Self-assessment of operation notes writing amongst residents in a teaching hospital
Context: Operation note writing is an integral part of the surgical procedure and chronicles the details surrounding it. Objective of the study: Is to determine the level of adherence of the surgical residents to standard guidelines on operation note writing. Subjects and Methods: This is a cross-s...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Nigerian Medical Association, Akwa Ibom State Branch
2019-08-01
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| Series: | Ibom Medical Journal |
| Subjects: | |
| Online Access: | https://ibommedicaljournal.org/index.php/imjhome/article/view/223 |
| _version_ | 1797271877088968704 |
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| author | Okugbo SU Agbonrofo PI |
| author_facet | Okugbo SU Agbonrofo PI |
| author_sort | Okugbo SU |
| collection | DOAJ |
| description |
Context: Operation note writing is an integral part of the surgical procedure and chronicles the details surrounding it.
Objective of the study: Is to determine the level of adherence of the surgical residents to standard guidelines on operation note writing.
Subjects and Methods: This is a cross-sectional survey of residents in the department of surgery, University of Benin Teaching Hospital, Benin City, using an anonimised self-administered questionnaire, which was adopted from the Royal College of Surgeons guidelines on operation note writing.
Results: Thirty-one residents (19 Senior Registrars and 11 Registrars) were sampled. 51.6% of respondents were 1year or less in training. 71.7% of respondents regularly write operation notes, however 90.1% of respondents reported that the first assistant wrote operation notes; while 74.2% reported that they adhere to standard guidelines operation note writing. Date, name of surgeon and assistants, type of operative procedure, incision and findings were universally reported amongst respondents, whereas names of scrub nurses, time, prosthesis serial number, deep venous thrombosis and antibiotic prophylaxis were poorly reported. Only 3 respondents scored 100% with the mean score of 75.4% of identified parameters in the guideline used.
Conclusion: Training on operation note writing should be entrenched to ensure proper adherence to standard guidelines. Formative assessments of the process are imperative to improve compliance.
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| first_indexed | 2024-03-07T14:16:31Z |
| format | Article |
| id | doaj.art-66c77bd8c67340c7a6efb5958a81c9fc |
| institution | Directory Open Access Journal |
| issn | 1597-7188 2735-9964 |
| language | English |
| last_indexed | 2024-03-07T14:16:31Z |
| publishDate | 2019-08-01 |
| publisher | Nigerian Medical Association, Akwa Ibom State Branch |
| record_format | Article |
| series | Ibom Medical Journal |
| spelling | doaj.art-66c77bd8c67340c7a6efb5958a81c9fc2024-03-06T12:07:06ZengNigerian Medical Association, Akwa Ibom State BranchIbom Medical Journal1597-71882735-99642019-08-0112210.61386/imj.v12i2.223Self-assessment of operation notes writing amongst residents in a teaching hospitalOkugbo SUAgbonrofo PI Context: Operation note writing is an integral part of the surgical procedure and chronicles the details surrounding it. Objective of the study: Is to determine the level of adherence of the surgical residents to standard guidelines on operation note writing. Subjects and Methods: This is a cross-sectional survey of residents in the department of surgery, University of Benin Teaching Hospital, Benin City, using an anonimised self-administered questionnaire, which was adopted from the Royal College of Surgeons guidelines on operation note writing. Results: Thirty-one residents (19 Senior Registrars and 11 Registrars) were sampled. 51.6% of respondents were 1year or less in training. 71.7% of respondents regularly write operation notes, however 90.1% of respondents reported that the first assistant wrote operation notes; while 74.2% reported that they adhere to standard guidelines operation note writing. Date, name of surgeon and assistants, type of operative procedure, incision and findings were universally reported amongst respondents, whereas names of scrub nurses, time, prosthesis serial number, deep venous thrombosis and antibiotic prophylaxis were poorly reported. Only 3 respondents scored 100% with the mean score of 75.4% of identified parameters in the guideline used. Conclusion: Training on operation note writing should be entrenched to ensure proper adherence to standard guidelines. Formative assessments of the process are imperative to improve compliance. https://ibommedicaljournal.org/index.php/imjhome/article/view/223operation notesurgical trainees |
| spellingShingle | Okugbo SU Agbonrofo PI Self-assessment of operation notes writing amongst residents in a teaching hospital Ibom Medical Journal operation note surgical trainees |
| title | Self-assessment of operation notes writing amongst residents in a teaching hospital |
| title_full | Self-assessment of operation notes writing amongst residents in a teaching hospital |
| title_fullStr | Self-assessment of operation notes writing amongst residents in a teaching hospital |
| title_full_unstemmed | Self-assessment of operation notes writing amongst residents in a teaching hospital |
| title_short | Self-assessment of operation notes writing amongst residents in a teaching hospital |
| title_sort | self assessment of operation notes writing amongst residents in a teaching hospital |
| topic | operation note surgical trainees |
| url | https://ibommedicaljournal.org/index.php/imjhome/article/view/223 |
| work_keys_str_mv | AT okugbosu selfassessmentofoperationnoteswritingamongstresidentsinateachinghospital AT agbonrofopi selfassessmentofoperationnoteswritingamongstresidentsinateachinghospital |