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Implementation of a ward round pro-forma to improve adherence to best practice guidelines.

ABSTRACT: Our aim was firstly to assess adherence to best practice guidelines for the prevention of healthcare associated causes of inpatient mortality and morbidity by junior doctors. Secondly, we wanted to measure the impact of a ward round checklist on rates of adherence. The rates of correct prescribing of antibiotics, venous thrombo-embolism prophylaxis, and oxygen (pro re nata) as well as correctly completed paperwork for peripheral venous cannulas were measured in a spot audit of all medical notes of patients on a medical assessment unit. This was repeated two weeks and two months after the introduction of a specifically designed ward round checklist for junior doctors. Initial audit of 40 patient notes confirmed generally poor compliance with best practice guidelines in the prescription of antibiotics (58% correctly prescribed) and oxygen (42%), and in the use cannula care plans (39%). Venous thrombo-embolism prophylaxis prescribing on the other hand was widespread (82%). The introduction and extensive use of the ward round checklist did not have a significant impact on these figures as shown in the two following stop audits (30 and 36 notes respectively). Checklists are helpful in providing a structured and systematic approach to complex tasks and have been shown to have a measurable impact in improving patient care. Their effectiveness is however limited by their uptake and regular correct use. Obstructing issues include poor understanding of the need for change in practice, lack of individual accountability and variable involvement of clinical leaders. These issues must be addressed together in order to effect a successful change in clinical practice.

SUBMITTER: Boland X

PROVIDER: S-EPMC4645828 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Implementation of a ward round pro-forma to improve adherence to best practice guidelines.

Boland Xavier X

BMJ quality improvement reports 20150218 1

Our aim was firstly to assess adherence to best practice guidelines for the prevention of healthcare associated causes of inpatient mortality and morbidity by junior doctors. Secondly, we wanted to measure the impact of a ward round checklist on rates of adherence. The rates of correct prescribing of antibiotics, venous thrombo-embolism prophylaxis, and oxygen (pro re nata) as well as correctly completed paperwork for peripheral venous cannulas were measured in a spot audit of all medical notes ...[more]

PMID: 26734332

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Project description:ObjectiveThe overall aim of this project was to assess compliance with evidence-based criteria regarding newborn resuscitation among healthcare workers in the maternity units in Maragua District Hospital (a busy district hospital in Kenya).IntroductionGlobally, the majority of deaths under five years are attributable to neonatal causes. Perinatal asphyxia accounts for a significant portion of these deaths, especially in developing countries. These deaths are largely preventable, and interventions geared towards assisting newborns to initiate their first breath within the first minute of life have markedly reduced mortality.MethodsThis implementation project was conducted in the maternity units of a busy district hospital. Evidence-based audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute (JBI). Using the JBI Practical Application of Clinical Evidence System software (JBI PACES), a baseline audit was conducted including a sample size of 55 healthcare providers and 300 patient case notes followed by an identification of potential barriers and strategies to overcome them. A follow-up audit including a sample size of 55 healthcare providers was conducted by using the same audit criteria.ResultsImprovements in practice were demonstrated in all criteria. The baseline audit demonstrated that three of the five audit criteria were found to be less than 50%, indicating moderate compliance with current evidence with regards to newborn resuscitation. Following implementation of the strategies, which included a six-week education and demonstrative skills training, and updating of the protocols and equipment, there was a significant improvement in all the criteria audited, with the first four criteria achieving 100% compliance, and the fifth criteria achieving 90% compliance.ConclusionOn completion of the project, the participants demonstrated an increase in knowledge and skills on newborn resuscitation, which led to a significant reduction in admission of newborns with birth asphyxia to the newborn unit.

Project description:Background:Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students' and clinicians' clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. Methods:A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students' opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources. Results:Few changes were made to the existing simulation plan and format. Students' responses from surveys (n?=?367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. Discussion:Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. Conclusions:Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students' needs in rehearsing the registered nurse role.

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Implementation of a ward round pro-forma to improve adherence to best practice guidelines.

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Implementation of a ward round pro-forma to improve adherence to best practice guidelines.

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