323 Post-Take Pause Quality Improvement Project

Abstract

Abstract Aim To introduce a structured review of important clinical factors on the post-take surgical ward round for each patient, to reduce their risk of adverse events. Method In a surgical assessment unit of a district general hospital, QI methodology was used to gather baseline data from 31 post-take interactions; monitoring 13 clinical domains. Additionally, surveys were circulated among staff. Cycle two implemented the ‘Post-Take Pause’, a ten-point checklist requiring a consultant signature, with all medical staff receiving information about its use. Cycle three incorporated further involvement of the nursing and advanced nurse practitioner team. The final fourth cycle implemented a revised checklist based on feedback from users. Results Baseline data collection and surveys showed that a number of important clinical factors were not being routinely reviewed on the post-take surgical ward round. Areas of particular concern included: medicine reconciliation, venous-thromboembolism prophylaxis, and prescription chart review. Inadequate time for documentation was also highlighted. Cycle two and three reviewed 21 post-take interactions each and found completion of 33% and 66% respectively. Cycle four reviewed 18 interactions with 72% of checklists completed. Common themes identified through the Post-Take Pause included: anticoagulant and steroid use, missed thromboprophylaxis and regular medicines, hyperglycaemia, ECG review and escalation plans. Conclusions The Post-Take Pause ensures a consultant led systematic review of important clinical information in the post-take surgical ward round. Our results show that the involvement of the wider surgical team, alongside checklist edits based on feedback, significantly improved the compliance of the Post-Take Pause.