Dear Experts,
Let me share with my process, daily we are auditing 6 in-patient medial records, we have to check 60 items in each record if it is comply with the standard or not, yes/no data, after that we use the c-control chart to show the total number of incomplete items in each day from the six records, for example, in Sunday we have 73 incomplete item out of (6× 60) item.
The c-chart for January has been shown a trend of 6 consecutive points decreasing in values, and in February we got one points outside the lower control limit.
So may I ask how we can explain the February’ output.
Thanks.
Omar.

You would treat the point outside your LCL as a special cause and try to identify it. Since your target would be to reduce c (# of defects) your result in February could potentially be an opportunity to improve your process...if, as you said, the c values have been decreasing steadily through January into February this could simply be an indication of positive results as an effect of quality initiatives....e.g. you've been training your personnel to correctly fill out their forms and in effect you are seeing the positive result of that training, therefore validating that the training is effective. But basically the trend you are seeing and the point outside the LCL are telling you that something has possibly changed in the performance of your personnel that has reduced the number of defects, finding out what, if you don't already know, will be a step in the right direction for maintaining that trend.

Further, it could also indicate a negative trend in your auditing...e.g. it could indicate that your auditors are not correctly identifiying all nonconformances...I couldn't imagine this would be the case though as it sounds as if your audits are relatively simple reviews.

:D

Dear Experts,
Let me share with my process, daily we are auditing 6 in-patient medial records, we have to check 60 items in each record if it is comply with the standard or not, yes/no data, after that we use the c-control chart to show the total number of incomplete items in each day from the six records, for example, in Sunday we have 73 incomplete item out of (6× 60) item.
The c-chart for January has been shown a trend of 6 consecutive points decreasing in values, and in February we got one points outside the lower control limit.
So may I ask how we can explain the February’ output.
Thanks.
Omar.

You mentioned you had 60 items per record. It may be worthwhile to make a Pareto chart of the rate by each item before January, and the rate once the trend started (January). Then you can see if it is specific items that decreased, and if so, you should be able to determine why (hopefully due to a specific feedback/improvement action).

You did not specify the specific enviroment of the patient charting. ER vrs ICU vrs Med surg all have their own levels of influances on the time for a doc or nurse to keep a good chart. There are a lot of human and enviromental factors that influance this process.

It would be helpfull to verify if there is a higher occurance to specific individuals in a unit on any given shift as all the folks on a shift should be subject to the same enviromental influances in proper charting.

The key process variables that I see are patient acuity which should drive staffing ratio but does not allways happen. Other items that influance proper charting are the shift ( drives work load as night time with patients sleeping allows more time to keep up with charting) and individuals who fill out the charts.

Did anyone ask the person filling out the chart in question why items were missed or filled out incorrectly? Track these answeres to determin if there are some commen causes that can be addressed. Some times the simplest approach is the best.