I am a Britsh graduate, now training in New Zealand. I have completed both the MRCP and FRACP and will be starting advanced training in medical oncology in December.
Checklists On The Acute Medical Post-Take Round
Rebecca Roberts, North Shore Hospital, Auckland
Jinny Yoon, North Shore Hospital, Auckland
Maryanne Ting, North Shore Hospital, Auckland
Laura Chapman, North Shore Hospital, Auckland
Introduction: Checklists improve some healthcare processes 1+2 although the causative mechanism is disputed 3. Ward round checklists have been useful in some studies 4. The WDHB assessment pro-forma contains a post-take checklist (figure 1) of commonly occurring items including those previously identified as contributing to patient harm if missed. Baseline audit demonstrated poor use across medical teams.
Figure 1: Post-take checklist
Aim: To test the impact of the introduction of a checklist stamp (figure 2) on checklist use plus actual decisions and documentation on the acute medical post-take round.
Figure 2: top of post-take checklist stamp
Methods: Checklists stamps were introduced with education of staff and daily reminders before the post-take rounds for 1 week. Stamps were available in the handover room and given to staff. Review of post-take notes was carried out for 3 weeks of patients on the Assessment and Diagnostics Unit (ADU). Data was collected on which SMO led the ward round, use of stamp and/ or pro-forma checklist and actual completion of checklist items including cardiopulmonary resuscitation (CPR) status.
Results: 357 general medical post-take notes were reviewed (table 1). 171 (48%) had a checklist fully or partially completed after the introduction of the stamps. This represents an improvement on the previous audit. Areas with low documentation were resuscitation status, intravenous lines and thromboembolism prophylaxis. Figure 3 shows the resuscitation figures: 59% of patients did not have a completed resuscitation status, which is a decline since the introduction of stamps.
Table 1: overall stamp/checklist use
Figure 3: CPR status documentation
Discussion: Using stamps improved overall use of the checklist but key areas are still poorly done. CPR status completion was worse than previously despite DHB guidance that all patients should have CPR status completed. Possible reasons for ongoing low checklist use include resistance to checklist use 3, limited impact of education as a driver for behavioural change. In addition there may be a documentation gap – issues discussed but not documented.
Conclusion: The ward round stamps improved checklist use on the short term but documentation and/or completion of basic ward round tasks was still inadequate.