Implementation of Emergency Department patient safety checklist

Quality Improvement Poster Download

Background & Problem

Providing good basic care, including timely analgesia and regular observations for patients in Emergency Departments can be challenging. Variations in our practice had been noted by CQC inspectors and raised by staff and patients. This QIP to introduce a local standardised checklist for both Emergency Departments has been undertaken as part of a wider regional project supported by the West of England Academic Science Network.

Aim

The aim of this project is to standardise and improve the delivery of basic care to patients managed in the majors and resuscitation areas of both Emergency Departments. In particular:

• To ensure that patients are getting regular repeat observations if indicated
• To improve frequency of pain scoring and administration of pain relief where indicated.
• Improved documentation the above
• To improve the safety and clinical outcomes for patients accessing the emergency care system.

Method

Baseline data was collected for both departments using key performance indicators including pain scoring, frequency of observation and documentation of NOK/Refreshments offered. The checklist was adapted for local use and initially implemented in CGH in March 2016. This checklist was further modified following feedback and PDSA cycle. The checklist was introduced to GRH on 1st June 2016. Monthly data collection is ongoing for both sites, a randomised sample of 5% of eligible patients are reviewed and KPIs recorded on a standardised data collection sheet. The implementation team have regular meetings and a number of PDSA cycles have been completed to try and improve the use of the checklist on both sites.

Results

The project is ongoing. The checklist is being used in both sites and data analysis shows that when it is used there has been an improvement in pain management and the frequency and recording of vital signs.

Implications

This project has highlighted the difficulty of implementing a checklist in a busy Emergency Department when it is perceived that it is ‘another piece of paper’. The next PDSA cycle involves the development and introduction of a paperwork booklet which contains both the checklist and the observation chart.