Background: proper documentation of Atherosclerotic\nCardiovascular Disease (ASCVD) risk score and its consequent\nmanagement in the newly applied electronic medical records (EMR)\nfor diabetic�s patients attending non-communicable diseases clinic\nin West Bay Health Center is less than ideal during Jan 2015 and Feb\n2015. Poor documentation of ASCVD risk score and its consequent\nmanagement will result in improper management for type 2 diabetic\npatients, and it will lead to undesirable consequences.\nAim: To improve the documentation of ASCVD risk score and its\nconsequent management in the EMR of diabetic patients attending\nnon communicable disease clinic (NCD) at west bay health center in\naccordance to American Heart Association and American College\nof Cardiology (AHA/ACC) guidelines for ASCVD risk assessment\nby end of April 2015.\nMethods: Pre-intervention Checklist was developed to collect\nbaseline data regarding the percentage of documentation of\nASCVD risk score and its consequent management from the EMR\nfor 60 Diabetic Patients attends NCD clinics. Intervention in the\nform of training session was done for all NCD nurses regarding\nthe importance of ASCVD risk score Calculation method and\nrole of nurses in documentation. For all doctors that run the NCD\nclinic training session was done regarding the ASCVD risk score\ninterpretation, documentation, and importance of preventive\nmanagement based on the score calculated with allocation of space\nin the new NCD chart in EMR for ASCVD risk score documentation\nand consequent management based on the score calculated and\ncreate a reminder poster in NCD nurse station and NCD clinics.\nResults: Percentage of complete ASCVD risk documentation for\ndiabetic patients in electronic medical (EMR) increased to 87%\nwith given proper treatment based on the calculated score after the\nintervention.\nConclusions: Intervention in the form of nurse and physician\nTraining improved the documentation of ASCVD by 87 %. This\nusually raise the issue that while implementing new systems,\nwe must put into consideration previous processes and making\nsuitable improvements.
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