Introduction Of Proforma Research Articles

Retrospective Review of Falls in Medical Inpatients Following Introduction of a Falls Proforma at Wexford General Hospital

Abstract Background Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors. Methods We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores. Results Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5. Conclusion These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.

Audit on non-invasive ventilation (NIV) in acute hypercapnic respiratory failure along with an introduction of proforma for acute NIV prescription

Hypercapnic respiratory failure is a cause of significant morbidity. It occurs in 20% of patients who are admitted with exacerbation of chronic obstructive pulmonary disease. Non-Invasive-Ventilation (NIV) is a mandatory treatment modality for them. The timely and accurate commencement along with the appropriate maintenance and weaning of NIV is crucial. In this audit cohort, most of the acute-NIV standards were not met as per the British Thoracic Society recommendations. Late detection, poor knowledge of acute NIV-Protocol, and maintenance of NIV has led to these suboptimal standards of the cohort. Therefore, we have suggested an NIV-Proforma to overcome them expecting a good outcome.

Improving Acute Orthopaedic Admission Note Documentation Standards at a Tertiary Centre Through Proforma Introduction: A Quality Improvement Initiative.

Background Clear, accurate written documentation plays an important role in the handover of medical information, helping to improve care efficiency and avoid medical errors. Both HSE and the Irish National Orthopaedic Models of Care guidelines include key documentation standards for admission notes. Standardised medical admission proforma can help improve documentation standards, but their usage across Irish orthopaedic units is limited to three centres. We evaluated whether an admission proforma improved the documentation standards of acute orthopaedic trauma admission notes within our regional trauma unit. Methods Cycle 1 consisted of a retrospective review of 50 consecutive acute orthopaedic trauma admissions. Exclusion criteria included planned admissions, age <16 years, spinal or pelvic trauma, and 'hip' fractures for whom an existing proforma was in use. Cycle 2 consisted of a prospective review of 50 consecutive acute trauma admissions using the new proforma. Each cycle was scored against a pre-determined checklist incorporating Irish Health Service Executive and Orthopaedic Models of Care documentation standards, with results collated and statistical analysis then performed using Fisher's exact test. Findings Significant improvements in admission note compliance with national documentation were observed. This encompassed multiple domains including clinical identification, e.g., consultant identification (78% to 100% p=0.0005), clinical history, time of injury (72% to 100% p=0.0001), medical history, smoking status (86% to 100% p=0.0001), and patient assessment, vital signs (28% to 70% p=0.0001). Conclusion Improvements in admission note compliance with national documentation standards followed the introduction of a standardised proforma. These findings may encourage the introduction of similar proforma in other units, with potential benefits in patient care.

431 Writing the Right Way! Improvement of Operation Notes in an Orthopaedic Ward – a Closed Loop Audit

Abstract Introduction Operation notes are recognized as standard for documentation of details of operation but still it's often neglected. Proper documentation is necessary as it is correlated with good patient care, quality assurance, future decisions, and medico-legal issues. Aim The objective of this study is twofold: one to compare the documentation of notes against standard RCS (Royal College of Surgeons) guidelines and secondly making sure that surgeons follow these by educating them through presentations, brochures, aide memoires and introduction of proformas. Method We prospectively studied 50 post-op notes against standard RCS guidelines consecutively both pre and post intervention. Asymmetric data was analyzed after 4 weeks using the Fischer-Exact Test and statistical significance was set as &amp;lt;0.05. Results A total of 18 guidelines were audited. First loop showed deficiencies in fields of elective/emergency, operative diagnosis, operative findings, complications, extra procedure performed, tissue removed/added, details of closure, blood loss and antibiotic prophylaxis. After intervention documentation improved and percentages rose and reached almost 100%. Conclusion Proper documentation is of great importance as it carries both medical and legal implications. Three step intervention showed remarkable improvement in documenting of these operation notes according to standard RCS guidelines.

