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

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 Elective admission POAC clerking Clerking scanned Patient unwell Information available!

5. Action planning Problem identified  possible solutions discussed  consensus Plan Initial data collection  intervention begun  regular reaudit Do Identify problems  modify intervention  reaudit Study Permanent changes to clerking process Act

6. Driver Diagram Clerking Full history Fully documented Admin Booked to POAC Proforma filed Proforma scanned Education SHOsRegistrars

7. Methods Date12/10/201121/11/2011 full2517 partial3420 none76 total6643 Date12/10/201121/11/2011 % full3840 % partial5247 % none1114 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 Date12/10/201121/11/201106/02/201205/03/201226/03/201210/04/201226/04/2012Total full25174465542448277 partial34201713 814119 none767197340 total66436879763965436 Date12/10/201121/11/201106/02/201205/03/201226/03/201210/04/201226/04/2012 % full38406582716274 % partial52472516172021 % none111410112185

9. Initial presentation Percentage of admission clerkings completed Intervention started

10. Initial presentation Intervention reviewed Intervention started

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

12. Initial presentation Intervention reviewed Percentage of elective admission clerkings completed Intervention started

13. Initial presentation Percentage of admission clerkings completed 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