Ward round template: enhancing patient safety on ward rounds

Abstract

Introduction and aimsConcerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.MethodThe quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.Summary of resultsDocumentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.ConclusionsFollowing introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study

“…An opportunity exists to apply AMS and IPC principles to every single patient on every ward round and should not be reserved to dedicated stewardship rounds only. Gilliland et al 48 reports that AMS documentation went from 0% to 100% following the introduction of a ward round template. 48 In another study, the implementation of a ward round checklist increased checks of invasive devices from 9% to 72%.…”

“…Gilliland et al 48 reports that AMS documentation went from 0% to 100% following the introduction of a ward round template. 48 In another study, the implementation of a ward round checklist increased checks of invasive devices from 9% to 72%. 18 The key learning from this paper relates to patterns of communication and teamwork focused on AMS and infection management across surgical teams.…”

From chaos to a new norm: The Birmingham experience of restructuring the largest plastics department in the UK in response to the COVID-19 pandemic

“…Having a ward round checklist is a safe practice that has been demonstrated to enhance patient safety. 8 Having this checklist ( Figure 2 ) meant that we were unlikely to miss essential points during the ward round. Following the plastics led ward round, a senior member of a medical team (senior registrar or consultant) would attend the ward to discuss any challenging medical problems or to review patients if required.…”

“…We therefore devised a ward round checklist to be utilised during the medical ward rounds. Having a ward round checklist is a safe practice which has been demonstrated to enhance patient safety [8] . Having this checklist ( Fig.…”

Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma

“…Templates and checklists have improved patient outcomes in medical, surgical and high-care settings. 1,2 The daily consultant-led ward round entry serves as the primary communication between the multidisciplinary team (MDT) and acts as the medicolegal record. There are barriers in junior doctors scribing complete ward round entries using blank sheets.…”