Developing a ward round checklist to improve patient safety

Abstract

Checklists have been shown to improve care and reduce morbidity and mortality in the healthcare setting.[1] Their application in safety-critical industries outside of medicine continues to offer a strong argument for their application to medicine.[2] The daily in-patient medical ward round is a complex process and includes multiple potential risks to patient safety. This project aims to evaluate the effectiveness of a ward round review checklist on one general medical ward in a district general hospital in the UK.A baseline audit was performed, examining case-notes for a set of pre-defined outcome measures relevant to patient safety. Compliance with documentation of each outcome measure was assessed prior to the introduction of a ward round checklist. This was followed by a quality improvement project through the use of PDSA cycles, with the aim of introducing and developing a ward round checklist over a nine month period. Following the introduction of a checklist, overall compliance with documentation of each outcome measure improved from 45% to 89%.In conclusion, a quality improvement project involving the introduction of a ward round checklist for daily use has resulted in improved documentation of outcome measures that are relevant to patient safety. Teamwork and leadership skills from clinicians committed to improving patient safety is essential to sustaining improvements in traditional ward round practice.

Ward rounds: can an aide‐memoire help new doctors?

“…Of the 13 aspects of care covered in the survey there was a statistically significant increase in the frequency with which FY1s considered nutrition, mobility and discharge planning following the introduction of the aide‐memoire. These were among the least frequently considered aspects in the initial survey, so improvements in these important areas are particularly valuable, supporting the idea that a ward‐round checklist can facilitate holistic patient care and junior doctors’ learning . Although the aide‐memoire has some value in preparing FY1s, self‐reported levels of preparedness remained relatively low in the post‐intervention survey, and there was a strong desire for formal teaching in this area.…”

“…The aide‐memoire (Figure ) was developed by the authors based on their own experiences and Royal College of Physician guidelines, with support from senior colleagues. The content is similar to ward‐round checklists developed by other teams . It was developed as a learning tool to help newly graduated doctors familiarise themselves with aspects to consider on ward rounds, and a prompt for consistent and comprehensive care, and then promoted as an ‘aide‐memoire’ with the intention of minimising any resistance from clinicians .…”

“…7,8 It was developed as a learning tool to help newly graduated doctors familiarise themselves with aspects to consider on ward rounds, and a prompt for consistent and comprehensive care, and then promoted as an 'aidememoire' with the intention of minimising any resistance from clinicians. 7,8 It was distributed in two formats: a credit card-sized version, to be carried behind the doctor's identity badge, and an A4-sized poster, to be attached to the medical-note trolleys. The aide-memoires were introduced during the mandatory introduction for FY1s in August 2015 in order to maximise exposure to the aide-memoire, and to prepare and encourage FY1s to conduct thorough and systematic ward rounds from the very start of their clinical post.…”

“…Teaching ward round competencies to medical students and newly graduated doctors through simulation and observed practice has been explored, but this is time and resource intensive . A number of teams have developed ward‐round checklists, and have demonstrated their value for improving care and safety on ward rounds, but a key limitation of this is the resistance to a ‘checklist approach’ to medicine . Checklists may be of particular value for junior doctors, but their specific role in preparing newly graduated doctors for conducting ward rounds has not previously been formally explored.…”

An exploratory study of healthcare professionals’ perceptions of interprofessional communication and collaboration

“…However, strong leadership is required to strengthen communication between physicians and nurses and develop a team culture. Leaders of teams must ensure that all members of the team are involved in decision-making (Hale & McNab, 2015). Participants expressed that interprofessional communication and collaboration in clinical rounds improves when members of the team are equipped with the right clinical knowledge and expertise.…”