Annual Report and Accounts - The Great Western Hospital

No. Audit Title
8. Diabetes
Ketoacidosis
(DKA)
Management
9. Re-Audit Use of
Troponin Test
10. NICE Self Harm in
Emergency
Department
11. Laparoscopic
Cholecystectomy
(LC)-
Patient
satisfaction -
Important factors
to patients
12. Obstetric
Haemorrhage
(Midwifery Led
Unit)
13. Client
Identification at
Hillcote
14. Provision of
Information about
Prescribed
Medicines
Audit Summary/Learning and Action
from seeing a clinical psychologist. There were some issues with
cleanliness and standard of meals. Extremely positive results received for
standard of care post discharge. Actions include changes to patient
information leaflet to emphasise the details of support available for the
relatives. A clinical psychologist is now in post. Cleaning is being
monitored by the ward and fed back to Carillion.
Majority of patients are managed according to the guidelines however
capillary ketone measurement to confirm diagnosis is not done well and
there is lack of awareness and over reliance on urinary ketones. Actions
include: To add a new sheet to the DKA protocol for nurses to check, as
well as clear indication for stopping insulin infusion .To ask Emergency
Department Assistants to ensure that ketones strips are always available.
The re-audit illustrated a large improvement in performance. The initial
audit results showed poor compliance with only 28% of test fully complying
with guidelines. The guidelines were updated in order to clarify when the
tests should be used. After a period of education the re-audit showed 94%
of patients now fully complying with guidelines. This process has saved
the trust over £4000 per year. Updated guidelines have clarified usage;
this is reflected in a reduction in the number of tests ordered. Action
Summary-Ward troponin education needs to be incorporated into the
induction program for Acute Assessment Unit and Emergency
Department.
Performance is significantly short of NICE guidelines
Action Summary- Dissemination of results to encourage better
documentation and referral rate for this group of patients. Work with the
Mental Health Service to identify what is achievable and to ensure this
group of patients is receiving adequate care. Re-Audit following
implementation.
The review aimed at assessing the importance of cosmesis v’s other
factors in gall bladder surgery.93% of patients were happy or extremely
happy with the current procedure. 48% experienced some wound related
issues (pain, infection) and 65% of those were at the umbilicus. Cosmesis
was rated less important than other factors in gall bladder surgery. Action
Summary-Given patients are generally satisfied by the current procedure,
the aim is to invest in improving day case rates for LC.
This audit demonstrated good compliance with the correct management of
Post Partum Haemorrhage within the setting of the midwifery led unit or if
transfer to an acute unit was required, however it highlighted some areas
for improvement in documentation. Actions include - All staff to be made
aware of the need to: - Document discussion of events and discussion with
parents of reasons for transfer and consent. Respirations and fluid balance
charts should be documented where appropriate and revise audit tool.
The audit demonstrated 100% compliance. Hillcote have improved greatly
on recording the NHS number or any appropriate number of their photo
pages.
The service will aim to continue with this high level of performance.
The audit aimed to gather baseline data on patient's perceptions of the
quality and quantity of information they received about medicines newly
started at GWH. Majority of patients reported being given information on
what medicine was prescribed, why it was prescribed and how to take it,
during their hospital stay. Furthermore, the results demonstrate a very low
compliance around information provided on what side effects patients
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