Using Qualitative Research to Drive Quality Improvement: An Audit of Swab and Needle Check Documentation

 

Introduction
The retention of foreign objects, such as swabs, is a “never event” with serious implications for patient safety. Recent incidents and a move to digital documentation emphasized the need for robust swab and needle count protocols in birthing rooms, anticipating an impedance to compliance. This audit and Quality Improvement Project (QIP) aimed to assess and enhance compliance with Trust standards for swab and needle count documentation following the introduction of digital records on Badgernet.

Methods
The audit reviewed 33 consecutive birth records from 2024 to evaluate documentation compliance, specifically the presence of swab counts and dual verification signatures. Based on the findings, we launched a QIP that included a staff survey to identify barriers to compliance. Thematic analysis of survey responses was performed to highlight key areas of concern.

Results
The audit indicated substantial non-compliance: although 100% of cases included at least one verifier, only 58.3% had the required two signatures. The QIP set an objective for full compliance with documentation standards by March 2025. Using a cause-and-effect analysis, electronic documentation emerged as a key issue, with compliance dropping 20% since the adoption of Badgernet software. Further investigation through survey data and semi-structured interviews, applying qualitative research principles, allowed for inductive and deductive coding of responses. Key themes identified were limited PC access, form complexity, and challenges in securing a second signature due to shift changes. Based on these findings, we developed a Standard Operating Procedure (SOP) with visual aids to support efficient and accurate documentation.

Conclusion
This audit identified critical gaps in swab count documentation compliance, exacerbated by the transition to Badgernet. A qualitative approach to problem-solving informed the QIP, resulting in a simplified SOP with visual aids. A re-audit is planned to measure the effectiveness of these interventions in improving compliance and minimizing retained swab incidents

Keywords: Swab count, needle check, retained foreign objects, NHS never events, quality improvement, Badgernet.