Confusion in an older patient on a general hospital ward requires prompt and appropriate management. To this end, evidence-based guidelines have been produced and disseminated by Gwent Healthcare NHS Trust. An audit was carried out when it became apparent that junior doctors might not be aware of the guidelines and that their availability on the wards was limited. An action plan was generated and a second audit carried out. Our aim was to establish whether the doctors' knowledge of the guidelines and their availability on wards changed as a result of our action plan and audit.
The audit consisted of a survey of general wards at the Royal Gwent Hospital and at St Woolos Hospital to assess availability of the guidelines and a questionnaire administered to a sample of junior doctors. The guidelines were available on 17% of wards; 11% of junior doctors were aware of them. Results of the audit informed implementation of an action plan. The second audit showed a limited improvement in availability (increased to 34%) and awareness (increased to 15%) of the guidelines, with no statistically significant difference.
Apparently well-thought-out action plans may produce minimal change, but unless the audit cycle is completed this fact cannot be corroborated. In generating action plans, more consideration may need to be given to the factors that influence the spread of change in healthcare systems.
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