369 Do We Need to Standardise the Neurosurgery Post-Op Note: A QI Project

Abstract Aim Accurate, informative, and consistent documentation in the postoperative period is an essential aspect enabling effective and safe communication between healthcare professionals. Limited documentation can increase the risk of errors and suboptimal care. The Royal College of Surgeons (RCS) identified 18 criteria for operation note documentation for ‘Good Surgical Practice’, enabling continuity of care. Currently, the structure and information documented in a tertiary neurosurgical department varied. The aim of this quality improvement project was to improve the documentation in the department using a proposed proforma. Method A proforma was identified using the RCS guidelines and distributed via email. Operation notes of all patients undergoing neurosurgical procedures were compared against RCS guidelines from November 1st – November 30th, 2020, pre-proforma introduction. Operation notes were then re-audited from July 1st – July 31st post-proforma introduction. Results 66 operations were identified in the pre-proforma group, and 49 in the post-proforma group. Date, time, details of tissue alteration, operative findings, incision, prosthesis identification, antibiotic use and signature were well documented in both pre and post proforma introduction (&amp;gt;90%). In the reaudited group there was an improvement in documentation of anaesthetist (37 vs 24%), complications (78 vs 35%), extra procedures (18 vs 2%), blood loss (22 vs 12%), and a small decrease in the documentation of DVT prophylaxis (59 vs 53%). Conclusions A structured proforma is useful for enhancing communication in the post-operative period. We aim to create a standardised template in the trust's note-taking system to standardise the documentation process and provide further training on the importance of documentation.

776 INTRODUCING TREATMENT ESCALATION PLANS (TEP) FOR OLDER PERSONS: RESPONSE TO THE COVID-19 PANDEMIC

IntroductionTEP detail appropriate ceilings of care and guide treatment of patients based on shared decision making. TEP documentation was not standard within our trust up to 2018. We aimed to design and introduce a standardised TEP proforma and evaluate its use in older persons aged ≥80.MethodsData was obtained from patient notes and questionnaires within the Medicine for Older Persons department (MOP) from four PDSA cycles between 2018–2020. Cycle 1 was a service evaluation. Based on this data, a TEP form was created and approved for use in all adult patients. Cycles 2, 3 and 4 evaluated TEP after introduction of the proforma.ResultsThere was a 239% increase in TEP after introduction of the proforma, compared to baseline (cycle 1: n = 14/47 [29.8%], cycle 2: n = 17/112 [15.2%], cycle 3: n = 30/97 [30.9%], cycle 4: n = 42/59 [71.2%]). The increase in TEP between cycles 3 and 4 coincided with the COVID-19 epidemic. Clinicians were more confident in actioning TEP based on the proforma, compared to those written in the notes (cycle 2: 83% confidence vs 54%, cycle 3: 100% vs 35%, Cycle 4: 98% vs none written in the notes). An improvement in understanding the purpose, comprehensiveness and location of TEP forms was observed. Feedback suggested TEP provided clear guidance for 1. ceilings of care; especially useful out of hours 2. discussions with critical care and 3. patient handover between staff and successive shifts.ConclusionTEP forms offer clear guidance on ceilings of care. Introduction of the TEP proforma has led to more frequent and proactive discussions with patients on ceilings of care and have facilitated a culture change in the management of older persons. Use of the forms increased during the COVID-19 pandemic but are now viewed as an essential component of patient safety and have been successfully implemented trustwide.

A retrospective audit of the introduction of a facial trauma admission Proforma

<b>Introduction</b>: Comprehensive documentation has particular pertinence when recording information for facial trauma patients. Patient records have a medico legal value, as a common aetiology of facial trauma is as a result of a criminal event. In addition notes ensure continuity of care whilst being reviewed by multiple members of the team and aid effective surgical decision. Commonly, documentation at presentation is incomplete and varied in format. This retrospective two-cycle audit analysed information captured at initial presentation of surgically managed mandibular fractures at the Queen's Medical Centre, Nottingham, to identify if an improvement in record keeping occurred using a dedicated trauma proforma. <b>Materials and Methods</b>: Ten clerking records before and after proforma introduction were accessed through Medway or DHR computer systems, and analysed against the minimum dataset for documentation stipulated by Royal College of Surgeons of England guidelines. These included dates of injury/assessment; referral source; mechanism of injury; medical history; occlusion; tenderness; dental trauma; imaging; diagnosis and management plan recording. The standard was that 100% of records were complete. <b>Results/Statistics</b>: Prior to the proforma, some data points were consistently not recorded; presence of pain (50%); dental trauma (30%); diagnosis (50%) and analgesia (30%). Overall, the proforma improved record keeping by 26% in data captured, particularly in domains that were poorly recorded. However it should be noted that one third of patients records examined in the second cycle, included completed proformas. <b>Conclusions/Clinical Relevance</b>: This audit demonstrated an increase in data quantity and quality, with the use of a dedicated proforma. With multiple handovers during shifts and frequent staff turnover, a structured proforma prevents information from being omitted and provides a way of obtaining the information needed, in a standardised, reproducible way. A structured proforma aids future audits and assessment of service performance. Furthermore, proformas provided a high education value to junior members of the team, who commonly admit trauma patients, and act as an aid-memoir to guide clinical examination. Consequently, digitalisation of this proforma on Medway, is planned to increase access to the proforma, which is particularly apt for this cohort of patients examined in this study, as access to a paper proforma has its limitations.

