Improving vascular surgical ward rounds through implementation of ward round checklists

Abstract Aims With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care. Methods Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism (VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4 week period. Ward round stickers were then implemented and a second cycle was completed 2 months later over another 4 week period. Results Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items > 85%. Conclusion This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.

Download Full-text

305 Using Urology Specific Ward Round Sheets to Improve Clinical Documentation

British Journal of Surgery ◽

10.1093/bjs/znab259.739 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

D Evans

Keyword(s):

Nursing Staff ◽

Clinical Information ◽

Ward Round ◽

Clinical Documentation ◽

Cross Sectional ◽

Time News ◽

Surgical Ward ◽

Optimal Patient Care ◽

Ward Rounds ◽

Sectional Analysis

Abstract Aim To improve the documentation of vital clinical information on the urology ward round. To prompt clinical staff to review antibiotics, venous thromboprophylaxis, patient observations, and formulate a plan in a structured format. Method A retrospective, cross-sectional analysis was performed on the urology ward to assess whether the following parameters were documented/accounted for during ward-round: date, time, NEWS score, antibiotics, venous thromboprophylaxis, and whether the entry was easily found in the medical notes. Following this, a urology-specific ward-round sheet was synthesised between the medical and nursing staff. This standardised sheet was easily identifiable in the notes and ensured all the above parameters were accounted for by prompting the note-taker to record them. Two months following introduction of this standardised ward-round sheet the same parameters were analysed on all the urology inpatients in the same retrospective, cross-sectional manner. Results Documentation of the NEWS score improved from 30% to 93% with the introduction of the ward-round sheet. Similarly, documentation of whether antibiotics were reviewed improved from 30% to 60%, and documentation of venous thromboprophylaxis improved from 20% to 53%. It was also noted that the ward-round entry was easier to find with the ward-round sheet. Conclusions Documentation of key clinical information is vital to ensure optimal patient care. Surgical ward-rounds can be quick paced and important considerations such as antibiotics and venous thromboprophylaxis may be missed. This simple intervention improved the documentation of the intended parameters. The next step is to alter and improve the ward-round sheet before re-auditing.

Download Full-text

Improving the quality of the daily ward round in a Plastic Surgery unit by adapting the SAFE Ward Round Tool of the Royal College of Surgeons of Edinburgh

Journal of Patient Safety and Risk Management ◽

10.1177/2516043520960572 ◽

2020 ◽

Vol 25 (6) ◽

pp. 233-238

Author(s):

Harry D Koumoullis ◽

Martin Shapev ◽

Gabriel Wong ◽

Sophie Gerring ◽

Goerge Patrinios ◽

...

Keyword(s):

Plastic Surgery ◽

Emergency Admission ◽

Daily Practice ◽

Ward Round ◽

Surgical Tool ◽

Surgical Ward ◽

Ward Rounds ◽

Surgery Department ◽

Pro Forma

Aim Our goal was to audit the quality of the ward round documentation in our Plastic Surgery department by using the SAFE Ward Round Tool of the RCS Edinburgh’s as a reference standard, and to create an in-house pro-forma based on results and discussion. Method An initial cycle based on the SAFE Tool was undertaken with prospective audit of individual daily ward round entries. A sticker pro forma was introduced and re-audit was done using the same criteria. Based on results and discussion, the pro-forma was further improved. Re-audit was performed to assess percentage of completion of its contents. Results The first cycle showed 47% (n = 42) completion rate and re-audit after implementation of the sticker found a rise up to 70% (n = 42). The third cycle examining solely sticker completion yielded a compliance of 88% (n = 61). This improvement reflected to the enthusiastic comments received from staff working in allied specialties. Conclusions Significant lapses in daily ward round documentation were revealed by our methodology. A sticker pro-forma, which we have named the Surgical Tool for the Assessment of Rounds (STAR), was introduced and provided measurable and sustainable improvements on our daily ward round practice. That had as a result the safeguarding of patient safety in the frame of Good Medical Practice. We suggest same methodology to be followed based on the SAFE Ward Round Tool for surgical ward rounds improvement in all the surgical and interventional specialties particularly when there is a component of emergency admission in their daily practice

