Quality Improvement Project for Patient Prescription Record

Quality Improvement Project for longanimous Prescription RecordThe aim of this smell progression mould is to ensure that fellates record in the designated blow on patients Prescription and administration record (to be referred to as Kardex) if High Dose neu situationptic drugs Monitoring is relevant YES or NO (to be referred as applic adequate to(p) Y/N) and subsequently if yes, that the High Dose Antipsychotic Therapy monitoring form (to be referred to as Monitoring form and the Early Warning Signs (EWS) Form defy been activated for completion. The purpose of this is to secure patient safety from the side effects of the medication.There is widespread yard which pass alongly links antipsychotic medication contri scarceing to physical health problems such as cardiovascular problems, weight gain, endocrine problems, metabolic syndrome and sudden death (Gumber et al, 2010 Churchword et al, 2009 Tyson et al, 1999). Many premature deaths of people with serious psychological i llness are due to poor medical care that fails to monitor risk factors which may be due to side effects of medication (Cohen Hove, 2001). A council report by the Royal College of Psychiatrists (2006) revealed that past audits of last dose antipsychotic prescribing for in- patients showed poor adherence to monitoring recommendations. All patients on postgraduate dose antipsychotic treatment must be monitored. These guidelines attempt to clarify the identification of patients on high dose antipsychotics, factors to be taken into account before such prescribing and the documentation required when antipsychotics are prescribed in high dose furthermore it is a policy requirement of Forth V exclusively toldey that this documentation is completed for these patients (Forth V completelyey, 2011).The bear down on accommodate highlighted a concern when evaluating the patients Kardex audit, it showed 100% non-compliance for the completion of the Yes/No response for high dose antipsychot ics monitoring. after when the patients are receiving high dose antipsychotics, there was inconsis tency of the completion of the Therapy monitoring form and EWS form. A young audit of patient Kardexes corroborate the charges protect finding (see Pareto chart, Appendix B).To begin the deal of the quality improvement rove, a general cellblock conflux was held and attended by all round in the ward that was on channel. During the confluence the charge nurse highlighted the recent findings of the Kardex audit. Concerns were raised that many disciplines on the Kardex were non universe completed, and reminded staff nurses that this is non acceptable and needs to be improved. As a nurse it is extremely authorised to keep accurate documentation, good record keeping is an fundamental part of nursing practice, and is necessary to the preservation of safe and effective care (Nursing and Midwifery Council, (NMC) 2010).As an attempt to focus the quality improvement project more sp ecifically the results of the audit were presented using a Pareto chart (Appendix B). The selective information confirmed the areas on the Kardex which were not being completed however, high dose antipsychotic monitoring Yes/No was the highest at 100% non-completion, accordingly it was agreed that a new strategy would be implemented to improve this. McLaughlin and Kaluzny (2006) state that the defect centre on does not necessarily need to be the greatest frequency to be improved first, and trouble should be considern to that defect that may bring in a devastating result, such as an adverse event or even death. However the defect in this instance was the highest and potentially could hasten an adverse event.Following the meeting a questionnaire (Appendix C) was devised and completed anonymously by the pharmacists, consultants and staff nurses to identify the prow causes of why this area on the Kardex was not completed. A fishbone diagram was employ to illustrate the findings (Appendix D). When populating the fishbone diagram with the data, it was surface to see that there were many causal agencys that each member of the multidisciplinary team had not completed the applicable area on the Kardex. Role confusion was a common theme from each member of the team. Hill-Smith et al (2012) claims that this is not unusual indoors multi-disciplinary teams and that respectful converse and clear instructions is of high importance in the sales pitch of high quality clinical care. Therefore based on these findings PDSA one was developed (Appendix G1). This tested whether the nurse attending the MDT meeting completes the Applicable Y/N on the patients Kardex following an telecommunicate varan and a verbal prompt from charge nurse before attending the meeting. The test confirmed there was a breakdown in communication, the nurse did not receive the email or a verbal reminder from the charge nurse prior to attending the MDT meeting therefore they were not aware of the procedure that had been disputeed and as a consequence the applicable area on the form was not completed, this was confirmed by an audit of the Kardex (Appendix H). This informed the decision for PDSA two (Appendix G2). The nurse arrange the shift should use the optic prompt find on the shift coordinating sheet to remind the nurse attending the MDT meeting, to update applicable Y/N on the patients Kardex. The teensy change of a visual reminder on the shift coordinating sheet proved to be success. It reminded the coordinating nurse to verbally prompt the nurse attending the MDT meeting to complete the patients Kardex in the applicable area, which was shown by the Kardex audit after the shift all patients Kardexes were completed and as a consequently the Therapy form and EWS from were also initiated for completion. These findings are consistent with Simpson (2007) research, where teams have clear operating procedures in place, care coordinating is enhanced.The assumption was that the email and verbally prompt from the charge nurse would result in nurses completing the Applicable Y/N on all patients Kardexes, following the MDT meeting by twenty-third February 2014 by 100%. Furthermore, if yes the Therapy form and the EWS form activated for completion.Audits were carried out on the dates shown to give a snapshot of the completion of Applicable Y/N on all patients Kardexes in the IPCU ward at that time. Initial findings of the first audit by the charge nurse on 01/02/2014 revealed that Applicable Y/N was completed 0%. The second audit carried out to confirm the previous results on 08/02/2014 which confirmed the charge nurses findings of 0% compliance of Applicable Y/N. PDSA one