Improving the documentation quality of point-of-care ultrasound scans in the emergency department

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the...

Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK

ObjectivesFollowing a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known...

Completeness in clerking: The surgical admissions proforma.

BackgroundThe accessibility of surgical patient data is a key safety concern, and relies on efficient clerking and handovers. This project assessed whether the introduction of a surgical clerking proforma improved the recording of patient information in the surgical admissions unit (SAU) at Northwick Park Hospital.Materials and methodsExisting patient notes were assessed on content and ease of access, using two independent surveys conducted over a 5-day period. The first survey audited patient notes before (n = 28) and after (n = 23) the introduction of the proforma. It assessed whether key patient details were documented, in line with the 17 criteria set out in the Guidelines for Clinicians on Medical Records and Notes by The Royal College of Surgeons in England. The second survey questioned healthcare professionals before (n = 25) and after (n = 17) proforma implementation on the accessibility of patient data and coherency of patient notes.Results5 of the 17 criteria showed significant differences post proforma implementation. Of these differences, the recording of height and occupation was most notable (p < 0.01). Medication history, weight and investigations also showed significant increases in documentation (p < 0.05). In all 3 questions asked to healthcare professionals, fewer healthcare professionals were required to revisit archived notes following proforma implementation (p < 0.05).ConclusionOur study illustrates that a comprehensive surgical clerking proforma improves patient data documentation and saves healthcare professionals' time compared to the freehand clerking method. The implications of such work are far reaching, and if well implemented could allow a new reliable platform for further clinical audits.

Thromboprophylaxis prescribing among junior doctors: the impact of educational interventions.

BackgroundVenous thromboembolism (VTE) prophylaxis in an important aspect of the care of hospitalised patients, for which the National Institute for Health and Care Excellence (NICE) has issued guidance. Guidance compliance continues to be a concern. Junior doctors are the main group responsible for prescribing thromboprophylaxis. We aimed to compare local pharmacological thromboprophylaxis prescribing against NICE guidelines in a surgical department at a district general hospital, and determine whether interventions aimed at improving compliance were effective.MethodsOver four months, a two cycle audit of prescribing patterns for VTE prophylaxis was performed using data collected at four intervals: 1. Baseline 2. Following pro-forma introduction and feedback 3. A second baseline data collection. 4. Following VTE prophylaxis teaching.ResultsA total of 394 admissions were included. Correct identification and prescribing for at-risk patients ranged between 76 and 93 %, whilst risk assessment documentation and explanation to patients occurred in fewer than 50 and 66 % respectively. Prescribing and risk assessment improved in the first cycle (chi2 = 6.75, p = 0.009 and chi2 = 10.70, p = 0.001 respectively), a consequence of one specialty improving following additional feedback. Teaching was not associated with improvements. Overall compliance with NICE guidelines was achieved in no more than 25 % of admissions.ConclusionsDespite junior doctors generally prescribing VTE thromboprophylaxis appropriately, overall compliance with guidelines remained poor regardless of educational interventions. Verbal feedback was the only intervention associated with modest improvements. A pressurised work environment may limit the impact of educational interventions. Guidance simplification or devolving responsibility to other members of staff may improve compliance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1480-9) contains supplementary material, which is available to authorized users.

Proceedings of the International Cancer Imaging Society (ICIS) 15th Annual Teaching Course.

Accurate staging of cancer underpins the decision making for individual patients, the collection of outcomes data and the development of appropriate services. Unfortunately, this is not something that the wider oncology community has done well and there are many valid reasons why this part of cancer patient management has proved challenging. However, there are ways in which Clinical Radiologists can improve on staging reporting and contribute to better patient care. The CASPAR project was set up to explore the value of, and the processes necessary, for proforma reporting in common cancers. Audits of histopathology reporting of colorectal cancer stage have shown an increase in minimum staging data from 31%-100% following the introduction of proforma reporting. As a consequence, minimum data-set reporting of prognostic histopathological data for resected cancers has become a global standard of care. The impact that this has on clinical outcomes is evident from subsequent studies which have shown that patients with staging reports where data set items are missing have poorer survival outcomes. Imaging reporting, and the accurate identification of tumour stage, plays a critical role in the allocation of patients to appropriate pathways, particularly in those cancers where preoperative strategies are employed for identifiable groups of patients. The CASPAR project sought to test the hypothesis that reporting practice and staging could improve through the implementation of proformas. The results will be discussed during this meeting but they do show an absolute improvement of 40% in hospitals that successfully made the implementation. Barriers to implementation are multifactorial but there are important issues with regard to technical capability and workforce availability. National data collection and entry into research trials requires accurate staging and both are likely to be enhanced by the consistency, completeness and accuracy that structured proformas encourage.

