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Initiative to improve quality of paediatric ward-round documentation by application of 'SOAP' format
Neha Joshi1, Himanshi Bakshi2, Abhishek Chatterjee1
1Paediatric, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Insights
Implementing visual reminders significantly improved pediatricians' use of the Subjective, Objective, Assessment, and Planning (SOAP) note format, enhancing patient record quality and safety.
Area of Science:
- Healthcare Quality Improvement
- Medical Documentation Standards
- Pediatric Patient Care
Background:
- Unstructured ward-round notes in a multidisciplinary hospital led to inconsistent patient information, compromising communication and safety.
- Paediatricians aimed to enhance documentation quality by adopting the Subjective, Objective, Assessment, and Planning (SOAP) format.
- Initial low compliance (13%) with SOAP format usage necessitated further interventions despite training.
Purpose of the Study:
- To identify and implement effective interventions to increase the adoption of the SOAP note format among paediatricians.
- To evaluate the impact of various interventions on the consistent application of structured medical documentation.
Main Methods:
- Brainstorming sessions with paediatricians generated practical solutions for improving SOAP note compliance.
- Plan-Do-Study-Act cycles were utilized to test interventions, with continuous team feedback incorporated.
- Interventions included verbal reminders, individual feedback, and the display of the SOAP acronym, later adapted to visual reminders.
Main Results:
- Verbal reminders and individual feedback did not significantly alter SOAP usage rates.
- Acronym display initially boosted compliance from 13% to 90%, but decreased to 45% during the COVID-19 pandemic.
- Visual reminders implemented during the pandemic period successfully reinstated compliance to a median of 84%.
Conclusions:
- Tailoring interventions to frontline clinicians' constraints and the local work environment is crucial for successful implementation.
- Both acronym display and visual reminders served as effective visual reinforcements for adopting structured note-taking.
- The study highlights the importance of adaptable strategies to maintain documentation standards, especially during disruptive events like the COVID-19 pandemic.
Background:
Audits on record keeping practices at our multidisciplinary hospital revealed unstructured ward-round notes which were dissimilar from each other on aspects of patient information. Written as per the discretion of the rounding physician, the practice compromised team communication and medicolegal safety and risked patient harm. Paediatricians decided to address this concern for their department and proposed to improve the quality of documentation by structuring their notes using subjective, objective, assessment and planning (SOAP) format. On observing only 13% compliance with SOAP use despite education and training to use it, a series of interventions were explored to increase its application.
Methods:
Brainstorming sessions with the paediatricians provided practical solutions. These were tested one by one using plan-do-study-act cycles to understand their impact. Team feedback was pursued towards the end of each cycle to understand the opinion of each team member.
Interventions:
Interventions included verbal reminders, individual feedback and SOAP acronym display. Each of these were tested singularly and serially. Acronym display proved successful until the arrival of COVID-19, which disrupted its implementation and redirected paediatricians' work priorities. This led to exploration of a new solution, and paediatricians recommended use of visual reminders at the handover site. Quantitative information was analysed to reject or retain the ideas.
Results:
Verbal reminders and individual feedback made no difference to SOAP usage. Acronym display improved compliance from 13% to 90% but it fell to 45% during COVID-19. Its replacement with visual reminders during pandemic times reinstated the compliance to a median of 84%.
Conclusions:
Selection of a change idea that respected front liner's constraints and suited local work environment proved valuable. Both acronym display and visual reminders served as visual reinforcements towards embracing a note format and proved effective. Perceived benefits from methodically written notes encouraged paediatricians to re-establish simpler measures to retain SOAP application, otherwise disrupted during the COVID-19 pandemic.
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