To Escalate or to Palliate? An Audit of Patients at Risk of Deterioration on Medical Wards

Grewal, Bhajneek; Johnson, Fiona

doi:10.1136/bmjspcare-2014-000654.231

Cited by 2 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We focussed on ceiling of care decisions; these are often poorly documented and a common issue causing concern when reviewing deteriorating patients on call. 12 15 It would be impractical to conduct a formal handover of every patient to the on-call team, therefore documentation in the patient notes must be up-to-date and easily accessible to the weekend staff.…”

Section: Designmentioning

confidence: 99%

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care

Akhunbay-Fudge

Buss

Ward

et al. 2014

BMJ Qual Improv Report

View full text Add to dashboard Cite

Patient handover is paramount for effective patient care and is often poorly documented or incomplete. North Bristol NHS Trust weekend handover proformas identify medical patients requiring weekend review. Many patients seen during on-call shifts are not handed over. Our aim was to develop Friday ward round proforma sheets for medical patients, to encourage clear documentation of management plans in order to improve handover of important information, particularly ceiling of care decisions.Questionnaires were completed by F1 doctors regarding current handover systems. Baseline data collected by on-call F1s included time of understanding a patient's ceiling of care decision, and difficulty of comprehension of medical notes. Repeat data were collected with novel proformas in situ. Multiple cycles were performed to refine the sheets and target problems arising in their use.Ninety-three percent of F1s wanted improved patient handover, with ceiling of care (87%) and management plans (73%) being the most difficult areas to understand. Time taken to ascertain ceiling of care decisions improved with the introduction of Friday handover proformas; mean time 153 seconds before and 5 seconds after. Clarity and documentation of management plans improved, with 50% improvement in ease of understanding medical notes.Results demonstrate that introducing Friday ward round proformas for medical patients improves communication between weekday and on-call teams, highlights current escalation of care plans, and leads to faster decision-making. Future plans include the introduction of a short educational session to the new F1 doctors and continued progress with introduction into hospital stationary.

show abstract

Section: Designmentioning

confidence: 99%

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care

Akhunbay-Fudge

Buss

Ward

et al. 2014

BMJ Qual Improv Report

View full text Add to dashboard Cite

show abstract

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions

Johnson

Whyte

Loveridge

et al. 2017

BMJ Qual Improv Report

View full text Add to dashboard Cite

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report ‘Time to Intervene’ (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016).Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record.Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place.There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG).The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR.Clarity and openness about these discussions have been welcomed by patient focus groups facilitated via our acute medicine patient experience committee. There has been a shift in medical culture where transparency about limits of care has contributed to improving patient safety and quality of care through reducing unnecessary CPR supported by focus groups of staff.

show abstract

To Escalate or to Palliate? An Audit of Patients at Risk of Deterioration on Medical Wards

Cited by 2 publications

References 0 publications

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care

Improving handover of patient care using a new weekend proforma with a focus on ceiling of care

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions

Contact Info

Product

Resources

About