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Full clerkings at the N.O.C.

Quality Improvement Project. Full clerkings at the N.O.C. Ioannis Spiliotis, Sarah Briggs Supervisor: Dr Matt Scarborough. Background. All inpatients should have full clerking documentation Most admissions at NOC are elective and clerked in pre-assessment clinic on paper proforma

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Full clerkings at the N.O.C.

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  1. Quality Improvement Project Full clerkings at the N.O.C. Ioannis Spiliotis, Sarah Briggs Supervisor: Dr Matt Scarborough

  2. Background • All inpatients should have full clerking documentation • Most admissions at NOC are elective and clerked in pre-assessment clinic on paper proforma • Clerking proformas are scanned into EPR, with no further clerking on arrival • No prompt for past medical history or drug history • If called to see patient on call, this information often absent • Implications for patient safety

  3. Project aims • All patients admitted to NOC to have full clerking visible on EPR including: • HPC, PMHx, DHx including allergies, Examination findings • Action planning: • What changes can we make that will result in improvement? • Alter paper proforma to include prompt • SHO education (but should be standard; rotate every few months) • Electronic proforma

  4. Process Mapping

  5. Action planning

  6. Driver Diagram

  7. Methods • Cross sectional check of EPR of all current inpatients • Exclusion criteria: any admitted within preceeding 4 hours • 40% only with full clerking • Sticker added to proforma with DHx/PMHx

  8. Data

  9. Percentage of admission clerkings completed Initialpresentation Intervention started

  10. Initialpresentation Intervention started Intervention reviewed

  11. Absolute numbers of elective admission clerkings completed Initialpresentation Intervention started Intervention reviewed

  12. Percentage of elective admission clerkings completed Initialpresentation Intervention started Intervention reviewed

  13. Percentage of admission clerkings completed Initialpresentation Intervention started

  14. Have we made a difference • Significant increase in full clerkings • ‘Blip’ in early april – after easter bank holiday • Persistent proportion (15-20%) with partial clerking • Delays in admission – significant proportion on old proforma • Need to prompt ‘allergies’? • No real change in number with no clerkings • Did not attend POAC? • Clerking not scanned?

  15. What next? • Addition of PMHx, DHx and allergies to clerking proforma • Creation of EPR clerking proforma with prompts for full clerking information • Targeting of emergency admissions • SHO/registrar education – what’s expected • Use of an admission proforma? • Population of existing sections for PMHx and allergies on EPR

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