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

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

scholarly journals 1702 A Proforma To Improve Documentation of Surgical Ward Rounds

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.

scholarly journals 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?

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.

Evaluation of satisfaction with nursing care in the Children’s Surgery Department

2021 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
Edyta Laska ◽  
Anna Cepuchowicz
Keyword(s):  
Nursing Care ◽  
Emotional State ◽  
Emergency Admission ◽  
Test Method ◽  
Surgical Ward ◽  
Level Of Significance ◽  
Surgery Department ◽  
Task Oriented ◽  
Quality Of Nursing

Aim: The aim of the study is to assess the satisfaction of parents with nursing care at a pedi-atric surgery department. Material and method: The research was conducted among parents / caregivers of children discharged from the ward in the period from February to April 2019. The study involved 50 respondents. The test method was a diagnostic poll method in the form of a questionnaire. The research tool was a questionnaire of own authorship. Results: Factors determining satisfaction with child care on a surgical ward are: the age of the child, the mode of the child’s admission to the ward, accessibility, and the nurse’s sup-port. Thirty-one parents were in favour of the multi-purpose nature of nursing care on the ward. The others felt that nursing care was task-oriented. Parents of the youngest children (mean age 4.9 years) expected the nurse to be kind or professional (mean age 5.5 years). Parents of early childhood children (mean age 7.2 years) were more likely to expect under-standing, and parents of the oldest children (mean age 9.0 years) expected communicative-ness. It was shown that throughout the entire period of hospitalization, caregivers of children under 3 years of age (n = 13; 100.0%) or aged 3-6 years (n = 15; 78.9%) stayed with their chil-dren more often. There was a correlation between the mode of admission and the emotions that parents felt during the admission of their child to hospital, as shown in Tab. 5. The level of significance (p<0.001) in the hypothesis tested, was lower than the typical level of signifi-cance of 0.05. In the case of emergency admission (n = 13; 54%) and planned admission for surgery (n = 17; 74%), emotions related to helplessness and anxiety predominated. Conclusion: Parents rated the quality of nursing care on the ward well. Parents’ expectations of the nurse are not dependent on the age of the child. The mode of admission of the child to the ward did not affect the expectations towards the nurse. The age of the child affected the time the caregiver stayed with the child on the ward. The mode of admission of the child affected the emotional state of the parents of the caregivers.

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

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&lt;.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&lt;.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.

scholarly journals 1396 Improving Documentation During A General Surgical Ward Round

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Gidwani ◽  
J Kilkenny ◽  
R Lawther
Keyword(s):  
Ward Round ◽  
P Value ◽  
Senior Doctor ◽  
Chi Square ◽  
Record Keeping ◽  
Retrospective Audit ◽  
Surgical Ward ◽  
Chi Square Test ◽  
Ward Rounds

Abstract Introduction Clear documentation at ward rounds is essential to patient safety. The purpose of this audit was to identify areas that could be improved in the documentation at surgical ward round. Method A retrospective audit of the most recent ward round entry, in two surgical wards, was carried out against the Royal College of Physicians ‘Generic Medical Record Keeping Standards’. Patient name, Health & Care number (HCN), date, time(24hr), senior doctor present, signature, printed name, GMC/contact details of the scribe were analysed. After data collection, the standards were circulated to all doctors during departmental teaching and displayed on note trollies. A re-audit was then undertaken. Chi-square test was used to compare the two audit cycles and p value of &lt; 0.05 was considered significant. Results 21 patient notes were analysed in the initial audit. Patient name and HCN was noted in 86%(18/21) and 67%(14/21) respectively. 100% of notes included date and senior doctor. Time of entry, signature and printed name/Bleep/GMC number were noted in 81%(17/21), 90.5%(19/21) and 57%(12/21) respectively. 24 patients were included in the re-audit. Results revealed improvement in all parameters as follows: patient name (95.8% 21/24;p=0.23); HCN (91.6%; 22/24;p=0.036),; date and senior doctor (100% as before); time (87.5%; 21/24;p=0.55); signature (100%; 24/24), and printed name/GMC/bleep (87.5%; 21/24;p=0.022). Conclusions This closed loop audit demonstrates an overall improvement in the quality of surgical documentation at ward rounds with a very simple intervention. Additionally, a statistically significant improvement was noted in recording HCN and printed name/GMC/bleep.

SP2.1.5Does the introduction of ward round stickers improve surgical ward rounds?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Vivek Sharma ◽  
Emma Fitz-patrick ◽  
Dhiraj 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 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 &gt; 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.

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

2021 ◽  
Vol 21 (Suppl 2) ◽  
pp. 17-18
Author(s):  
Niall Brown ◽  
Joseph Horne ◽  
Andrew Low
Keyword(s):  
Junior Doctor ◽  
Ward Round ◽  
Ward Rounds ◽  
Pro Forma

scholarly journals 305 Using Urology Specific Ward Round Sheets to Improve Clinical Documentation

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.

scholarly journals Do ward round stickers improve surgical ward round? A quality improvement project in a high-volume general surgery department

2018 ◽  
Vol 7 (3) ◽  
pp. e000341 ◽  
Author(s):  
Jimmy Ng ◽  
Ahmed Abdelhadi ◽  
Peter Waterland ◽  
Jonathan Swallow ◽  
Deborah Nicol ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Good Practice ◽  
Ward Round ◽  
Quality Improvement Project ◽  
Medical Council ◽  
Improvement Project ◽  
Baseline Performance ◽  
Surgical Ward ◽  
Surgery Department

IntroductionIncreasing pressure and limitations on the NHS necessitate simple and effective ways for maintaining standards of patient care. This quality improvement project aims to design and implement user-friendly and clear ward round stickers as an adjunct to surgical ward rounds to evidence standardised care.Project design and strategyBaseline performance was measured against the recommended standards by the Royal College of Physicians, General Medical Council and a study performed at the Imperial College London. A total of 16 items were studied. All members of staff in surgery department were informed that an audit on ward round entries would be implemented but exact dates and times were not revealed. In the first cycle, ward round sticker was implemented and results collected across three random days for use and non-use of sticker. Feedback was collected through the use of questionnaires. In the second cycle, the ward round sticker was redesigned based on feedback and results collected for use and non-use of sticker.ResultsBaseline performance noted in 109 ward round entries showed that checking of drug chart, intravenous fluid chart, analgesia, antiemetic, enoxaparin, thromboembolic deterrents ranged from 0% to 6%. With the introduction of ward round stickers in both cycles, there was noticeable improvement from baseline in all items; in ward round entries where stickers were not used, performance was similar to baseline.ConclusionThis 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. Constant efforts need to be made to promote compliance and sustainability. Commitment from all levels of staff are paramount in ensuring standardised patient care without overlooking basic aspects.

General surgical foundation doctor: optimisation of daily practice

2020 ◽  
Vol 96 (1136) ◽  
pp. 339-342
Author(s):  
Emmanuel Feldano ◽  
Michael Clark ◽  
Benjamin Ramasubbu
Keyword(s):  
Structural Changes ◽  
Positive Impact ◽  
Daily Practice ◽  
Daily Routine ◽  
Improvement Project ◽  
Surgical Ward ◽  
Significant Difference ◽  
Working Day ◽  
And Performance

IntroductionThe role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes.MethodsThe project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed).ResultsThere was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved.ConclusionThe implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

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