Proportion Of Charts Research Articles

Education and training as key drivers for improving the quality of fluid balance charts: findings from a quality improvement project

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or...

Pharmacist charting in the preadmission clinic of a Sydney teaching hospital: a pilot study

AbstractAimTo trial a pharmacist charting service, comprising medication charting, in the preadmission clinic (PAC) at a Sydney teaching hospital.MethodsA prospective pre/post‐trial was conducted comprising a 1‐month baseline audit and a 1‐month trial of pharmacist charting (i.e. pharmacists' preparation of patients' medication charts during routine consultations). Purpose‐designed data collection forms were used to document: pharmacist and doctor consultation times, time taken by pharmacists to prepare medication charts, and completeness and accuracy of the prescribed medication charts. A semi‐structured survey was used to elicit feedback from PAC staff regarding the pharmacist charting service; the data were thematically analysed using manual, inductive coding.ResultsSeventy‐two medication charts were completed by PAC pharmacists during the 1‐month trial. Completeness of charts improved post‐intervention (5.4 vs 80.6%, p < 0.001), as did the accuracy of charts (proportion of charts with inaccuracies: 41.1 vs 1.4%, p < 0.001); only one (1.4%) pharmacist‐prescribed medication chart was identified as having an inaccuracy. The changes in mean consultation times per patient for doctors and pharmacists, respectively, changed from pre‐ to post‐intervention as follows: pharmacists 18.9 ± 6.5 min to 20.6 ± 8.3 min (p = NS); and doctors 25.0 ± 9.6 min to 19.0 ± 6.4 min (p < 0.001). A statistically significant relationship was found between pharmacist consultation time and patients' numbers of medications (p < 0.001) and age group (p = 0.004).ConclusionPharmacist charting in the PAC has been shown to improve medication chart completeness and accuracy, helping to ensure medication safety in the hospital setting. A further, long‐term trial will help confirm the clinical benefits of such a service.

PO-0965 An Audit In Paediatric Prescribing

Background and aims Prescribing errors are common in hospitals. Within Addenbrooke’s, the paediatrics department was found to make more prescribing errors than any other. We aimed to undertake a closed-loop audit of prescribing errors in paediatrics at Addenbrooke’s. Methods Data was collected from all readily available drug charts on all paediatric wards, once weekly over 6 weeks (first cycle May 2013, second cycle Oct–Nov 2013). Each drug chart was inspected for ‘pharmacist identified’ errors, with minimum standards set in key areas. Between cycles, interventions included: meeting of senior clinicians and pharmacist; prescriber received standardised email after errors, for discussion with consultant; follow-up of non-responders; audit data and protocol disseminated; paediatric teaching on prescribing. Results A total of 3436 (first cycle) and 3516 (second cycle) prescriptions were reviewed with 12% and 16%, respectively, containing an error. The commonest error in both cycles was drug name. Set standards were achieved for correct drug name and dose, but not for legible signature, allergy documentation or weight documentation. The proportion of drug charts with 0 errors increased in the second cycle. Those with 1–5 errors decreased. However, the proportion of charts with 6+ errors increased (many ‘high error’ charts contained multiple errors by one prescriber). Conclusions The implemented changes had no significant effect on the rate or type of errors identified. Minimum standards are not being met in some areas. It is possible that a few ‘rogue’ prescribers may be responsible for many errors, in which case targeted strategies may be effective.

Are primary care practitioners in Barbados following diabetes guidelines? - a chart audit with comparison between public and private care sectors

BackgroundOver 19% of the population ≥ 40 years of age in Barbados are diabetic. The quality of diabetes primary care is uncertain.FindingsCharts of diabetic and hypertensive patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all diabetic patients ≥ 40 years of age were then selected. Processes of care, and quality targets for blood pressure (BP), fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c) were documented.252 charts of diabetic patients (125 public and 127 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 61%, mean duration of diagnosis 9 years, and hypertension diagnosed 78%. Patients had an average of 4.7 clinic visits per year, 66% were prescribed metformin, 68% a sulphonylurea, 25% a statin, 21% insulin, 15% aspirin and 12% a glucosidase inhibitor. Public patients compared to private patients were more likely to be female (77% vs. 46%, p < 0.01); have a longer duration of diagnosis (11.4 vs. 6.6 years, p < 0.01), have more clinic visits per year (5.2 vs. 4.3, p < 0.01), and to be using insulin (28 vs. 15% p = 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, FBG 76%, total cholesterol 72%, urine tested for albumin 66%, serum creatinine 62%, dietary advice 61%, exercise advice 49%, lipid profile 48%, foot examination 41%, HbA1c 33%, dietician referral 23%, retinal examination 18%, tobacco use 17%, body mass index 0%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = < 0.01); tests for total cholesterol (78% vs. 65%, p = 0.02), albuminuria (72% vs. 59%, p = 0.03), serum creatinine (79% vs. 44%, p < 0.01), and foot examination (50% vs. 32%, p = < 0.01); dietician referral (37% vs. 8%, p < 0.01), and tobacco use (26% vs. 8%, p < 0.01). For those tested, the most recent BP was < 140/90 for 43%, HBA1c was < 7% for 28%, and FBG was < 6.7 mmol/L for 27%.ConclusionsInterventions such as body mass assessment, lifestyle advice, screening for retinopathy, monitoring blood glucose control, and achieving BP and glycaemic targets need improvement.

Are primary care practitioners in Barbados following hypertension guidelines? - a chart audit.

