Using a venous thromboembolism checklist significantly improves VTE prevention: a junior doctor led intervention

Does an Orthopedic Ward Round Pro Forma Improve Inpatient Documentation?

INTRODUCTION

Thorough documentation is of utmost importance in a patient hospital experience. It forms an accurate record of an inpatient stay, facilitates handover between medical colleagues, and is also a legal document. Medical notes tend to be detailed and insightful on admission, but the daily ward round notes have often fallen short of expectation. With most patient records entered by junior level of staff, it is important to ensure that adequate documentation occurs.

METHODS

We analyzed notes entered in patient charts at set periods and compared them against standards set out in the Royal College of Surgeons Ireland and England, as well as Medical Council guidelines from the two countries. After this, a pro forma was established to standardize the medical record keeping on patient ward rounds. Compliance with guidelines was assessed by comparing notes before introduction of the pro forma and after their introduction.

RESULTS

Before its introduction, 0% of notes fulfilled the full criteria selected for the pro forma documentation. After intervention, there was a good initial response, with notes capturing an average 86% of the required information. A reaudit of compliance 2 months after introduction showed a 9% decrease of information completeness to 75%.

CONCLUSIONS

Introduction of a pro forma for the documentation of daily ward rounds improved compliance of ward round notes when compared with internationally recognized guidelines, with no additional time required during ward rounds. Despite improved compliance, continued effort is needed to achieve a better standard of care.

Application of the WHO surgical safety checklist outside the operating theatre: medicine can learn from surgery

Safety checklists in medicine are designed to identify a potential error before it results in harm to a patient. The World Health Organization (WHO) safety checklist was widely implemented in surgical practice in the UK after significant reductions in death, and peri-operative complications were achieved in eight countries worldwide in the 'Safe Surgery Saves Lives' campaign of 2008. Nevertheless, use of the checklist for invasive medical procedures is not yet routine. Such procedures are becoming ever more complex, necessitating multidisciplinary team management and involving higher-risk patients, with the need for general anaesthesia on occasion. As a result, the potential for error increases and the need for a safety checklist has become more apparent. Such a checklist can be modified to provide a framework for specialty-specific safety checks, enhanced team-working and communication for invasive medical procedures. Following an audit of use of the WHO checklist in 20 cases under general anaesthesia in our quaternary referral cardiac catheterisation laboratory, we discovered use of this safety tool was poor (performed/documented: sign in 30%/40%, time out 10%/15%, sign out 10%/15%) and we identified two 'near miss' incidents within the audit period. We then developed and implemented a modified WHO checklist for the specific challenges faced in the cardiac catheterisation laboratory. Following a staff education programme, a subsequent audit of 34 cases demonstrated improvement in all sections (performed/documented: sign in 91.2%/82.4%, time out 85.3%/76.5%, sign out 73.5%/64.7%) with no patient safety incidents during the post-intervention audit period. Well-designed, procedural checklists may well prove to be of benefit in other areas of interventional medicine.

Präventionschecklisten im OP und in der Endoskopie

<b><i>Hintergrund: </i></b>Unerwünschte Ereignisse oder sogar folgenschwere Fehlleistungen entstehen in der Medizin nicht zufällig. Analog zu anderen hochriskanten Arbeitswelten wie der Luftfahrt oder der Kernenergie stellen sie eine Verkettung unglücklicher Umstände bzw. den Zusammenbruch der Multibarrierenstrategie dar. Aus diesem Grund wurden im Laufe der letzten Jahre Checklisten etabliert, die als Teil dieser Sicherheitsbarrieren die Patientensicherheit erhöhen. <b><i>Methode: </i></b>Zur Literaturrecherche wurden die Datenbanken von Medline und PubMed sowie der Internetsuchdienst von Google unter den Suchworten «Checkliste», «Sicherheitscheckliste», zum Teil kombiniert mit «Endoskopie» bzw. «Endoscopy», «Surgical Safety Checklist», «Safety Checklist», «Checklist», «Safety Management» und «WHO-Checklist(e)» abgefragt. Die so identifizierten Publikationen wurden im Folgenden auf die relevanten endoskopischen und chirurgischen Belange hin zusammengestellt und um eigene Erfahrungen aus der Chirurgie und Endoskopie ergänzt. <b><i>Ergebnisse: </i></b>Operationschecklisten sind nachweislich effektive Instrumente zur Erhöhung der Patientensicherheit und Vermeidung von unerwünschten Ereignissen. Dies ist insbesondere auf eine verbesserte Kommunikation bzw. Teaminteraktion zurückzuführen, mit dem Effekt einer dadurch veränderten Sicherheitskultur. Voraussetzung ist ein gutes Checklistendesign und die gelebte Anwendung der Checklisten durch die Leitungsebenen. <b><i>Schlussfolgerungen: </i></b>Operationssaal(OP)-Checklisten verbessern nachhaltig die Sicherheitskultur und erhöhen dadurch die Patientensicherheit. Diese positiven Ergebnisse sollten zunehmend in andere Bereiche der Medizin wie die Endoskopie transferiert werden.