Data collected was anonymous and non-identifiable. The checklist focuses on issues related to hospital-acquired infections, I.V. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. With a systematic approach you can make progress rather than defer decisions. The majority, 29(76%), of respondents documented their clinical findings and plan after the ward round was complete. This site is owned and operated by Informa PLC ( “Informa”) whose registered office is 5 Howick Place, London SW1P 1WG. The audit was registered with the Clinical Audit Department at Lancashire Teaching Hospitals NHS Foundation Trust. 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. But we describe and promote it princi-pally as a tool for use by the multidisciplinary team in the context of a ward round… Banfield DA, Adamson C, Tomsett A, Povey J, Fordham T, Richards SK. 2. Its use as the basis of structured ward round documentation was then measured. Key aspects of patient assessment can be missed or not be documented in case notes. Registered in England and Wales. 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. 6. 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. 1. Ward Checklist. The checklist includes aspects of ward round preparation, the Information regarding the WR checklist was provided to nursing staff and junior doctors via clinical governance meetings and teaching sessions. From editorial acceptance to publication. Patient safety is a key quality indicator for healthcare organizations. 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 The documentation of fluid balance improved to 76% and patient observations to 87%. Additionally, it serves as an educational tool for junior doctors reviewing patients who may be inexperienced in WR practice. general surgery, orthopaedic surgery and urology. Talia AJ, Drummond J, Muirhead C, Tran P. Using a structured checklist to improve the orthopedic ward round: a prospective cohort study. World Health Organisation. Ward round checklist – completed example (G Caldwell example b.) Patient consent was not required. The authors report no conflicts of interest in this work. World Health Organisation. The reduction in reported adverse events could in part be indirectly attributed to the effect of the checklist. The introductory video describes the various parts of the toolkit: The final SHINE report describes the project and the results in detail. Br J Surg. 2018;7(1):e000045. Back to Journals » Journal of Multidisciplinary Healthcare » Volume 12, The surgical ward round checklist: improving patient safety and clinical documentation, Authors Krishnamohan N, Maitra I, Shetty VD, Published 16 September 2019 -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. Volume 2019:12 Pages 789—794, Editor who approved publication: The different parts of the toolkit are explained in the separate documents, downloadable below. A succinct WR checklist improves documentation and ensures that key issues are not missed at patient assessment on WRs. 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. Sadly, in a court of law, unless documented in the case notes it is considered not done. 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By continuing to browse and use the site you are agreeing to our use of cookies. Adverse events related to the six parameters reported pre- and post-checklist implementation are summarized in Table 2. BMJ Open Qual. BMJ Open Qual. 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. A re-audit was completed 3 months post-checklist implementation. England, Boland X. 3. Birmingham, Dove Medical Press is a member of the OAI. A structured WR checklist standardizes key aspects of care that need to be addressed on a daily surgical WR. All junior doctors should be trained in ideal WR documentation and informed of the benefits of the checklist at each induction. However, this would be expensive and more importantly raises concerns of privacy and storage. Patient safety and care quality are the primary objectives for hospitals, patients, and their families. Safety checklists used outside of medicine help standardize performance and minimize errors. We describe our experience of its implementation within the general surgical department of a teaching hospital in the UK. 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. 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 … Pitcher M, Lin JTW, Thompson G, Tayaran A, Chan S. Implementation and evaluation of a checklist to improve patient care on surgical WRs. T: +44 (0)131 527 1600 F: +44 (0)131 557 6406 E: mail@rcsed.ac.uk, 85-89 Colmore Row, 9. 10. Orthopedics. 8. 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. It prompts the clinician to address those aspects of patient care which might otherwise be missed. UK UK Senior surgical and nursing colleagues are the key drivers in ensuring its successful implementation and promoting a culture to improve patient safety. 3. Before the round make sure you have a full list of patients, including outliers. Kuala Lumpur, 72 case notes were randomly selected and reviewed pre-checklist implementation. Complications due to healthcare are well documented and constitute an important public health problem. 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. Me… 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’. 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. To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. We use cookies to track usage and optimise user experience. •  Testimonials   A post-checklist implementation audit of 61 case notes was performed between Jan 2016 and August 2016. Tool 3 can be adapted for an individual unit's needs and reproduced using the Powerpoint document. Implementation of a ward round pro-forma to improve adherence to best practice guidelines. Data was kept confidential in accordance with Trust policy. 14. Scotland, Search worldwide, life-sciences literature Search. Figure 2 Documentation of aspects of care pre- and post-checklist implementation. Edinburgh, For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. 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. It was printed on … The checklist does not serve merely as a ‘tick box’ exercise. While various other types of checklists have been described, using the checklist as a label has its advantages. 13. Results are summarized in Figure 2. The sustained improvement at 3 months indicates that performance can be maintained beyond the initial implementation period. Each had an eye on the clock above the nurse’s station. SC005317 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 The 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. Do ward round stickers improve surgical ward round? 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. ... Dr Caldwell’s Ward Round Checklist The WR checklist benefits patient safety. Contact Us   Royal College of Physicians, Royal College of Nursing. Following introduction of the WR checklist, overall documentation improved to 79%. 2009;360(5):491–499. If you agree to our use of cookies and the contents of our Privacy Policy please click 'accept'. Initially, members of the surgical team were unaware of the checklist. Herring R, Caldwell G, Jackson S. Implementation of a considerative checklist to improve productivity and team working on medical WRs. In fact, the ward round is as core to the business of inpatient medicine as the theatre session is to the practice of surgery. Results from the subsequent 3-month re-audit confirm a sustained improvement. •  software development by maffey.com This contributes towards a culture of improving patient safety. 