was carried out on 10/2/2014 the change revealed 0% improvement in the completion of Applicable Y/N. PDSA two was implemented on 21/2/2014 the change was self-made, the results of the audit revealed that Applicable Y/N was completed on all patients Kardexes by 100% this in turn ac tivated the completion of the Therapy form and EWS Form.Comparison of questions, predictions, and analysis of dataEngaging with the quality improvement (QI) project has required me to learn and apply new skills in practice.The fulfil of plan, do, study, act (PDSA) cycles were a new technical skill which I had to not only learn myself, but teach fellow staff nurses on the ward, as this was also, a new process to them. I learnt that PDSA cycles provisionally test an idea by testing a change and assessing its impact. After implementing the first cycle, I learnt that it does not always get the results expected when making changes to your process it taught me that it was better, and more effective to trial a humbled change to see if it made a difference, before implementing the change permanently. This also gave staff the opportunity to be involved and offer suggestions and see if the proposed changes would work.I also learnt that communication is an essential and fundamental process d uring the chassis of the QI. According to Adams (1999), to persuade others to ask an improvement or change, the negotiator must be influential. The Charge nurse in this instance was the influential position to lead change. Unfortunately they were not able to fulfil their pledge in PDSA one, but they carried out the ward meeting and used this as a platform to discuss the Kardex audits with the staff which informed them of the need to make an improvement in practice. Once the need for the new process was established and its principles by the email from the charge nurse, informing the reasoning for a change in practice, this was used as a base for PDSA two. I learnt that it is just as important to define the risk of not making a change (Plummer, 2000) and in this circumstance, changing practice would not only enhance quality of care to patients, but it would promote the involvement between staff nurses and the MDT, building trust and confidence to make the change, whereas the risk o f not making the change, could potentially cause an adverse eventA final tuition point I would like to include was how staff nurses initially were resistant to change. In my opinion from observing, the nurses were preferably defensive as though they were being blamed for not doing their job correctly. The questionnaire used was an effective communication tool and successful resource for managing this resistance. It give staff the opportunity to anonymously feedback their reasons for not completing the applicable area on the Kardex, it also let them express their opinion without being condemned. Also, I feel that during this time, they were able to adjust and prepare for the change which minimised resistance (Bernhard and Walsh, 1995). I matte up it was essential to take note of all their views as privates and as team members, which provided further explanation of their reasoning for non-completion. Accountability was a consistent reason used by nurses for their reason for non-co mpletion, as they felt it was a doctor or the pharmacist role and they did not want to be accountable for making the decision. When it was clarified that it was a team decision, by email from the charge nurse, the nursing staff felt run oned. Mitchell (2001) states that accountability in nursing is a complex abridge and ack this instantledged the importance of team support in the identification of roles and responsibilities. Frequent ideas and conversations with staff were held over the ten days, in advance of the change in PDSA two which I feel made the improvement successful and run smoother as nursing staff were aware of the new change.I have learnt that within nursing it is important to continually improve the way we work. Working at every level ontogenesis the kat onceledge, technical skills, including leadership, are vital for long-term improvement. Continually learning may be important not only to ensure that we have the skills infallible to improve the quality of health c are, but also to enhance the pauperism to do so.Discuss the projects significance on the local system and any findings that may be generalizable to other systemsRelocation to a new site change what been good practice and now a gap had appeared in the process of monitoring patient.The outcome of this project was a success. It was predicted that by 23rd February 2014 applicable Y/N would be completed by 100%. By establishing the success of the visual prompt in PDSA two on the co-ordinating sheet, was a very small but effective change.As a consequence, at the following staff meeting it was decided that the visual prompt would be a permanent fixture on the coordinating sheet, as it was a sustainable reminder to future shift coordinators, thus improving the initiation of therapy monitoring and EWS forms, and overall patient safety outcomes.Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your thoughtfulnesss on the role of the team?The factors which promoted success in the project were support and leadership from the charge nurse at the beginning of my placement. They helped identify areas in the ward which they felt needed improvement. Furthermore, as a student who had never been in a mental health ward, I felt overwhelmed with the task and this support and guidance helped me through the project.The use of the tools were a great way to involve staff on the ward to feel part of the project and broke down the barriers of pointing blame and focussed their attention in a systematic way, and explored the potential causes of the non-completions.I was amazed as how such a small change help facilitate and test change in a manageable way. I now understand that Quality improvement as a way of approaching change in healthcare that focuses on self-reflection, assessing needs and gaps, and considering how to improve in a multifaceted manner. I feel I have gained an enormous un derstanding in about quality improvement in that it aims to create an ethos of continuous reflection and a commitment to ongoing improvement. It provides nurses to gain an the skills and knowledge needed to assess the performance of healthcare and individual and population needs, to understand the gaps between current activities and best practice and to have the tools and confidence to develop activities to snub these gapsThus, the scan did not focus only on narrowly defined quality improvement models such as plan, do, study, act (PDSA) cycles.