Improving inpatient care on the geriatric ward in Royal Oldham Hospital with the ‘Harm-Free Care’ proforma

Introduction: 

A local audit of inpatient target oxygen saturation prescriptions identified multiple areas of inpatient care that were inconsistently addressed, prompting us to widen the scope of the audit. To provide a standardised approach to addressing these areas, we developed the ‘Harm-Free Care’ proforma (HFCP), which prompts healthcare professionals to review ten key areas of patient care on a weekly basis, including recent investigations, catheter care, bowel charts and nutrition. These are particularly important components of care in older patients, where regular reviews identify and address common contributors to hospital-acquired complications. 

Methods: 

Prospective data collection of geriatric inpatient notes was undertaken across five audit cycles between September 2025 to July 2026. The first four cycles assessed compliance with target oxygen saturation prescription policy. The HFCP was introduced as the intervention in cycle two, and compliance with each of its ten parameters was assessed in the fifth cycle. 

Results: 

A total of 127 patients were included in this project over the 5 cycles. Compliance with target oxygen saturation prescriptions improved from 52% to 84.6% over 4 months following HFCP implementation.  

In the final cycle, 63% of patients had a HFCP completed. Of these patients, all had six of the ten parameters fully documented. Up to date VTE assessments were present in 94.1% of patients with a completed HFCP, compared with 40% without. Additionally, documented family discussions occurred in 58.8% and 0% respectively, and nutrition reviews in 94.1% and 60% respectively. 

Conclusions: 

Implementation of the HFCP was associated with improved compliance with target oxygen saturation prescriptions, as well as higher compliance with key areas of harm-free care, particularly family discussion and nutrition reviews. Given HFCP completion was 63%, this should be continually re-audited at regular intervals to ensure improved implementation and a maximised impact on patient care.