Setting: Ward 7B, Lister Hospital, East and North Hertfordshire NHS Trust
Background: Hourly digital observations including fluid balance charts are inadequate and insufficient which leads to compromised patient safety and delayed discharges. The baseline e-observations compliance was 36% and the fluid balance compliance was 35%, both well below than the team would like them to be. Improving compliance with digital observations will result to deterioration being picked up earlier and treated sooner. It also has a positive impact on patient journey and has financial benefits if inpatient bed days are reduced.
Shared Purpose: The project leader teamed up with the clinical practice educators, the resus team, and the stoma nurses.
Understanding the problem: The primary themes identified from incidents according to the Datix system were unreliable completion of basic observations, delayed review by appropriate team, and lack of fluid balance record completion.
Project aim: To improve compliance with digital observation (including fluid balance) on Ward 7B to 50% by October 2023 and 80% by March 2024
Drivers: The primary drivers were training and education, processes, communication and clear roles and responsibilities.
Measurement: Hourly digital observations compliance and fluid balance compliance.
Change ideas: The team sought training and support from the clinical practice educators acknowledging their expertise. Discussions around observations and fluid balance completion were included in daily safety huddles. The team improved communication around this and reminded team if observations were outstanding. The ward had a Patient safety at a glance (PSAG) boards which highlighted overdue fluid balance and observations. New staff members were advised to shadow stoma nurses and sepsis teams.
Outcome: The hourly digital observations compliance increased from 37% to 42% and the fluid balance compliance increased from 31% to 54%
Next steps: Collaborate with the digital transformation team. Continue to involve the clinical practice team for more training. Regularly celebrate team’s success and to circulate positive feedback received from patients or other teams. Arrange regular meetings to discuss any incidents related to fluid balance charts and observations.
Ashokan-Ramachandran---Improving-digital-observation-of-patients-on-Ward-7A.pdf