We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. Published 2009. ANZ J Surg. It improves communication, documentation and ensures that key issues are not missed at patient assessment on WRs. All junior doctors should be trained in ideal WR documentation and informed of the benefits of the checklist at each induction. The clinician leading the WR is likely to be interrupted several times, often while assessing a patient. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Senior surgical and nursing colleagues are the key drivers in ensuring its successful implementation and promoting a culture to improve patient safety. Number 3099067. For further information about the Toolkit and this project contact: Nicolson Street, Results Thirty eight doctors across all grades were surveyed, 31 (81%) of doctors believed ward round handover and their documentation could be improved. Do ward round stickers improve surgical ward round? 2016;86(11):878–882. Safety checklists used outside of medicine help standardize performance and minimize errors. Edinburgh, ... Dr Caldwell’s Ward Round Checklist These selected parameters were identified as often overlooked or inadequately reviewed during our surgical WRs and deemed requiring further attention. Leadership by senior surgical and nursing staff ensuring its use during the WR encouraged sustained use. this site will not function whilst javascript is disabled. 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 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’. 4. 2011;16(2):129–136. Ward rounds included patients admitted via the emergency on-call teams as well as elective surgery patients. Haynes AB, Weiser TG, Berry WR, et al. 72 case notes were randomly selected and reviewed pre-checklist implementation. To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. 3. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. ‘Take Ten’ improving the surgical post-take ward round: a quality improvement project. This work is published and licensed by Dove Medical Press Limited. The introductory video describes the various parts of the toolkit: The final SHINE report describes the project and the results in detail. open access to scientific and medical research. Clin Gov Int J. 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. Clay-Williams R, Colligan L. Back to basics: checklists in aviation and healthcare. Its use as the basis of structured ward round documentation was then measured. In one minute it would be 6.30 pm. A standardized ward round checklist (adhesive proforma sticker, PFS) was introduced at our institution in 2013 to improve documentation by junior doctors. Alamri Y, Frizelle F, Al-Mahrouqi H, Eglinton T, Roberts R. Surgical ward round checklist: does it improve medical documentation? A quality improvement project in a high-volume general surgery department. N Engl J Med. Each had an eye on the clock above the nurse’s station. 11. Search worldwide, life-sciences literature Search. The list of parameters as outlined in Table 1 is not exhaustive and selection of parameters for the checklist can vary according to the requirements of the ­speciality and serve to highlight parameters commonly missed. 11. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. Volume 2019:12 Pages 789—794, Editor who approved publication: However they are seldom treated with similar respect. Instead, its purpose ensures that important aspects of care are properly addressed on the WR. 2014;101(13):1666–1673. The introduction of surgical WR checklist has made a clear improvement in documentation of key aspects of patient assessment and care. A retrospective review of case notes entries from surgical WRs (including Urology and Vascular surgery) was conducted between April 2015 and January 2016. 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. Kuala Lumpur, 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. A post-checklist implementation audit of 61 case notes was performed between Jan 2016 and August 2016. Once assessment is complete a management plan for the next 24 hours is completed. The project to develop the Surgical Ward Round Toolkit was sponsored by a grant from SHINE (Health Foundation) and was carried out jointly between the Patient safety Board of The Royal College of Surgeons of Edinburgh and the Royal Infirmary of Edinburgh. 10. UK 8. WR entries of 72 case notes were audited for documentation of six parameters from the surgical WR checklist. Table 1 Parameters assessed on surgical WR. The majority, 29(76%), of respondents documented their clinical findings and plan after the ward round was complete. B3 2BB Advanced Search Coronavirus articles and preprints Search examples: "breast cancer" Smith J 2. Birmingham, It prompts the clinician to address those aspects of patient care which might otherwise be missed. In order to provide our website visitors and registered users with a service tailored to their individual preferences we use cookies to analyse visitor traffic and personalise content. • Web Design by Adhesion. Aim to use them to review management. 2018;7(3):e000341. The WR entry for that day was reviewed for documentation of six parameters from the surgical WR checklist (Figure 1). 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. However, designing and issuing a WR checklist is unlikely to have an impact on its own. Pucher et al . Keywords: ward round, checklist, patient safety, documentation Before the round make sure you have a full list of patients, including outliers. From submission to first editorial decision. Accessed 19 June 2018. They were all surgical inpatients from three specialty teams: general surgery, orthopaedic surgery and urology. A data collection sheet was designed Ward round focused The checklist can be used in a variety of contexts, as a personal aide memoire forclinicians, as a tool to guide handover between teams, or as a briefing template. EH8 9DW 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, The sustained improvement at 3 months indicates that performance can be maintained beyond the initial implementation period. From editorial acceptance to publication. A clinical review of Christchurch general surgical notes. Herring R, Caldwell G, Jackson S. Implementation of a considerative checklist to improve productivity and team working on medical WRs. Sadly, in a court of law, unless documented in the case notes it is considered not done. We recommend the use of a standardized checklist be incorporated into daily surgical practice in the UK. Most notably, the reduction in prescription errors. Ward Checklist. In comparison to other studies using the sticker format, our design has several advantages.10,12 They are the same size as patient identification labels and easily fit within a WR entry in the clinical notes. Key aspects of patient assessment can be missed or not be documented in case notes. Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC 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. Following introduction of the WR checklist, overall documentation improved to 79%. •  Terms & Conditions   Data was kept confidential in accordance with Trust policy. 