Several features of Owing to the small sample size, the patients were not subdivided into relevant teams or according to which grade of doctor led the ward round. 1. A crucial factor for successful documentation is engagement by the senior clinicians and nursing staff on its benefits which ensures appropriate use of WR checklist labels occurs as doctors rotate through the surgical placement.Keywords: ward round, checklist, patient safety, documentation. Kuala Lumpur, 72 case notes were randomly selected and reviewed pre-checklist implementation. From editorial acceptance to publication. BMJ Open Qual. This contributes towards improved communication between clinical staff and the patient and ultimately patient safety. WRs in Medicine: Principles for Best Practice. introduce the concept of a medical ward round considerative checklist to improve ward round processes, effectiveness, reliability and efficiency, aid team working and foster better communication. Additionally, it serves as an educational tool for junior doctors reviewing patients who may be inexperienced in WR practice. These WRs last several hours, sometimes all day due to the large number of acute in-patients in the hospitals, thus earning the colloquial name of ‘marathon’ WRs. The introduction of surgical WR checklist has made a clear improvement in documentation of key aspects of patient assessment and care. Get all the relevant information you need, and find a nurse before you start—this saves time later on Start with … Dove Medical Press is a member of the OAI. The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. England, The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. open access to scientific and medical research. Clin Gov Int J. The WR checklist benefits patient safety. SC005317 Further, the improved performance noted could be attributed to the Hawthorne effect as described in another study.5 Assessment of whether improved documentation using the WR checklist impacts patient outcomes such as length of stay or morbidity and mortality would be useful. 9 have shown that ward round checklist use resulted in significantly improved standardization, evidence‐based management of post‐operative complications and the overall quality of ward rounds. Dr Scott Fraser, Nitya Krishnamohan, Ishaan Maitra, Vinutha D Shetty Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UKCorrespondence: Nitya KrishnamohanDepartment of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, UKEmail [email protected]Purpose: The daily surgical ward round (WR) is a complex process. https://www.who.int/patientsafety/topics/safe-surgery/checklist/en/, Creative Commons Attribution - Non Commercial (unported, v3.0) License. Instead, its purpose ensures that important aspects of care are properly addressed on the WR. Advanced Search Coronavirus articles and preprints Search examples: "breast cancer" Smith J The checklist includes aspects of ward round preparation, the 14. Data was kept confidential in accordance with Trust policy. With a systematic approach you can make progress rather than defer decisions. You can learn about our use of cookies by reading our Privacy Policy. Boland et al identifies these factors as lessons learnt in their study.14 Informal verbal feedback from FY1 doctors was positive. The checker must highlight anything omitted, speak up and get it done! The work focused on the many adverse events experienced by patients on wards rather than operating theatres. BMJ Open Qual. Orthopedics. From submission to first editorial decision. London: RCP; 2012. Data whether any cases of venous thromboembolism (VTE) diagnosed was directly due to failure of thromboprophylaxis prescription and implementation was not analyzed in this audit. Do ward round stickers improve surgical ward round? 11. ANZ J Surg. ICU ward round should be standardised across the ICU, with the same start time and location every day Use first names among all team members to flatten the hierarchy and encourage ‘speaking up’ better to finish the ward round earlier and address minor details later (e.g. INTRODUCTION. The checklist does not serve merely as a ‘tick box’ exercise. But we describe and promote it princi-pally as a tool for use by the multidisciplinary team in the context of a ward round… Furthermore, even if assessment is complete, the interpretation of these vital assessments can easily be lost in translation when transcribed to documentation in the case notes. To assess outcome on patient safety, adverse events relating to these six parameters reported to the local clinical governance team were reviewed between January 2014 and December 2015 prior to implementation of the checklist and between January 2016 and December 2016 post-checklist implementation. Documentation of assessment of fluid balance improved from 8% to 76%. N Engl J Med. Reasons include duplication of documentation, time spent completing a checklist without perceived benefit, and poor communication within the team regarding the purpose and timing of checklist use.13 This was overcome by regular teaching and training on its use and benefits at surgical audit meetings and at junior doctor induction. It is inevitable that assessment of one or more variables may not occur. A post-checklist implementation audit was performed on 61 case notes randomly selected between January 2016 and August 2016. The authors report no conflicts of interest in this work. •  Recommend this site Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. Birmingham, This site is owned and operated by Informa PLC ( “Informa”) whose registered office is 5 Howick Place, London SW1P 1WG. A key factor for successful documentation is engagement by the senior clinicians and nursing staff on its benefits which ensures appropriate use of WR checklist labels occurs as doctors rotate through the surgical placement. Haynes AB, Weiser TG, Berry WR, et al. The sustained improvement at 3 months indicates that performance can be maintained beyond the initial implementation period. The documentation of fluid balance improved to 76% and patient observations to 87%. 