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Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust

BACKGROUND: Advance care treatment escalation plans (TEPs) are often lost between healthcare settings, leading to duplication of work and loss of patient autonomy. OBJECTIVE: This quality improvement project reviewed the usage of TEP forms and aimed to improve completeness of documentation and visib...

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Autores principales: King, Oliver, Collman, Emily, Evans, Alice, Richards, James, Hughes, Elin, Acquah, Lydia, Parsons, Helen, Morrison, Jo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844060/
https://www.ncbi.nlm.nih.gov/pubmed/35871371
http://dx.doi.org/10.3233/JRS-227027
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author King, Oliver
Collman, Emily
Evans, Alice
Richards, James
Hughes, Elin
Acquah, Lydia
Parsons, Helen
Morrison, Jo
author_facet King, Oliver
Collman, Emily
Evans, Alice
Richards, James
Hughes, Elin
Acquah, Lydia
Parsons, Helen
Morrison, Jo
author_sort King, Oliver
collection PubMed
description BACKGROUND: Advance care treatment escalation plans (TEPs) are often lost between healthcare settings, leading to duplication of work and loss of patient autonomy. OBJECTIVE: This quality improvement project reviewed the usage of TEP forms and aimed to improve completeness of documentation and visibility between admissions. METHODS: Over four months we monitored TEP form documentation using a standardised data extraction form. This examined section completion, seniority of documenting clinician and transfer of forms to our hospital electronic patient record (EPRO). We added reminders to computer monitors on wards to improve EPRO upload. RESULTS: Initial data demonstrated that 95% of patients (n = 230) had a TEP, with 99% of TEPs recording resuscitation status. However, other sections were not well documented (patient capacity 57% completion and personal priorities 45% completion, respectively). Only 11.9% of TEPs documented consultant involvement. Furthermore, only 44% of TEPs with a do not attempt resuscitation (DNACPR) decision were uploaded. Following this, we added reminders to computer monitors explaining how to upload TEP decisions to EPRO, which increased EPRO uploads to 74%. CONCLUSION: Communication of TEPs needs improving across healthcare settings. This project showed that the use of a physical reminder can greatly improve communication of treatment escalation decisions. Furthermore, this intervention has inspired future projects aiming at making communication more sustainable through the use of discharge summaries.
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spelling pubmed-98440602023-01-30 Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust King, Oliver Collman, Emily Evans, Alice Richards, James Hughes, Elin Acquah, Lydia Parsons, Helen Morrison, Jo Int J Risk Saf Med Research Article BACKGROUND: Advance care treatment escalation plans (TEPs) are often lost between healthcare settings, leading to duplication of work and loss of patient autonomy. OBJECTIVE: This quality improvement project reviewed the usage of TEP forms and aimed to improve completeness of documentation and visibility between admissions. METHODS: Over four months we monitored TEP form documentation using a standardised data extraction form. This examined section completion, seniority of documenting clinician and transfer of forms to our hospital electronic patient record (EPRO). We added reminders to computer monitors on wards to improve EPRO upload. RESULTS: Initial data demonstrated that 95% of patients (n = 230) had a TEP, with 99% of TEPs recording resuscitation status. However, other sections were not well documented (patient capacity 57% completion and personal priorities 45% completion, respectively). Only 11.9% of TEPs documented consultant involvement. Furthermore, only 44% of TEPs with a do not attempt resuscitation (DNACPR) decision were uploaded. Following this, we added reminders to computer monitors explaining how to upload TEP decisions to EPRO, which increased EPRO uploads to 74%. CONCLUSION: Communication of TEPs needs improving across healthcare settings. This project showed that the use of a physical reminder can greatly improve communication of treatment escalation decisions. Furthermore, this intervention has inspired future projects aiming at making communication more sustainable through the use of discharge summaries. IOS Press 2022-12-02 /pmc/articles/PMC9844060/ /pubmed/35871371 http://dx.doi.org/10.3233/JRS-227027 Text en © 2022 – The authors. Published by IOS Press https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
King, Oliver
Collman, Emily
Evans, Alice
Richards, James
Hughes, Elin
Acquah, Lydia
Parsons, Helen
Morrison, Jo
Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title_full Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title_fullStr Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title_full_unstemmed Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title_short Improving the visibility and communication of treatment escalation plans in Somerset NHS foundation trust
title_sort improving the visibility and communication of treatment escalation plans in somerset nhs foundation trust
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844060/
https://www.ncbi.nlm.nih.gov/pubmed/35871371
http://dx.doi.org/10.3233/JRS-227027
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