Full clerkings at the N.O.C.

Ioannis Spiliotis, Sarah BriggsSupervisor: Dr Matt Scarborough

Quality Improvement Project

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

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

Process Mapping

Action planning

Driver Diagram

Methods

Date 12/10/2011 21/11/2011

full 25 17

partial 34 20

none 7 6

total 66 43

Date 12/10/2011 21/11/2011

% full 38 40

% partial 52 47

% none 11 14

• 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

Data

Date 12/10/2011 21/11/2011 06/02/2012 05/03/2012 26/03/2012 10/04/2012 26/04/2012 Total

full 25 17 44 65 54 24 48 277

partial 34 20 17 13 13 8 14 119

none 7 6 7 1 9 7 3 40

total 66 43 68 79 76 39 65 436

Date 12/10/2011 21/11/2011 06/02/2012 05/03/2012 26/03/2012 10/04/2012 26/04/2012

% full 38 40 65 82 71 62 74

% partial 52 47 25 16 17 20 21

% none 11 14 10 1 12 18 5

Initialpresentation

Percentage of admission clerkings completed

Intervention started

Initialpresentation

Intervention reviewed

Intervention started

Initialpresentation

Intervention reviewed

Absolute numbers of elective admission clerkings completed

Intervention started

Initialpresentation

Intervention reviewed

Percentage of elective admission clerkings completed

Intervention started

Initialpresentation

Percentage of admission clerkings completed

Intervention started

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?

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