BackgroundAbout 55% of the population 40 to 80 years of age in Barbados is hypertensive. The quality of hypertension primary care compared to available practice guidelines is uncertain.FindingsCharts of hypertensive and diabetic patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all hypertensive patients ≥ 40 years of age were then selected and processes of care and blood pressure (BP) maintenance < 140/90 documented.343 charts of hypertensive patients (170 public, and 173 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 63%, mean duration of diagnosis 9.1 years, and diabetes diagnosed 58%. Patients had an average of 4.7 clinic visits per year, 70% were prescribed a thiazide diuretic, 42% a calcium channel blocker, 40% an angiotensin receptor blocker, and 19% a beta blocker. Public patients compared to private patients were more likely to be female (73% vs. 52%, p < 0.01); have a longer duration of diagnosis (11.7 vs. 6.5 years, p < 0.01), and more clinic visits per year (5.0 vs. 4.5, p < 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, total cholesterol 71%, urine tested for albumin 67%, serum creatinine 59%, dietary advice 55%, lipid profile 48%, exercise advice 45%, fasting blood glucose for non-diabetics 39%, dietician referral 21%, tobacco advice 17%, retinal examination 16%, body mass index 1%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = < 0.01); tests for total cholesterol (77% vs. 67%, p = 0.04), albuminuria (77% vs. 58%, p = < 0.01), serum creatinine (75% vs. 43%, p < 0.01), and fasting blood glucose for non-diabetics (49% vs. 30%, p = 0.02); dietician referral (34% vs. 9%, p < 0.01), and tobacco advice (24% vs. 10%, p < 0.01). Most (92%) diastolic BP readings ended in 0 or 5 (72% ended in 0). At the last visit 36% of patients had a BP < 140/90 mmHg.ConclusionsImprovements are needed in following guidelines for basic interventions such as body mass assessment, accurate BP measurement, use of thiazide diuretics and lifestyle advice. BP control is inadequate.

Chart documentation quality and its relationship to the validity of administrative data discharge records

The validity of administrative data may be vulnerable to how well physicians document medical charts. The objective of this study is to determine the relationship between chart documentation quality and the validity of administrative data. The charts for patients who underwent carotid endarterectomy were re-abstracted and rated for the quality of documentation. Poorly and well-documented charts were compared by patient, physician, and hospital variables, as well as on agreement between the administrative and re-abstracted data. Of the 2061 charts reviewed, 42.6 per cent were rated well documented. The proportion of charts well documented varied from 14.6 to 87.5 per cent across 17 hospitals, but did not vary significantly by patient characteristics. The kappa statistic was generally higher for well-documented charts than for poorly documented charts, but varied across comorbidities. In conclusion, poorly documented hospital charts tend to be translated into invalid administrative data, which reduces the communication of clinical information among healthcare providers.

Physician Medical Direction andClinical Performance at an Established Emergency Medical Services System

Objective. Few developed emergency medical services (EMS) systems operate without dedicated medical direction. We describe the experience of Hamad Medical Corporation (HMC) EMS, which in 2007 first engaged an EMS medical director to develop andimplement medical direction andquality assurance programs. We report subsequent changes to system performance over time. Methods. Over one year, changes to the service's clinical infrastructure were made: Policies were revised, paramedic scopes of practice were adjusted, evidence-based clinical protocols were developed, andskills maintenance andeducation programs were implemented. Credentialing, physician chart auditing, clinical remediation, andonline medical command/hospital notification systems were introduced. Results. Following these interventions, we report associated improvements to key indicators: Chart reviews revealed significant improvements in clinical quality. A comparison of pre- andpost-intervention audited charts reveals a decrease in cases requiring remediation (11% to 5%, odds ratio [OR] 0.43 [95% confidence interval (CI) 0.20–0.85], p = 0.01). The proportion of charts rated as clinically acceptable rose from 48% to 84% (OR 6 [95% CI 3.9–9.1], p < 0.001). The proportion of misplaced endotracheal tubes fell (3.8% baseline to 0.6%, OR 0.16 [95% CI 0.004–1.06], (exact) p = 0.05), corresponding to improved adherence to an airway placement policy mandating use of airway confirmation devices andsecuring devices (0.7% compliance to 98%, OR 714 [95% CI 64–29,334], (exact) p < 0.001). Intravenous catheter insertion in unstable cases increased from 67% of cases to 92% (OR 1.31 [95% CI 1.09–1.71], p = 0.004). EMS administration of aspirin to patients with suspected ischemic chest pain improved from 2% to 77% (OR 178 [95% CI 35–1,604], p < 0.001). Conclusions. We suggest that implementation of a physician medical direction is associated with improved clinical indicators andoverall quality of care at an established EMS system

Quality and Use of Trauma Histories Obtained From Psychiatric Outpatients: A Ten-Year Follow-Up

In 1996 Eilenberg and colleagues reviewed 180 charts and reported that trauma histories were poorly documented at a general psychiatric clinic. This study is a ten-year replication of that work. A total of 107 randomly selected charts from the same clinic were reviewed for assessment of trauma history. The quality of the assessments was rated. Fifty-six percent of charts contained a thorough description of trauma severity, compared with 15% in the initial study. Documentation of posttraumatic symptoms improved significantly in all categories but remained low. Documentation of diagnostic formulations and treatment plans for patients with a trauma history was thorough in a small proportion of charts (14%), as was found in the initial study (9%). Although some improvements were found in recording trauma histories, eliciting such a history did not lead to thorough documentation of posttraumatic symptoms or to inclusion of the history in the diagnostic formulation or treatment plan.