4. Before the round make sure you have a full list of patients, including outliers. Number 3099067. Table 1 Parameters assessed on surgical WR. Its implementation has been beneficial in the National Health Service. There is significant variability in the conduct of surgical WRs in the NHS and potential for errors.1 Safety checklists are used in various fields outside of medicine, namely the aviation industry to help standardize performance and minimize human factor-related errors.2,3 These principles have been adapted to its use in health care.2 Checklists aid completion of complex tasks and reduce omissions and variations in practice while strengthening team communication, performance and patient experience.1 The WHO safety checklist is a key example that has improved patient safety and reduced mortality and morbidity in surgery.4,5, The considerative checklist developed by Caldwell et al streamlined the complex process of the WR into a systematic approach describing key aspects of care.3 Pitcher et al identified the deficiencies in general surgical WRs and the benefits of a checklist approach in overcoming this.6 A randomized controlled trial conducted in a simulated environment showed improved standardization, evidence-based management of post-operative complications and quality of WRs.7 These findings and other studies reported in literature demonstrate the benefits of the WR checklist and its impact on patient safety, improving documentation, communication and patient outcomes.3,6,8,9. During the surgical WR, the yellow label was placed within the clinical entry and completed following assessment, review and documentation of each of these parameters. The variability in ward round documentation in the case notes was felt to be due to the lack of a structured approach to documentation. 2009;360(5):491–499. Concerning the teaching of ward round practice itself, it can be noticed that ward round skills and teaching receive more and more attention in surgical literature, as a checklist, an assessment tool and a learning environment for teaching ward rounds have been developed [21, 28, 37]. Herring R, Caldwell G, Jackson S. Implementation of a considerative checklist to improve productivity and team working on medical WRs. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. 3 Ward rounds are critical to the smooth flow of the patient journey as they are the key method by 4 which patients in hospital are systematically reviewed by the multidisciplinary team. A number of studies have described an adverse event rate of 3–17% in hospitals in North America, Australia, New Zealand, Denmark, and the UK.1–12 The human cost to patients, families, and their carers is considerable, as is the cost to health-care systems. DOC, 221.5 KB This is an example list of the roles to be represented in a multidisciplinary ward round team and helping to ensure every decision made along the patient pathway adds value. This is communicated to patient, medical and nursing staff involved in patient care and clearly documented in patient case notes. Register your specific details and specific drugs of interest and we will match the information you provide to articles from our extensive database and email PDF copies to you promptly. A comprehensive list of parameters needs to be considered (Table 1). Design. Takeaways: 1. A quality improvement project in a high-volume general surgery department. Ward rounds included patients admitted via the emergency on-call teams as well as elective surgery patients. The suggestion for the use of a daily review checklist resulted from the successful implementation of "daily goals" in the intensive care unit and the "daily progress" sheet already being used in the medical high-dependency area in the adjacent ward. 2015;24(7):428–431. 8. • Interactive session: working through the ward round checklist 12.35 Ensuring multidisciplinary board and ward rounds add value by moving from Red2Green: Bringing the Last1000days and Red2Green to life through #EndPJparalysis Anne-Marie Riley Deputy Chief Nurse (Operations) The overall documentation of the six parameters was only 26% in the pre-checklist group and assessment of fluid balance was documented in only 8%. We offer real benefits to our authors, including fast-track processing of papers. BMJ Qual Improv Rep. 2015;4(1):u204775.w2440. | Privacy | Cookies | Sitemap | Contact Us | Terms and Conditions. 