Shared learning database
Type and Title of Submission
Assessment of the reliability of the Patient Observations undertaken in an acute hospital setting.Description: Category:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG50 - Acutely ill patient in hospitalCategory(s) that most closely reflects the nature of the submission:
Description of submission
To ensure that the implementation of new documentation is accompanied by an improvement in the standards of patient observation charts in order to decrease the risk to patients and improve care.Objectives
1. To ensure that all areas of the observation chart are routinely completed and acted upon. 2. To target resources to areas which need help to improve the quality of their patient observations. 3. To ensure that initiative improves patient care and safety.Context
A previous study by the Trusts Patient Safety Team highlighted that the NICE guidance (CG50) recommendations were not being met and that the observations set was not consistently being completed by the nursing staff. This resulted in limited faith in the reliability of the MEWS alert system within the Trust. To facilitate improvement the Patient Observation Chart was reviewed and redesigned to make patient monitoring a more rational process for nursing staff. This involved a period of consultation with staff and a comprehensive review process. In order to ensure that this initiative was improving care, to highlight areas of good practice and those who required improvement, an assessment process was devised to allow quick review and feedback on levels of completion of information on the observation chart.Methods
1. Improved levels of completion of observation charts 2. More reliable and consistent calculation of the track and trigger MEWS score system. 3. Ward level monitoring of performance to allow appropriate allocation of resources. 4. System to track improvements or to highlight concerns within the clinical area. 5. To show that the new observation chart initiative has not harmed care.Results and evaluation
An assessment tool was developed in which nine categories of information were assessed for completeness. These were "all-or-nothing" assessments which were adopted in order to push areas into best practice. It was felt that there was no leeway for observations to be missed for patients within the acute setting. Results were assessed on a ward by ward basis over time in order to track changes over time to ensure that standards were raised and maintained.Key learning points
1. Be clear on the information you wish to assess. 2. Work needs to a partnership between clinical staff and those who will analyse your data. 3. Clear timescales and reporting routes are key to ensure fast turnaround of data and interventions based on results. 4. Do not underestimate the time and manpower resources which are required to undertake this project.
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|Job Title:||Clinical Effectiveness Facilitator|
|Organisation:||Brighton & Sussex University Hospitals NHS Trust|
|Address:||Latilla Annexe, Royal Sussex County Hospitals NHS Trust|
|Phone:||01273 696955 et 4685|
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This page was last updated: 26 September 2008