 pairs Phas 1: n= 132 patints Phas 2: n= 182 patints McNmar s Tst applid to calculat for statistical significanc.

6 Rsults: Bdsid Patint Consultation Ask & Listn Focusd Examinatio n Hand Hygin Numbr Prcntag Numbr Prcntag Significan c 114 of % 182 of % P= of % 166 of % P< Rsults: Bdsid Patint Consultation 104 of % 91 of % P<0.0001

7 Rsults: Patint Safty Numbr Prcntag Numbr Prcntag Significanc Pain 105 of % 173 of % P< Eating/Dit 73 of % 121 of % P< Urin/IDC 12 of 78 15% 50 of 66 76% P< Rsults: Patint Safty Cannula (IV) 9 of 98 9% 92 of % P< DVT prophylaxis Wounds/Drai ns Nurs Prsnt? 33 of % 149 of % P< of 77 51% 83 of 88 95% P< of % 141 of % P<0.0001

8 Rsults: Bdsid Charts Numbr Prcntag Numbr Prcntag Vital Signs 122 of % 179 of 181 Drug Chart 96 of % 177 of 180 Fluid Balanc 22 of % 140 of 156 Rsults: Planning Numbr Prcntag Numbr Significan c 99% P= % P< % P< Prcntag Significanc Blood Tsts 14 of % 75 of 79 95% P< Radiology 20 of % 62 of 65 95% P< Rfrrals 63 of % 40 of 49 82% P= Discharg Plan 58 of % 64 of 71 90% P<0.0001

9 Rsults: Documntation & Summary Documntatio n Numbr Prcntag Numbr Prcntag Significan c 117 of % 179 of % P= Patint 100 of % 167 of % P< Nursing 64 of % 89 of % P< Rlativs 6 of 58 10% 17 of 28 61% P= Footr Txt 9

10 KEY CHANGES IMPLEMENTED Using a chcklist to prompt that all clinical car is rviwd on th ward around. Buy in by Unit Had and th whol multi - disciplin tam to support th chcklist and ward round changs.

11 OUTCOMES SO FAR 1. Statistically significant improvmnt in most paramtrs. Comparabl with rcnt studis (Dhillon P. t.al. & Caldwll G. t.al.) 2. Hand Hygin wors aftr th us of chcklist. Phas 1 affctd by bias. Fals dduction of hand hygin study. Phas 2 (52.7%) is consistnt with Wstrn Halth rport of Hand Hygin Complianc (Doctors) 1/4/ /6/2012 (49% Complianc) 3. Som clinicians rluctant to act on prompts primarily bcaus of tim prssur. Us of a chcklist with prompting, significantly improvs complianc of ky aspcts of car affordd during th Surgical Ward Round

12 OUTCOMES SO FAR CON T

13 LESSONS LEARNT Nds to b supportd by th vry mmbr of th multi disciplin tam. To continu to improv th chcklist thr nds to b nominatd prson on th ward round to b in-charg of th chcklist. Incras in lngth of tim on Ward Round. An additional 30s pr patint. Howvr th tam dos gt fastr as thy ar us to th paramtrs of th chcklist.