How complete are our clerkings? A project aimed at improving the quality of medical records by using a standardised proforma.

Clerking a patient is the first and most important contact that any medical team has with the patient. It provides information that may not be available later in the admission if recorded improperly, such as referral letters, collateral history, dosette boxes or prescription sheets. The quality of data recorded from this encounter was examined at a busy district general hospital surgical department. Initial measurement demonstrated that less than half of certain key parameters like dosages of medication were being recorded by clerking doctors. A clerking proforma was therefore designed to combat this problem. Over three audit cycles (n = 170, 150, 174) the proforma showed statistically significant improvements in the proportion of data that was captured at initial contact with the patient. We conclude that the introduction of proformas for clerking significantly improves the collection of data that impacts patient care during their hospital stay.

P268 Can we improve “door-to-mask” times for patients with chronic obstructive pulmonary disease (COPD) requiring non-invasive ventilation (NIV)?

IntroductionCOPD is a leading cause of mortality and morbidity and timely use of NIV improves outcomes. National guidelines recommend early intervention in persisting acidosis however, audit data suggests that many...

Documentation of advice regarding safer sexual practices and partner notification within an HIV clinic

Guidelines for the sexual health care of our HIV patients and provision of post-exposure prophylaxis following sexual exposure have been produced by both British Association of Sexual Health & HIV and British HIV Association (BHIVA). In the light of recent criminal prosecutions, BHIVA produced guidance for HIV clinical teams regarding discussions with patients about HIV transmission and reducing the risk to sexual partners. This audit examined the advice given to HIV patients with regard to safer sexual practices, sexually transmitted infection screening and partner notification and found that, on the whole, the standards set by national guidelines were adhered to, although areas for improvement were identified. We hope that the introduction of proformas with specific prompts for these subjects for HIV clinic visits will improve clinical standards in this area.

Introduction of a proforma in the management of under age attendees at a genitourinary clinic

The aim of this review was evaluation of a recently developed proforma for improving assessment and management of patients under the age of 16 in the genitourinary (GU) medicine clinic. A case-note review of all under-16s attending between June 2000 and March 2001 was undertaken (109 patients). Comparison with review from 1998 prior to proforma introduction was carried out. In all, 99 proformas were completed. Fewer young patients were seen solely by junior doctors since proforma introduction (27-45%) (P=0.012), more were referred to health advisors (79% versus 66%) (P = 0.056),but follow-up remains suboptimal (72% versus 78%). Possibility of abuse was assessed in 102 patients (17 cases of non-consensual sex versus six in 1998). In all, 54% were using no contraception and only 21% were consistently using barrier methods; 41% had sexually transmitted infections diagnosed. The proforma is useful for collecting data and directing management when completed fully, and has revealed greater numbers of children involved in risky behaviour and abuse.

The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision

Current guidelines advise discussion with patients before issuing a ‘do not attempt resuscitation’ (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. CPR decisions were documented in 27 (36%). Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.

An audit of emergency contraception: a look at patient characteristics and the effects of a consultation proforma.

The aim of this study was to examine the characteristics of patients requesting emergency postcoital contraception at a genitourinary medicine (GUM) clinic. We also compared the quality of information obtained during the consultation, before and after a proforma was introduced. A retrospective review of all clinical notes of patients who attended for postcoital contraception between January and December 1994 and April to June 1995 was performed. Eighty-three per cent of patients were aged 17-29 years, 68.8% were in relationship, 41.3% were not using regular contraception, 33.8% accepted a sexual health screen and of these, 14.8% had a concurrent sexually transmitted disease (STD). The introduction of a consultation proforma significantly improved certain areas of the consultation. The results suggest that sexual health screens should be encouraged in women attending GUM clinics for postcoital contraception and that the use of a proforma improves the quality of information obtained.