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. All rights reserved. Several features of ANZ J Surg. Once assessment is complete a management plan for the next 24 hours is completed. 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. However they are seldom treated with similar respect. | Privacy | Cookies | Sitemap | Contact Us | Terms and Conditions. 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. A couple of visitors stood aside as the Professor marched up the corridor. The documentation in the case notes is delegated to the most junior member of the team usually the foundation year one doctor. 2011;16(2):129–136. WR entries of 72 case notes were audited for documentation of six parameters from the surgical WR checklist. N Engl J Med. Advanced Search Coronavirus articles and preprints Search examples: "breast cancer" Smith J 2018;7(2):e000170. •  Associations & Partners   In this audit, the six parameters selected for the checklist were considered important aspects of care within our practice. BMJ Open Qual. Haynes AB, Weiser TG, Berry WR, et al. 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 A ward checklist should be completed prior to a patient’s operation. The yellow color also makes it stand out. The clinician leading the WR is likely to be interrupted several times, often while assessing a patient. 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. BMJ Qual Improv Rep. 2015;4(1):u207456.w2979. 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. The number of parameters selected also needs to consider the size of label used that is conducive with the clinical entry. Keywords: ward round, checklist, patient safety, documentation Most often the Consultant or Surgical Registrar leads the surgical WR. WHO Surgical Safety Checklist. However, designing and issuing a WR checklist is unlikely to have an impact on its own. 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. 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. The checklist helps bring focus to these aspects of care. During a ward 5 round, the current status of each patient is established and the next steps in their care planned. Ng J, Abdelhadi A, Waterland P, et al. By accessing the work you hereby accept the Terms. WRs in Medicine: Principles for Best 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. These selected parameters were identified as often overlooked or inadequately reviewed during our surgical WRs and deemed requiring further attention. For cohort B, a structured checklist was introduced for use during the ward round and inserted into the medical record (Figure 2). 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. Number 3099067. You can learn about our use of cookies by reading our Privacy Policy. 56000 Cheras that, for physicians, the consultant ward round was where we needed to look (Figure 2). In 12 encounters (13%) a nurse was present on the ward round. EH8 9DW 2016;86(5):356–360. Copyright 2017 Informa PLC. 2015;24(7):428–431. Clay-Williams R, Colligan L. Back to basics: checklists in aviation and healthcare. In an ideal world, all interactions with patients could be video recorded and stored in an inbuilt computer in each patient bed. •  Recommend this site Figure 1: Image of Adhesive Ward Round Checklist. The variability in ward round documentation in the case notes was felt to be due to the lack of a structured approach to documentation. 12. 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.. open access to scientific and medical research. Available from: https://www.who.int/patientsafety/topics/safe-surgery/checklist/en/. 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. Pucher et al . 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]. The work focused on the many adverse events experienced by patients on wards rather than operating theatres. https://www.who.int/patientsafety/topics/safe-surgery/checklist/en/, Creative Commons Attribution - Non Commercial (unported, v3.0) License. Results Thirty eight doctors across all grades were surveyed, 31 (81%) of doctors believed ward round handover and their documentation could be improved. •  Privacy Policy   We recommend the use of a standardized checklist be incorporated into daily surgical practice in the UK. Ng J, Abdelhadi A, Waterland P, et al. 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. Takeaways: 1. 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. 2016;86(11):878–882. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. A quality improvement project in a high-volume general surgery department. This is communicated to patient, medical and nursing staff involved in patient care and clearly documented in patient case notes. Alamri Y, Frizelle F, Al-Mahrouqi H, Eglinton T, Roberts R. Surgical ward round checklist: does it improve medical documentation? Recommended standards of WR practice were obtained from joint guidance by the Royal College of Physicians and Royal College of Nursing.1 The concept of the surgical WR checklist was derived from the WHO safety checklist.4 The surgical WR checklist summarizes parameters described in Table 1 into key categories. This study assessed the use of a checklist to correct these omissions. A WR checklist label with the parameters was designed for use for each WR entry. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. Get all the relevant information you need, and find a nurse before you start—this saves time later on Start with … 2. Boland et al identifies these factors as lessons learnt in their study.14 Informal verbal feedback from FY1 doctors was positive. However, bias due to various factors such as efficacy of reporting these events is a limitation with this data. A yellow label containing key parameters was designed for use for each WR entry (Figure 1). Junior team members often do not fully understand the diagnosis and management plan. The checker must highlight anything omitted, speak up and get it done! To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. In our experience, the sheer volume of workload makes the ability for doctors to carry out thorough documentation suboptimal at times. A clinical review of Christchurch general surgical notes. 11. T: +60 3 914 54926 E: malaysia@rcsed.ac.uk, © 2021 - THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH - REGISTERED CHARITY NO. The daily surgical WR is a complex process. BMJ Qual Improv Rep. 2015;4(1):u204775.w2440. Let us for a moment compare the two. Hale G, McNab D. Developing a ward round checklist to improve patient safety. this site will not function whilst javascript is disabled. Table 1 Parameters assessed on surgical WR. They were all surgical inpatients from three specialty teams: general surgery, orthopaedic surgery and urology. 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. In this audit, the quality of the documentation was not assessed. 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. 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. The labels are concise and easy to follow, encouraging continued use. 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. Do ward round stickers improve surgical ward round? Malaysia, Published 2009. A quality improvement project in a high-volume general surgery department. • 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) Ward round non-technical skills for surgeons (WANTSS) Booklet.pdf, Surgical Research Fellow, Dr Klaas Schuur -, Chair of the RCSEd Patient Safety Board and Project Supervisor Mr Simon Paterson-Brown -.