World Health Organisation. Before the round make sure you have a full list of patients, including outliers. The number of parameters selected also needs to consider the size of label used that is conducive with the clinical entry. this site will not function whilst javascript is disabled. The documentation of fluid balance improved to 76% and patient observations to 87%. 11. Following introduction of the WR checklist, overall documentation improved to 79%. EH8 9DW Takeaways: 1. However, bias due to various factors such as efficacy of reporting these events is a limitation with this data. A structured WR checklist standardizes key aspects of care that need to be addressed on a daily surgical WR. 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. A retrospective review of case notes entries from surgical WRs (including Urology and Vascular surgery) was conducted between April 2015 and January 2016. The sustained improvement at 3 months indicates that performance can be maintained beyond the initial implementation period. BMJ Open Qual. • 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) WHO Surgical Safety Checklist. that, for physicians, the consultant ward round was where we needed to look (Figure 2). 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. Led by Royal College of Surgeons of Edinburgh, this project used an adapted non-technical skills for surgeons (NOTSS) system and a ward round based structured checklist to reduce errors and improve safety on surgical wards. Ng J, Abdelhadi A, Waterland P, et al. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. In one minute it would be 6.30 pm. 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. 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. 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Accessed 19 June 2018. It was printed on … UK Using an adapted NOTSS (Non-Technical Skills for Surgeons) system and a ward round based structured checklist, the aim of the Toolkit is to reduce errors and improve safety on surgical wards. Information regarding the WR checklist was provided to nursing staff and junior doctors via clinical governance meetings and teaching sessions. 2014;101(13):1666–1673. The introductory video describes the various parts of the toolkit: The final SHINE report describes the project and the results in detail. Results are summarized in Figure 2. 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. • Web Design by Adhesion. Instead, its purpose ensures that important aspects of care are properly addressed on the WR. 7. Dove Medical Press is a member of the OAI. The daily surgical WR is a complex process. During a ward 5 round, the current status of each patient is established and the next steps in their care planned. A surgical safety checklist to reduce morbidity and mortality in a global population. BMJ Qual Saf. In fact, the ward round is as core to the business of inpatient medicine as the theatre session is to the practice of surgery. 2018;7(1):e000045. 11. The reduction in reported adverse events could in part be indirectly attributed to the effect of the checklist. However, designing and issuing a WR checklist is unlikely to have an impact on its own. A separate audit would need to be conducted to address this. To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. Complications due to healthcare are well documented and constitute an important public health problem. In the three months following implementation of a surgical ward round checklist; authors report reductions in prescription, antibiotic, fluid balance and patient observation chart errors. 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. The different parts of the toolkit are explained in the separate documents, downloadable below. 12. •  Terms & Conditions   The checker must highlight anything omitted, speak up and get it done! 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. The variability in ward round documentation in the case notes was felt to be due to the lack of a structured approach to documentation. 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. 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. The checklist does not serve merely as a ‘tick box’ exercise. Let us for a moment compare the two. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. Its use as the basis of structured ward round documentation was then measured. The clinician leading the WR is likely to be interrupted several times, often while assessing a patient. 10. We aimed to examine the current pattern of PFS documentation (2 years after its introduction) and to identify which fields, if any, have been the most problematic to complete. The use of the WR checklist has been established as part of our WR practice since the audit. The yellow color also makes it stand out. Most often the Consultant or Surgical Registrar leads the surgical WR. •  Top, © Copyright 2021  •  Dove Press Ltd   Scotland, 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%). Senior surgical and nursing colleagues are the key drivers in ensuring its successful implementation and promoting a culture to improve patient safety. 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. 5. 9. By continuing to browse and use the site you are agreeing to our use of cookies. Number 3099067. The WR checklist benefits patient safety. Keywords: ward round, checklist, patient safety, documentation This site is owned and operated by Informa PLC ( “Informa”) whose registered office is 5 Howick Place, London SW1P 1WG. Most notably, the reduction in prescription errors. It improves communication, documentation and ensures that key issues are not missed at patient assessment on WRs. The majority, 29(76%), of respondents documented their clinical findings and plan after the ward round was complete. Boland X. All junior doctors should be trained in ideal WR documentation and informed of the benefits of the checklist at each induction. Right on cue, the double doors to the ward swung open. A medical-surgical geriatric unit developed a checklist to be used during interprofessional rounds and maintained by the nurse. https://www.who.int/patientsafety/topics/safe-surgery/checklist/en/, Creative Commons Attribution - Non Commercial (unported, v3.0) License. While various other types of checklists have been described, using the checklist as a label has its advantages. To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. They were all surgical inpatients from three specialty teams: general surgery, orthopaedic surgery and urology. Banfield et al showed improvement in compliance with the checklist over time and this was maintained even at 2 years, demonstrating the sustainability of such a change in practice.9. access, ejection fraction, falls, and oxygen. •  Recommend this site The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. 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. 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. open access to scientific and medical research. Malaysia, Table 1 Parameters assessed on surgical WR. 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, Western Sussex Hospitals Wards Round Considerative Checklist Make one member of the team the “Safety Checker” who uses this checklist before leaving each patient. This is communicated to patient, medical and nursing staff involved in patient care and clearly documented in patient case notes. -Limited evidence for check lists on ward rounds but strong evidence for use in clinical practice: Common practice in surgery with huge benefits on morbidity and mortality peri-operatively (NEJM 2009 360: 491-499 A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. Data collected was anonymous and non-identifiable. Open access peer-reviewed scientific and medical journals. However they are seldom treated with similar respect. 