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Documentation of Prognostication Discussion
Divakaran E Edassery1, Rajashree K Chittezhathu1, Jyothi Jayan Warrier1
1Pain and Palliative Care Society, Institute of Palliative Care, Thrissur, Kerala, India.
Background:
Our organization is a NGO that provides palliative and supportive care at outpatient (OP), home visits and inpatient (IP), and Hospice settings. During patient encounter at different settings, documentation of discussion on prognostication was not done on the patients' case sheets. This had created communication gap between the professionals, the patients and their family members. Due to this, there was a mismatch between the patients' expectations and the services provided.
Aims:
The aim of the study was to implement A3 protocol and to increase the documentation status from zero to 75% by the end of five months after the commencement of the project.
Settings And Design:
OP - Department of Palliative Care Clinic A3 method.
Material And Methods:
The process map of the newly registered patients was followed. Root cause analysis was done using the Ishikawa Diagram. The main cause was that there was no specific format for documentation of prognostication. The professionals also felt some difficulty in disclosing the information as they were not following any prognostication tools upon which such discussions can be made. The key drivers were identified. Interventions were focused with specific contributors. A run chart was maintained to assess the progress of the interventionsStatistical Analysis Used: Percentage calculation.
Results:
This endeavor has resulted in raising the documentation status from 0 to 80%.
Conclusion:
A3 protocol has been successful in developing the format for documentation of prognostication. Our team has gained confidence in implementing the A3 in other domains too.
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