User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site...

Area of Science:

• Healthcare quality improvement
• Clinical documentation
• Patient safety systems

Background:

• Recognizing and responding to patient deterioration on general hospital wards is a global challenge.
• Evaluating new initiatives to enhance early detection and response is essential.

Purpose of the Study:

• To assess user compliance and documentation completeness with a novel observation and response chart.
• To determine if the chart facilitated appropriate rapid response system activation when clinically indicated.

Main Methods:

• A two-phase audit was conducted across ten Australian health service sites.
• Phase 1 involved an initial usability audit (2011), followed by retrospective and prospective audits after routine adoption (Phase 2; 2012).

Main Results:

• Chart compliance improved with the new design but remained suboptimal (4%-14%).
• Documentation deviations were noted, with numbers used instead of dots in 60% of graphing sections.
• Recognition of abnormal vital signs and rapid response system activation rates saw slight improvements with the new chart.

Conclusions:

• Suboptimal user compliance limited the chart's intended functionality and adherence to calling criteria.
• Addressing behavioral and work culture barriers is necessary to enhance chart completion, improve vital sign identification, and ensure timely rapid response activation.