Putting guidelines into practice: a tailored multi‐modal approach to improve post‐operative assessments. Issue 1 (26th October 2011)

• Record Type: Journal Article
• Authors: Ford, John A.; MacKay, Craig; Peach, Chris; Davies, Paul; Loudon, Malcolm
• Is Part Of: Journal of evaluation in clinical practice. Volume 19:Issue 1(2013)
• Page Start: 106
• Page End: 111
• Publication Date: 2011-10-26
• Subjects: Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/j.1365-2753.2011.01780.x
• Languages: English
• ISSNs: 1356-1294

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <p> <bold>Background </bold> The Scottish Intercollegiate Guideline Network (SIGN) published <italic>Postoperative Management in Adults</italic> in 2004, advocating post‐operative assessments to optimize post‐operative care. Our aim was to improve post‐operative assessments in a surgical high‐dependency unit (HDU).</p> <p> <bold>Methods </bold> A prospective audit of post‐operative admissions to surgical HDU over two 4‐week periods was performed. Medical and nursing documentations were reviewed. A tailored multi‐modal approach targeting specific barriers to change was used to implement changes; education of staff, introduction of designated HDU bleeps and a post‐operative assessment pro forma. Re‐audit was performed after 6 months.</p> <p> <bold>Main findings </bold> The first cycle included 72 patients and the second included 62 patients. Time to assessment improved after changes. Forty‐six (74%) patients compared with 27 (37%) patients before were assessed within 4 hours. The number of individual reviews increased and number of reviews due to nursing concerns decreased. Thirty‐eight (61%) patients compared with 15 (21%) patients before were assessed through an individual review and one (2%) patient compared with 23 (32%) patients due to nursing concerns. Documentation improved. Documentation of relevant past medical history, medications, allergies, complications and post‐operative instructions improved from 2 (3%), 1 (1%), 0, 8 (11%) and 26 (36%), to 18 (29%), 28 (45%), 20 (32%), 18 (29%) and 55 (89%), respectively. Difference between first and second cycles was highly significant throughout (<italic>P</italic> < 0.001).</p> <p> <bold>Conclusion </bold> Clinical practice was improved by a tailored multi‐modal approach. Educating staff, improving communication and documentation, and re‐audit has shown significant improvement. However, further improvements are required to reach best practice.</p> </abstract>