To increase completion of the First Priority Form to 90% by May 2019

Qualiy Improvement Poster Download

Background & Problem

The aim of this QI project is to improve patient safety and experience through an improved handover at the point of transfer from other areas within the Trust. It also aims to ensure timely assessment, recognition and communication of identified risk factors/issues between teams and clinical areas.

A driving factor for this QI project was an increased incidence of Serious Untoward Incidents on the 5th floor in March/April 2018. These incidents highlighted gaps in communication, transfer of critical information and affected patient safety.

The aim of this QI project was to improve completion of the First Priority Form across the 5th floor. The Trust wide form is used in the ‘golden hour’ at the point of transfer/admission to a ward/department to record certain risk factors. This form was poorly utilised/completed on the 5th floor and highlighted that risk factors were not being communicated in a timely manner, if at all.

An accurate handover of clinical information is of great importance to ensure continuity and safety of care. If clinically relevant information is not shared accurately and in a timely manner it may lead to adverse events, delays in treatment and diagnosis, inappropriate treatment and omission of care. The aim of the project is to also reduce the risk of miscommunication, misunderstanding and the omission of critical information.

Aim

To increase completion of the First Priority Form to 90% by May 2019

Method

We have focussed on improving the format of the form by re-designing and re-naming it, rather than introducing another document.

Results

A baseline audit of the original document revealed 0% compliance. We then undertook 3 PDSA cycles and audits demonstrated an increase of compliance to 90 – 100%.

Implications

Risk factors are clearly highlighted at the point of transfer and the form could then be rolled out through the surgical unit and hopefully Trustwide.