6. This work is published and licensed by Dove Medical Press Limited. To assess outcome on patient safety, adverse events relating to these six parameters reported to the local clinical governance team were reviewed pre – and post-checklist implementation.Results: Overall documentation of the six parameters improved following implementation of the WR checklist (pre-checklist=26% vs post-checklist=79%). The labels are concise and easy to follow, encouraging continued use. 2014;101(13):1666–1673. During a ward 5 round, the current status of each patient is established and the next steps in their care planned. However they are seldom treated with similar respect. Methods: Using a structured checklist, key aspects of surgical care were observed and recorded during ward rounds. Abbreviation: VTE, venous thromboembolism. Contact Us   To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. Most often the Consultant or Surgical Registrar leads the surgical WR. However, focusing on key aspects of care such as antibiotics, patient observations and VTE prescription as identified in a recent study by Gilliland et al, contributes towards improved patient clinical outcomes.8 Ensuring correct antibiotic use can contribute towards reducing Clostridium difficile rates and prompt identification and management of the ill patient results in lower morbidity.8 Attention to these aspects of care indirectly ensure improved inpatient care and safer and timely discharges.8, Issues with adherence to checklists can be encountered. 2. Let us for a moment compare the two. Implementation of a ward round pro-forma to improve adherence to best practice guidelines. Boland X. However, bias due to various factors such as efficacy of reporting these events is a limitation with this data. The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees. Gilliland N, Catherwood N, Chen S, Browne P, Wilson J, Burden H. Ward round template: enhancing patient safety on ward rounds. T: +44 (0)121 647 1560 E: birmingham@rcsed.ac.uk, The Advanced Surgical Skills Centre,UKM Medical Centre,Jalan Yaacob Latif,Bandar Tun, Razak, These selected parameters were identified as often overlooked or inadequately reviewed during our surgical WRs and deemed requiring further attention. By continuing to browse and use the site you are agreeing to our use of cookies. Most notably, the reduction in prescription errors. However, this would be expensive and more importantly raises concerns of privacy and storage. Complications due to healthcare are well documented and constitute an important public health problem. UK Pucher PH, Aggarwal R, Qurashi M, Singh P, Darzi A. Randomized clinical trial of the impact of surgical ward-care checklists on postoperative care in a simulated environment. Do ward round stickers improve surgical ward round? We recommend the use of a standardized checklist be incorporated into daily surgical practice in the UK. Open access peer-reviewed scientific and medical journals. B3 2BB You can learn about what data of yours we retain, how it is processed, who it is shared with and your right to have your data deleted by reading our Privacy Policy. The above percentage of manuscripts have been rejected in the last 12 months. Initially, members of the surgical team were unaware of the checklist. Br J Surg. The clinician leading the WR is likely to be interrupted several times, often while assessing a patient. Each had an eye on the clock above the nurse’s station. All rights reserved. Keywords: ward round, checklist, patient safety, documentation EH8 9DW 2018;7(3):e000341. The different parts of the toolkit are explained in the separate documents, downloadable below. 7. Bulk reprints for the pharmaceutical industry. Basic ward round structure Details.pdf, Tool 1. The ward round is a long standing and fundamental feature of inpatient care; its historical existence documented as far back as 1660.1 A ‘complex clinical process’, the ward round remains ‘critical to providing high-quality, safe care for patients in a timely, relevant manner’. Information regarding the WR checklist was provided to nursing staff and junior doctors via clinical governance meetings and teaching sessions. Alamri Y, Frizelle F, Al-Mahrouqi H, Eglinton T, Roberts R. Surgical ward round checklist: does it improve medical documentation? For cohort B, a structured checklist was introduced for use during the ward round and inserted into the medical record (Figure 2). Patient safety and care quality are the primary objectives for hospitals, patients, and their families. UK general surgery, orthopaedic surgery and urology. All junior doctors should be trained in ideal WR documentation and informed of the benefits of the checklist at each induction. This study assessed the use of a checklist to correct these omissions. Accessed 19 June 2018. Ownership by the senior and junior members of the team of its use promoted continued use. Hence, until newer and more efficient methods of recording WR assessments are developed, the WR checklist labels remain beneficial in improving the efficiency of WR documentation. Volume 2019:12 Pages 789—794, Editor who approved publication: Patient safety is a key quality indicator for healthcare organizations. If you agree to our use of cookies and the contents of our Privacy Policy please click 'accept'. 3. Banfield DA, Adamson C, Tomsett A, Povey J, Fordham T, Richards SK. that, for physicians, the consultant ward round was where we needed to look (Figure 2). It improves communication, documentation and ensures that key issues are not missed at patient assessment on WRs. The yellow color also makes it stand out. 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