Serum Potassium Levels and Mortality in Acute Myocardial Infarction Goyal A et al. JAMA. 2012; B157-164 The importance of potassium homeostasis in the post-infarction period has become a cornerstone in modern clinical practice. Several studies have shown that potassium levels of less than 3.5 led to a higher risk of arrhythmia induction. This study investigated what the optimal target potassium level should be, given the lower rates of serious arrhythmias following interventions such as beta-blockade and reperfusion therapy.
Aim
Training and knowledge of specialist neonatal care is frequently limited in low resource countries. We aimed to assess if the introduction of a standardised medical record could improve documentation, assisting nurses and doctors in their approach to daily care of the sick newborn.
Method
We gained national approval for the implementation of a novel neonatal medical record. The booklet was divided into sections for admission history, assessment and management, daily ward rounds, growth, prescriptions, investigation results, nursing documentation and discharge information. It was introduced in October 2013, with staff training provided for three weeks. An audit of documentation completeness was performed comparing 30 notes before and one month after the booklet was introduced.
Results
Completeness of documentation improved for 7 sections (see Table 1). With the new booklet 57% patients had an entry for every day of admission, compared to 23% previously. Growth charts, not previously available, were completed for 50% at admission. Investigation results and discharge planning had not improved. Use by nurses was inconsistent, with many defaulting to the old note format.
Abstract G223(P) Table 1Completeness of documentation by section: old notes versus new booklet
Section
Old notes:
New booklet:
Maternal history
35%
75%
Birth details
44%
75%
Admission assessment of baby
53%
78%
Admission plan
51%
71%
Ward round day 1
21%
73%
Ward round subsequent days
32%
75%
Parental communication
7%
10%
Prescriptions
57%
82%
Entries dated and signed
71%
90%
Investigations
47%
41%
Discharge information
24%
16%
Conclusion
A standardised neonatal medical record improved documentation by doctors. Nursing documentation was still lacking indicating further teaching and minor amendments to fit local agendas may be required. If improved neonatal outcomes (reduced mortality) are to be observed, full co-operation of staff is required to follow and document daily progress. This is a great quality improvement initiative for a low resource setting, and further assessment is needed after long term use of the document.
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