Abstract
Background:
TEP’s are a tool used in acute hospital admission to guide appropriate care in the event of deterioration. TEP’s, a gold standard in the SIGN 167 guideline, help ensure that care aligns with the patients’ and families’ wishes. Though all patients should ideally have one on admission, this can be challenging to achieve. Patients with CFS (Clinical Frailty Scale) >5, NEWS >5, DNACPR, or progressive conditions, however, are at higher risk of deterioration and ensuring a valid TEP is in place is vital.
Aim:
To increase the number of patients in the Orthopaedic ward with a valid TEP in place aiming for 90% completion in patients who meet the criteria.
Methods:
Data on 10 random patients meeting the criteria above was collected monthly from Oct 2024–May 2025, tracking TEP completion (with consultant signature), DNACPR, and patient involvement. Three PDSA cycles were completed. Interventions included adding a TEP prompt to the patient board during the morning huddle, a TEP status column in the handover sheet, and staff education via posters and a presentation.
Results:
Baseline data showed TEP completion ranged between 30 to 80% (mean 50%). Results following the PDSA cycles was as follows: cycle 1 90% (completed 90%), cycle 2 80% (completed 60%), cycle 3 80% (completed 70%).
On average, it took 4.24 days after admission until a TEP was completed (range 0-17 days). Consultant signature rate ranged from 30% to 90%. TEP was discussed family in 70% of cases.
Conclusion:
Initial results show an encouraging rise in TEP implementation. A January drop to 30% may reflect staff continuity issues. TEP completion is higher under the Orthogeriatric team due to structured handover prompts. Ongoing data is needed to indicate whether improvements are significant and sustained, alongside work to maximise TEP quality by improving consultant endorsement and ensuring patient/family involvement.