Quality Patient Focused Admissions

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Background & Problem

4A is a 24 bedded acute short stay admission ward incorporating 6 endocrine beds. Our patients are medical patients admitted as an emergency from the emergency department via the AMU. The goal of this project was to reduce complaints by ensuring that the admissions to the ward are patient focussed, welcoming and informative aiming to reduce anxiety. The project was focused on providing a welcoming orientation to the ward that could be completed by anyone. As part of this process we also aimed to increase the compliance in completion the of patient assessments that are required on admission to hospital and improve basic information gathering.

As part of this project we aimed to improve

• Orientation to ward, along with checking of next of kin details
• Completion of Falls assessments
• Completion of Must and Waterlow assessment
• Completion of pressure areas assessments and MRSA screens

We also looked at completion of property books and correctly completing the patient’s bedside name board.

The rationale behind targeting these areas for improvement was focussed from feedback from complaints from patients and from documentation audits highlighting areas which needed improvement.

The ward had previously had admission checklists, and the trust has a first hour priority checklist but we were finding if areas we not completed immediately on admission they would be filed in the notes with areas incomplete.

Ward 4a was also a ward with a high usage of agency staff. (this is now resolving) The goal was to ensure that through providing a clear process we would deliver quality care regardless of who was delivering that care.

Aim

Ensure that by December 2017 80% of all admissions to ward 4a received an orientation to the ward on arrival to the ward.

Method

To achieve our goal we developed a 2 sided admission checklist, one side had an orientation sheet, with all the information required to provide that orientation, regardless of knowledge of ward, the other side focussed on a checklist of key admission assessments and tasks. The Main driver for change however was the Audit sheet. This was completed the following day by the staff looking after the patient. The focus of the audit sheet was not to look compliance of completion but rather to review the checklist and then ensure that the assessment and orientation was completed. This also gave the opportunity to check comprehension of the previous orientation and address any issues.

Results

To date data is still being collated, However over a six week period of data collection we showed that we were able to achieve our target of 80% of collection data for a significant portion of the time, this however dropped off over weekend and whilst I was on annual leave. Ongoing as a team we will work to resolve the weekend slip. Further reviewing the data we have moved from a 30% collection rate to 60-90% for waterlow scores, 75-90% for Pressure area care and 45-80% for must scores.

Implications

Once the data is fully collated this will show a rise in completion of key admission assessments and could be rolled out across medicine, with small adjustment to the orientation information for each ward, The project has highlighted blockers for must scores being the ability to weigh patient in a sitting or standing position, even though some areas are small in change every area has improved.