title: Ten PM note of organophosphate poisoning: successful outcome of a medical audit with complete seven steps.
abstract: Medical audit in general consists of seven steps like choosing topic, setting criterion and standard, collecting first data, comparing data with standard, introducing change, collecting second data and reflecting. Its three basic premise are improvement of patient care by using existing knowledge, team work with ongoing educational process and change management and promotion of blame-free culture maintaining confidentiality. Audit mostly relates to a particular practice and is therefore not generalisable. An audit of residents' late evening routine notes of organophosphate poisoning patients is reported here, as the change introduced appears relevant to the situation of developing countries. Organophosphate poisoning patients should be managed in intensive care unit with close monitoring, as inadvertent stoppage or slowing of atropine infusion may occur, particularly at night, leading to reappearance of poisoning manifestations, which may cause respiratory failure and death. If they are managed in wards, residents-on-duty can check the clinical and intravenous drip status in the late evening and communicate with nurses and relatives to be particularly vigilant. In the audit done, such regular ten pm notes of organophosphate poisoning about the clinical and drip status and communication by residents were increased from 15.5% in the first to 81.7% in the second data collection (p < 0.01) after the introduction of the change. The ten pm note is being continued for about two years now. Implementation of ten pm note of organophosphate poisoning patients admitted in medical wards is feasible and appears useful to improve the quality of health care delivery and learning of residents.
authors.affiliation: Medical Education Unit, National Academy of Medical Sciences, Kathmandu, Nepal. mdb@ntc.net.np
authors.forename: M D
authors.initials: MD
authors.lastname: Bhattarai
mesh_terms: D006801:Humans; D007396:Internship and Residency; D008485:Medical Audit / Q000458:organization & administration* / Q000592:standards; D008499:Medical Records / Q000592:standards*; D009390:Nepal; D015279:Organizational Culture; D062025:Organophosphate Poisoning; D010362:Patients' Rooms / Q000458:organization & administration*