I Need a Weight!
An LSP QI Change Champions Project
Keywords:quality improvement, patient safety, prescribing
Children are not routinely weighed on arrival to our Paediatric Emergency Department which is a lost moment for health promotion. If they need intravenous or complex medications there is delay in prescribing and administering these because this is weight dependent. Even worse some patients are admitted to the ward without an accurate weight leading to drug errors.
I aim for our department to weigh 80% of all attenders and 100% of all infants under 6 months of age.
I developed High Level Process Maps to detail the path of the individual patient through the department including various times when they could be weighed. Fishbone maps helped me to understand that the reconfiguration of the department with the loss of the dedicated triage room meant that triage was happening in the corridor, not an appropriate place to undress and weigh an infant. Using baseline measurements I could see that some children were being weighed but it was staff-member dependent. I used Plan Do Study Act (PDSA) cycles to review my change ideas.
My first PDSA was to engage the Matron, the Consultants and the Practice Development Nurse. These discussions gave me a better understanding of the pressures on triage nurses, some of them new to their role. My second PDSA was to swap the normal triage chair in the corridor for the weighing-chair-scales. However, just because children sat on the scales did not mean they got a weight recorded. My third PDSA encouraged doctors to get infants weighed at the end of their examination when infants were undressed. Overall weight recording increased from 19% to 75%, infant weight recording increased 19% to 78%. Cases where weights were available at time of prescribing increased from 30% to 90%.
Participating in this QI programme has taught me to understand a problem before attempting to implement change and to study the effects of each change idea. I will take these skills forward with me in my career.
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