Clear Records: Exploring Patient and Staff Experience of Ward Rounds to Inform and Improve Ward Round Communication and Documentation

Abstract

Aims

1. 1. To improve ward round efficacy and efficiency.

2. 2. To make ward rounds more patient informed and create an updated ward round patient “preparation sheet”.

3. 3. To improve collaboration and communication between the multidisciplinary team (MDT).

4. 4. To review and modify ward round/Care Programme Approach (CPA) proformas.

Methods

1. 1. Quality Improvement training was delivered to the MDT.

2. 2. An anonymous Likert scale survey was completed by the MDT (n=10), to gather views on ward round experience and documentation.

3. 3. Patients: 2 interactive, breakout sessions (n=4) were facilitated to:

   • • Explore their experience of ward rounds through discussion and Likert scale questionnaires (n=4).

   • • Review the existing patient preparation sheet and coproduce a revised version.

4. 4. MDT: 4 interactive, breakout sessions were facilitated with staff (n=10) to create a:

   • • Process map of ward rounds.

   • • Fish bone diagram of the challenges within ward rounds.

   • • Reverse fish bone diagram, to consider solutions.

   • • Revised ward round and nursing proformas.

5. 5. A driver diagram was developed to generate change ideas.

6. 6. A scoping exercise was completed, comparing ward round proformas within the rehab division, to consider areas of best practice.

7. 7. A Plan Do Study Act (PDSA) cycle was initiated.

Results

1. 1. Patient discussion and questionnaire feedback re: ward round experience was positive. Patients felt “respected”, “supported,” “understood team roles” and “plans” within ward rounds.

2. 2. Patients mostly agreed with the current format of the patient preparation sheet, however wanted a visual prompt, for their recovery areas. A diagram, “My recovery wheel”, was designed, to include diet, hobbies, mood, exercise, substances etc.

3. 3. Staff felt “respected”, and “listened to” and “understood their roles” in the staff survey; MDT proformas and time keeping were highlighted as requiring improvement.

4. 4. The fishbone diagram identified challenges within: staffing, procedural factors, time, resources/equipment, training and education, communication, proformas and patient engagement.

5. 5. New, succinct, MDT ward round proformas were designed, with focus on rehab goals, in order to facilitate the patient journey and discharge pathway.

6. 6. A ward round prompt sheet for the chair was created.

Conclusion

1. 1. Both MDT and patients feel largely positive re: ward round experience.

2. 2. The improved patient preparation sheet is more patient centred, after being co-produced with patients.

3. 3. The MDT highlighted multifactorial challenges pertaining to ward rounds running in an efficacious and efficient manner.

4. 4. The next cycle of the project will focus on testing the new forms and change ideas.