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Type and Title of Submission


Title:

Documentation of Baseline Clinical Condition in Emergency Department Patients

Description:

An easily accessible and portable reference resource for junior medical staff

Category:

Clinical

Does the submission relate to the general implementation of all NICE guidance?

Yes

Does the submission relate to the implementation of a specific piece of NICE guidance?

No

Full title of NICE guidance:

CG56 - head injury

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

The aim of the project was to develop an easily accessible and portable reference resource for junior medical staff that would enable them to quickly access the scoring systems and checklists needed to assess, risk stratify and treat common medical conditions. Difficulty in remembering common scoring systems and accessing information was recognised as a source of frustration in a time-pressured environment. Junior doctors' awareness of and compliance with national guidelines appeared limited when assessed by casenote audit. The short duration of F2 placements (four months) provides little time to embed knowledge and change behaviours. Maintaining quality with a rapidly changing workforce is a challenge, particularly in the high-risk, high-volume environment of an ED. The resource supplemented the induction teaching programme, CDROM and short answer question that the F2 doctors undertake on joining the ED. Although developed specifically for junior staff undertaking their first emergency medicine job, senior ED staff also identified that they had difficulty in remembering common scoring and grading systems. It was important to have a resource that was flexible enough to be customised to the changing needs of the more experienced practitioner. The flexibility of the system meant that they would also be suitable for customising to the needs of other acute specialties. Current limitations on the use of hand-held electronic devices in the trust meant that this option was not available.

Objectives

1. To facilitate an improvement in doctors' documentation in the patients' clinical record.

2. To provide juniors doctors with resource material as to best practice, local and NICE guidance for certain patient groups.

Context

The starting point for this project was an audit of current clinical practice in relation to documentation of patients' baseline clinical condition by junior medical staff. The audit assessed what information was being documented, how assessment tools were being accessed by juniors, whether documenting severity scores influenced management plans and what information senior staff would expect to see in the patients' clinical record.

Methods

1 The results of the audit demonstrated that in 84% of cases juniors were not documenting baseline severity indexes for patients. 2 In 35% of cases documentation of baseline information would have changed the course of the patients' management. 3 The main reason juniors gave for not documenting this information was difficulty finding and accessing appropriate, evidence based and validates scores. 4 Cards were developed over a period of 9 months with the involvement of all senior staff in the Emergency Department. 5 All senior staff provided a list of what information should be documented and the appropriate assessment tools. These were then collated into a set of cards and approved by all staff 6 The completed card set was discussed and approved by the Trust's governance department 7 Cards were rolled out to all junior medical staff in August 2009

Results and evaluation

This is a local initiative which is occurring as part of a wider clinical governance programme. It has not been implemented to test a research hypothesis that the cards improve documentation and will not generate data suitable for peer-reviewed publication. Monitoring and evaluation of the intervention will be through: Snapshot surveys undertaken to determine what proportion of ED doctors are carrying the cards or have rapid access to them. A survey of users' feedback A re-audit of documentation in December 2009 to re-assess documentation and evidence-based practice. The results will be published locally through clinical governance updates within the Emergency Care Directorate and the trust. The cards will be re-evaluated in August 2012 to ensure evidence is up to date with any changes in guidance.

Key learning points

1. If you are finding certain areas difficult it is likely that others will be sharing your problem. Start with an audit of current practice 2. involve senior staff at the beginning as they have invariably had experience in changing clinical practice 3. the local clinical governance department are also valuable in securing funding, wider support and dissemination of results 4. Keep pushing to achieve aims, things take time in a large organisation and this can be frustrating. Overcoming obstacles and frustrations makes results all the more rewarding.

View the supporting material

Contact Details

Name:SARAH FREWIN
Job Title:FOUNDATION 2 DOCTOR
Organisation:SUNDERLAND ROYAL HOSPITAL
Address:KAYLL ROAD
Town:SUNDERLAND
County:TYNE AND WEAR
Postcode:SR4 7TP
Phone:07795186804
Email:s.e.frewin@doctors.org.uk

 

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This page was last updated: 25 September 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.