2. A comprehensive list of parameters needs to be considered (Table 1). A post-checklist implementation audit of 61 case notes was performed between Jan 2016 and August 2016. Ng J, Abdelhadi A, Waterland P, et al. Me… 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. Sadly, in a court of law, unless documented in the case notes it is considered not done. However, this would be expensive and more importantly raises concerns of privacy and storage. In this audit, the six parameters selected for the checklist were considered important aspects of care within our practice. Hale G, McNab D. Developing a ward round checklist to improve patient safety. The checklist focuses on issues related to hospital-acquired infections, I.V. The inclusion of details of a parameter within the WR entry was considered as compliance with documentation of a parameter. Pucher et al . This contributes towards improved communication between clinical staff and the patient and ultimately patient safety. T: +44 (0)131 527 1600 F: +44 (0)131 557 6406 E: mail@rcsed.ac.uk, 85-89 Colmore Row, Haynes AB, Weiser TG, Berry WR, et al. 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. Implementation of a ward round pro-forma to improve adherence to best practice guidelines. 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. Methods: Using a structured checklist, key aspects of surgical care were observed and recorded during ward rounds. This work is published and licensed by Dove Medical Press Limited. 2018;7(2):e000170. Patient safety is a key quality indicator for healthcare organizations. 3. | Privacy | Cookies | Sitemap | Contact Us | Terms and Conditions. For further information about the Toolkit and this project contact: Nicolson Street, 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. Copyright 2017 Informa PLC. 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.. A ward checklist should be completed prior to a patient’s operation. 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. B3 2BB Introduction and validation of a surgical ward round checklist to improve surgical ward round performance in a tertiary vascular service Isaac Tranter-Entwistle, Katherine Best, Ross Ianev, Timothy Beresford, Andrew McCombie, Peter Laws These selected parameters were identified as often overlooked or inadequately reviewed during our surgical WRs and deemed requiring further attention. Clay-Williams R, Colligan L. Back to basics: checklists in aviation and healthcare. •  Privacy Policy   14. Volume 2019:12 Pages 789—794, Editor who approved publication: We recommend the use of a standardized checklist be incorporated into daily surgical practice in the UK. 2009;360(5):491–499. Initially, members of the surgical team were unaware of the checklist. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. 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. But we describe and promote it princi-pally as a tool for use by the multidisciplinary team in the context of a ward round… We use cookies to track usage and optimise user experience. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Basic ward round structure Details.pdf, Tool 1. Leadership by senior surgical and nursing staff ensuring its use during the WR encouraged sustained use. Table 2 Reported adverse events pre-and post-checklist implementation. It provides initial checks for both operating staff and the ward nursing staff: Surgical check – requires the operating surgeon or a nominated deputy (who should be present in operating theatre throughout) to meet the patient on the ward prior to the operation 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. The audit was registered with the Clinical Audit Department at Lancashire Teaching Hospitals NHS Foundation Trust. Several features of Alamri Y, Frizelle F, Al-Mahrouqi H, Eglinton T, Roberts R. Surgical ward round checklist: does it improve medical documentation? The documentation in the case notes is delegated to the most junior member of the team usually the foundation year one doctor. 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 Each had an eye on the clock above the nurse’s station. All rights reserved. Qualitative data collected in a study by Ng et al reporting favorable feedback with 89% of respondents mentioning that the checklist should be used regularly reflects this observation.10. Documentation of assessment of fluid balance improved from 8% to 76%. 2015;24(7):428–431. BMJ Qual Improv Rep. 2015;4(1):u207456.w2979. It is inevitable that assessment of one or more variables may not occur. Do ward round stickers improve surgical ward round? Its implementation has been beneficial in the National Health Service. Bulk reprints for the pharmaceutical industry. The checklist includes aspects of ward round preparation, the Pitcher M, Lin JTW, Thompson G, Tayaran A, Chan S. Implementation and evaluation of a checklist to improve patient care on surgical WRs. The work focused on the many adverse events experienced by patients on wards rather than operating theatres. A quality improvement project in a high-volume general surgery department. They found it a useful learning tool and a guide to good documentation, reinforcing its use. 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. In our experience, the sheer volume of workload makes the ability for doctors to carry out thorough documentation suboptimal at times. 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. Banfield DA, Adamson C, Tomsett A, Povey J, Fordham T, Richards SK. Points to check or monitor: Tick check boxes (or cross if not applicable) Bed number 1 State: Current diagnosis stated & Other problems Biochemistry reviewed Observations reviewed Prescription chart reviewed State outstanding tests/i nvestigations Tool 3 can be adapted for an individual unit's needs and reproduced using the Powerpoint document. A data collection sheet was designed 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. The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. We describe our experience of its implementation within the general surgical department of a teaching hospital in the UK.Methods: A retrospective review of case note entries from surgical WRs (including Urology and Vascular surgery) was conducted between April 2015 and January 2016. 2. Javascript is currently disabled in your browser. general surgery, orthopaedic surgery and urology. Isaac Tranter‐Entwistle, Katherine Best, Ross Ianev, Timothy Beresford, Andrew McCombie, Peter Laws, Introduction and validation of a surgical ward round checklist to improve surgical ward round performance in a tertiary vascular service, ANZ Journal of Surgery, 10.1111/ans.15899, 90, 7 … Patient safety and care quality are the primary objectives for hospitals, patients, and their families. Registered in England and Wales. SC005317 Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC The introduction of surgical WR checklist has made a clear improvement in documentation of key aspects of patient assessment and care. The registrars, house staff and the medical students waited in line. Patient consent was not required. Figure 2 Documentation of aspects of care pre- and post-checklist implementation. 2017;40(4):e663–e667. BMJ Open Qual. Br 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. Terms and Conditions has made a clear improvement in documentation of six parameters from the surgical team unaware. Selected between January 2016 and August 2016 the quality of the WR checklist provided... 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