Shared learning database

Brighton & Sussex University Hospitals NHS Trust
Published date:
September 2008

Ensuring that the implementation of new documentation is accompanied by an improvement in the standards of patient observation charts, in line with the NICE guidance for acutely ill patients in hospital (CG50)

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

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. 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.

Reasons for implementing your project

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.

How did you implement the project

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.

Key findings

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.

Contact details

Caroline Mills
Clinical Effectiveness Facilitator
Brighton & Sussex University Hospitals NHS Trust

Secondary care
Is the example industry-sponsored in any way?