Guidelines for the Successful use of Diary Cards
Introduction
The sample form layouts printed by DRS may prove most useful for data collection, or could be modified according to local needs.
Further advice is available on request, contact the DRS Support and Development Officer: Dan Hughes, on 07967 819890.
General Guidance
It is helpful to have a nominated person to collect diary cards daily - this improves accuracy and reminds participants that a monitoring exercise is underway.
It can be helpful to inform the nursing staff, when undertaking a diary card exercise - they are often very helpful in reminding participants to fill in their cards!
Using and Completing the Forms
A new sheet should be used each "day", ie after a night on call. Starting a new shift at 8:00 am or 9:00 am is a common time to change to a new sheet
If a split shift is undertaken, include both shifts on one 24 hour sheet, but indicate the break (paid or unpaid).
Fill in sheets as you go along, especially overnight. Attempting to remember a night on call, in detail, at the end of a 2 week monitoring exercise is not sufficiently accurate. It is better to repeat a missed night, the following week, rather than invent data.
For the on call diary:
Commonly, work through the day and evening is continuous so that recording individual episodes of work can be unnecessarily time consuming. Recording of each episode is necessary once a natural break is reached e.g.
There are now many more full shift rotas, with no rest required other than natural breaks. For full shift rotas only, DRS includes samples of diary cards with a week or two weeks entry space on one page.
|
Task |
Start |
End | |||
|
Normal day |
09:00 |
18:30 | |||
|
bleeped |
21:20 |
21:32 | |||
|
patient in A&E |
21:40 |
22:14 | |||
At the end of the night, sleep and rest can be calculated by hand or by the DRS program, but there is also a record of interruptions.
Particular Features for ensuring a Successful Diary Card Study
The London and South East Regional Action Teams recommend diary studies as the method of choice for ongoing monitoring. As a minimum, we expect a 75% return rate of cards from all doctors, on all tiers as detailed in the monitoring guidance accompanying the new contract.
Our accredited acute Trusts are largely sustaining over 90% return rates.
To help ensure this we recommend:
1. Before starting any data collection, the exercise should be fully explained to the doctors. This should include enhancing their awareness of the purpose of the New Deal, the hours requirements and regulations and the value the trust places on maximising the quality of patient care and the minimisation of risk to patients and staff needs to be stressed.
2. Discuss the diary cards to be used. Agree how they are to be completed and the need to use the free text area for more detailed activity auditing. Specific areas of concern to all involved need documenting for future discussion.
3. Agree what is rest and what is not. Natural breaks do not constitute rest. (Ref. HSC 1998(240))
4. Ensure senior clinician interest, support and involvement.
5. Two weeks' cards are necessary, ideally one filled in for each day by each doctor. (unless only overnight work is being investigated) . However, the cards should be collected daily - who does this and how and when can be agreed by the group.
6. Any missing cards should be located. If some entries are forgotten overnight, then filling them in the next morning is acceptable. Filling them in two weeks later is not!
7. Analysis of the data at the end of the study should be prompt, allowing for feedback, discussion and action.
8. Local advertising to support the study can help - screensavers, badges, posters etc. have been used successfully. Displaying results in the mess, both of compliance with monitoring and then eventual New Deal compliance - introduce an element of 'healthy' competition.