Download Full-text

A patient-centred check sheet improves communication on the trauma ward round

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.8.472 ◽

2019 ◽

Vol 80 (8) ◽

pp. 472-475

Author(s):

Oliver S Brown ◽

Teri HH Toi ◽

Pedro R Barbosa ◽

Patra Pookarnjanamorakot ◽

Alex Trompeter

Keyword(s):

Patient Survey ◽

Management Plan ◽

Ward Round ◽

Improvement Project ◽

Orthopaedic Department ◽

Number Of Patients ◽

Surgical Ward ◽

Ward Rounds ◽

Transfer Of Information ◽

Initial Results

Background: Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient. Methods: A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one. Results: Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%. Conclusions: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.

Download Full-text

1702 A Proforma To Improve Documentation of Surgical Ward Rounds

British Journal of Surgery ◽

10.1093/bjs/znab259.185 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

E Armstrong ◽

M Koronfel

Keyword(s):

District General Hospital ◽

Ward Round ◽

Post Intervention ◽

Improvement Project ◽

Vte Prophylaxis ◽

Surgical Ward ◽

Management Plans ◽

Ward Rounds ◽

Assess Quality

Abstract Aim The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety. Method Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into: A re-audit was performed following introduction of a ward round proforma using the same criteria. Results The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%. Conclusions The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.

Download Full-text

264 Does the Introduction of Ward Round Stickers Improve Surgical Ward Rounds?

British Journal of Surgery ◽

10.1093/bjs/znab259.028 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

V Sharma ◽

E Fitzpatrick ◽

D Sharma

Keyword(s):

Quality Improvement ◽

Good Practice ◽

Ward Round ◽

Quality Improvement Project ◽

Improvement Project ◽

Vte Prophylaxis ◽

Baseline Performance ◽

Surgical Ward ◽

Ward Rounds ◽

Surgical Teams

Abstract Aim With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care. Method Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism(VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4-week period. Ward round stickers were then implemented, and a second cycle was completed 2 months later over another 4-week period. Results Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items > 85%. Conclusions This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.

Download Full-text

TP9.2.27A closed loop audit looking at the use of a checklist in surgical ward rounds to improve ward round documentation. Can we improve patient safety?

British Journal of Surgery ◽

10.1093/bjs/znab362.126 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Christopher Liao ◽

Emma Sheaff ◽

Harry Wilkins

Keyword(s):

Closed Loop ◽

Improve Patient Safety ◽

Clinical Care ◽

Ward Round ◽

Clinical Notes ◽

Legal Documents ◽

Surgical Ward ◽

Ward Rounds

Abstract Aims To assess if surgical ward rounds would improve through the use of a peri-operative ward round checklist in the clinical notes. Method We performed a closed loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”. Results In the first audit, our sample was 68, in the second, our sample was 64. With the use of a checklist (M = 67%, SD = 22%) ward round documentation was significantly better than without the checklist (M = 26%, SD = 10%), t(64)=8.85, p<.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p<.00001. Conclusions With the growing role of clinical notes as legal documents, handover tools, and pillars of care planning, and the move to use electronic patient record systems, improving the quality of documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, and so can improve clinical care. We will follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.

Download Full-text

Surgical ward round proforma can improve documentation and efficiency of ward rounds

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139412 ◽

2020 ◽

pp. postgradmedj-2020-139412

Author(s):

Dominic Dewson ◽

Victoria Eves ◽

Robert Gaskell ◽

Alex Hardman ◽

Ibrahim Akinpelu ◽

...