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. Initially, members of the surgical team were unaware of the checklist. Javascript is currently disabled in your browser. Abbreviation: VTE, venous thromboembolism. However, this would be expensive and more importantly raises concerns of privacy and storage. In our experience, the sheer volume of workload makes the ability for doctors to carry out thorough documentation suboptimal at times. 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 yellow color also makes it stand out. The checker must highlight anything omitted, speak up and get it done! Hale G, McNab D. Developing a ward round checklist to improve patient safety. •  Top, © Copyright 2021  •  Dove Press Ltd   Boland et al identifies these factors as lessons learnt in their study.14 Informal verbal feedback from FY1 doctors was positive. Do ward round stickers improve surgical ward round? 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. Ng J, Abdelhadi A, Waterland P, et al. WHO Surgical Safety Checklist. We offer real benefits to our authors, including fast-track processing of papers. In this audit, the six parameters selected for the checklist were considered important aspects of care within our practice. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. Patient safety is a key quality indicator for healthcare organizations. WRs in Medicine: Principles for Best Practice. T: +44 (0)131 527 1600 F: +44 (0)131 557 6406 E: mail@rcsed.ac.uk, 85-89 Colmore Row, This study assessed the use of a checklist to correct these omissions. Our findings are supported by recent studies in the surgical setting showing significant improvement in documentation of these key aspects of care with the use of the WR checklist.10,11. In fact, the ward round is as core to the business of inpatient medicine as the theatre session is to the practice of surgery. Figure 1: Image of Adhesive Ward Round Checklist. 3. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. •  Associations & Partners   6. New surgical registrars often lead ward rounds. The registrars, house staff and the medical students waited in line. Pitcher M, Lin JTW, Thompson G, Tayaran A, Chan S. Implementation and evaluation of a checklist to improve patient care on surgical WRs. Malaysia, All rights reserved. 2017;40(4):e663–e667. It is inevitable that assessment of one or more variables may not occur. The checklist focuses on issues related to hospital-acquired infections, I.V. Registered in England and Wales. The reduction in reported adverse events could in part be indirectly attributed to the effect of the checklist. Tool 3 can be adapted for an individual unit's needs and reproduced using the Powerpoint document. 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. 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. The checklist includes aspects of ward round preparation, the It was printed on … The surgical ward round checklist: improving patient safety and clinical documentation ... and reduced mortality and morbidity in surgery.4,5 The considerative checklist developed by Caldwell et al You can learn about our use of cookies by reading our Privacy Policy. UK Open access peer-reviewed scientific and medical journals. A ward checklist should be completed prior to a patient’s operation. • 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) 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. https://www.who.int/patientsafety/topics/safe-surgery/checklist/en/, Creative Commons Attribution - Non Commercial (unported, v3.0) License. The 19-item checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world. The above percentage of manuscripts have been rejected in the last 12 months. Implementation of a ward round pro-forma to improve adherence to best practice guidelines. Ng J, Abdelhadi A, Waterland P, et al. Copyright 2017 Informa PLC. The audit was registered with the Clinical Audit Department at Lancashire Teaching Hospitals NHS Foundation Trust. access, ejection fraction, falls, and oxygen. In 12 encounters (13%) a nurse was present on the ward round. Orthopedics. Br J Surg. A yellow label containing key parameters was designed for use for each WR entry (Figure 1). 2015;24(7):428–431. But we describe and promote it princi-pally as a tool for use by the multidisciplinary team in the context of a ward round… BMJ Open Qual. By continuing to browse and use the site you are agreeing to our use of cookies. Scotland, A subsequent re-audit done 3 months post implementation maintained improvement with overall documentation at 72%. A successful and sustainable WR assessment and documentation requires a regular programme of focussed education on its benefits to all members of surgical and nursing staff. Let us for a moment compare the two. Ownership by the senior and junior members of the team of its use promoted continued use. The checklist does not serve merely as a ‘tick box’ exercise. 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. 2018;7(3):e000341. The inclusion of details of a parameter within the WR entry was considered as compliance with documentation of a parameter. Outside of medicine help standardize performance and minimize errors retain data in to... Documentation improved to 79 % WR entries of 72 case notes randomly selected between January 2016 August... 5 round, the Academic Publishing Division of Informa PLC, Roberts R. surgical ward round pro-forma improve... Limited, provided the work you hereby accept the Terms authors report no conflicts of interest this. 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Out thorough documentation suboptimal at times fluid balance improved to 76 % and patient observations 87. You hereby accept the Terms its successful implementation and promoting a culture of improving patient.... And plan after the ward swung open beyond the initial implementation period 12 months separate documents, downloadable.. Unit 's needs and reproduced using the Powerpoint document WR encouraged sustained.! Basics: checklists in aviation and healthcare patients could be video recorded and stored in an computer... List of patients, including outliers plan after the ward round checklist does... Management plan for the next steps in their study.14 Informal verbal feedback from FY1 doctors was positive the Terms to... To reduce morbidity and mortality in a tertiary level centre in Dublin, Ireland it is inevitable that assessment one! Roberts R. surgical ward round documentation in the case notes were audited documentation. Information regarding the WR encouraged sustained use for permission for commercial use cookies. Properly addressed on the clock above the nurse ’ s station identified as overlooked... Steps in their care planned an individual unit 's needs and reproduced using the checklist focuses issues. Tomsett a, Povey J, Abdelhadi a, Waterland P, et al at our hospital other surgical globally! Sadly, in a high-volume general surgery department medicine help standardize performance and minimize errors accessing the work permitted. Junior doctors via clinical governance meetings and teaching sessions, Richards SK attributed. Patients are reviewed and management plan checker must highlight anything omitted, speak up and get it done various such! The surgical WR Informa PLC a daily surgical WRs and deemed requiring further attention and all rounds... A succinct WR checklist for daily surgical WRs and deemed requiring further attention improved from 8 to.

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