User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site audit study.
OBJECTIVE
To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated.


BACKGROUND
Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required.


METHODS
Two-phase audit.


METHODS
Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012).


RESULTS
Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%-14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart.


CONCLUSIONS
User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.
Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Doug
http://orcid.org/0000-0002-6081-5442
D
Elliott
Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Emily
E
Allen
Royal North Shore Hospital, Sydney, NSW, Australia.
Sharon
S
McKinley
Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.|South East Sydney Local Health District, Sydney, NSW, Australia.
Lin
http://orcid.org/0000-0002-8507-1283
L
Perry
Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
Christine
http://orcid.org/0000-0001-6534-8743
C
Duffield
Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.|Northern Sydney Local Health District, NSW, Australia.
Margaret
M
Fry
Charles Perkins Centre & Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.
Robyn
http://orcid.org/0000-0001-5588-9351
R
Gallagher
Centre for Team-Based Practice & Learning in Health Care, Kings College London, London, UK.
Rick
R
Iedema
Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia.
Michael
http://orcid.org/0000-0002-3831-537X
M
Roche
D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D008991:Monitoring, Physiologic; D019370:Observation; D011446:Prospective Studies; D012189:Retrospective Studies
audit; clinical deterioration; compliance; deteriorating patient; human factors design; nursing; observation charts; rapid response system; track and trigger