Keyword(s):

Ward Round ◽

Surgical Ward ◽

Ward Rounds

Download Full-text

642 A Closed Loop Audit Looking at The Use of a Checklist in Surgical Ward Rounds to Improve Documentation. Can We Improve Patient Safety?

British Journal of Surgery ◽

10.1093/bjs/znab259.078 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Christopher Liao ◽

Emma Sheaff ◽

Harry Wilkins

Keyword(s):

Patient Safety ◽

Closed Loop ◽

Improve Patient Safety ◽

Clinical Care ◽

Ward Round ◽

Clinical Notes ◽

Surgical Ward ◽

Legal Document ◽

Ward Rounds

Abstract Introduction Ward rounds are essential in assessing and planning patient care, but they are often subject to variable quality and structure. A ward round checklist could improve documentation and patient safety. Method We performed a closed-loop audit with a different novel ward round checklist in each audit, the second made from improving the first, based on feedback. We looked at checklist utilisation, and the quality of documentation in notes. We compared the quality of documentation in notes with the checklist, to notes without the checklist. The data was then collated and analysed. Standards from the Royal College of Physicians’ “Ward Rounds in Medicine”. Results In the first audit, our sample was 68, in the second, it was 64. With the use of a checklist (M = 67%, SD = 22%) documentation was significantly better than without (M = 26%, SD = 10%), t(64)=8.85, p<.00001. Ward documentation was especially improved regarding fluid balance, analgesia, and assessing physiotherapy needs. The second version of the checklist (M = 56%, SD = 28%) was used significantly more than the first checklist (M = 13%, SD = 22%), t(75)=7.59, p<.00001. Conclusions With the growing role of clinical notes as a legal document, a tool for handover, and a pillar of care planning, improving the quality of the documentation is imperative. This study shows that a systematic checklist significantly improves ward round documentation, which has already established in an improvement in clinical care. We hope to follow-up this study with a third audit, focusing on patient satisfaction and determining reduction in harm caused to patients with a ward round checklist.

Download Full-text

EP.TU.481Quality of Surgical Ward Rounds in a District General Hospital: an audit

British Journal of Surgery ◽

10.1093/bjs/znab311.062 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Heather Davis ◽

Portia Achunine ◽

Julia Jesuthasan ◽

Ashim Chowdhury ◽

Gandrasupalli Harinath

Keyword(s):

General Hospital ◽

District General Hospital ◽

Ward Round ◽

Early Warning Score ◽

Legal Implications ◽

Beta Hcg ◽

Surgical Ward ◽

Retrospective Data Collection ◽

Data Points ◽

Ward Rounds

Abstract Aims The fast-paced surgical ward round, alongside numerous competing distractions and demands, can result in poor rounds and subsequent imperfect documentation. This carries significant medico-legal implications. This audit assessed the standard of surgical ward round documentation at a district general hospital, against Royal College and other published guidelines. Methods A retrospective data collection of adult general surgical patients was undertaken over a period of eight weeks. We excluded bank holiday, weekends and paediatric cases. Documentation during ward rounds in patient notes were analysed and compared against the guidelines. Results 166 patient notes were included. Percentage compliance was assessed as a total, minus cases where not applicable. Good compliance ( > = 75%) was achieved in the majority of data points, including: date (100%), time (83%), ward round lead (99%), legibility (88%), early warning score (78%), current issues (80%) and management (100%). Poor compliance ( < = 25%) was seen in: presenting complaint (25%), fluid balance (16%), intravenous fluid review (21%), catheter review (23%), radiology results (25%), urinalysis (4%), beta HcG (0%), drug chart review (23%), antibiotic review (15%), assessment of venous thrombo-embolic risk (0%) and ceiling of care (1%). Conclusion Accurate, clear and complete documentation is crucial for patient safety and continuity of care, as well as for medico-legal reasons. This study shows there are several areas requiring improvement. The authors propose a proforma including the essential criteria to be integrated into the daily ward rounds.

Download Full-text