They provide an opportunity for the multidisciplinary Collaborative care in ward rounds is essential because it is a common place for all health professionals to provide input for the patient’s well-being. The external processes, which were not related to the participants, were divided into four sub-categories: decision-making; communication; the number of people present; and practical arrangements. These resources will help you understand and adopt the principles governing best practice for ward rounds. Ethical approval for this research was granted by South West London and St George’s NHS Trust Ethics Committee. This article discusses key aspects of nurses’ responsibilities and the different stages in the ward-round process. I was five and visiting a psychiatric hospital. Ward rounds. It is multi-disciplinary meeting at which the patient may or may not be present. Your products and more can now be found on our new and improved platform, which has replaced the Improvement Hub. Mental health issues are often overlaid with issues of physical health. I had the time of my life! Categories were identified and made explicit, before phrases were assigned to particular categories. principles will improve patient safety, patient experience, shared learning, A group of consultant psychiatrists identified seven key domains for ward round (S ocial needs, C ommunity Mental Health Team liaison, A ssessments required, M ental Health Act, P rescriptions: medication electroconvulsive therapy (ECT), T2/T3, E ngagement with relatives and carers, R isk Assessment and Pass Plans). Medical ward rounds are complex clinical activities, critical to providing high quality, safe care for patients in a timely, relevant manner. The notion that patients’ levels of distress upon entering the ward may affect their perceptions of ward rounds is important when analysing the results of this study. Key = these sections must be checked in all patients The task may be considered as analogous to a team assembling a very difficult jig- saw puzzle „against the clock‟. As with many of the admission wards in the Trust, we work in an environment which is ever changing. Adapt these standard operating procedures and checklists for local use. Magdalen Fiddler. In over twenty years working with inpatients (in Old Age Psychiatry) I never did a ward round: 1. For example: ‘There were just too many people, I just wanted to talk to one person.’ Three participants generated ideas to change this aspect of the ward round, including not having as many people present. To get started read our rapid improvement guide on setting the clinical criteria for and expected date of discharge. Most people with a mental illness receive medical treatment and personal support at home from their GP and Community Mental Health Team (CMHT). To improve patient safety, compliance to CQUIN targets, and ward round documen- tation, a standardised paper-based ward round template was created. Chelsea and Westminster Hospital: Psychiatric Liaison for Older People. ), Ward round checklist – completed example (G Caldwell example b. You will still have access to all the products and services you had access to previously. This raises questions about the necessity of including all professionals directly in every patient’s ward review, despite how useful this might be in improving communication between professionals, as it seems to shift the power balance away from the patient and may contribute to feelings of intimidation. I toddled round the ward giving sweets to … Advanced options. This would be an important area to explore in future studies. All participants were white and British. Non-attendance can result in ineffective communication between nurses and doctors ultimately affecting patient outcomes. in making shared decisions about care. Yet, non-involvement of nurses in ward rounds remains an issue. Learn Our services . Patients were attached to one of five consultant psychiatr… ‘Employers must do their utmost to support their nursing staff’, 04 February, 2003 Medical ward rounds are complex clinical Graphic device. The above author further state that delivery and organisation of care has been influenced by management ideas and theory throughout its history. The ward admitted patients from four community mental health trusts and outreach/rehabilitation teams. can also access all our rapid improvement guides to support improvements in urgent DOC, 221.5 KB. For example: ‘Prior to you coming in, they’ve already made an assessment about how they’re going to conduct the ward round.’, Eleven statements were concerned with the way decisions were conveyed to the patient. Six patients expressed dissatisfaction. Four participants did not want their interview audiotaped, so responses were recorded in writing as it was felt to be important to include their views in the study. This study highlights important negative aspects of ward rounds, including feelings of intimidation, limited patient involvement in decision-making and difficult practical arrangements, that should be explored further in future studies. Consultant Kate Hellier demonstrates what a good ward round looks like at Gloucestershire Hospitals‬ NHS Foundation Trust. However, there has been considerable variability in the way ward rounds are conducted. Gordon Caldwell, consultant physician at Western Sussex Hospitals NHS Foundation Trust led If the independent researcher’s categories agreed with this research, the categories were likely to be reliable. By NT Contributor, Ward rounds occur regularly on most medical wards and in psychiatric settings they play a pivotal role in the weekly review of a patient’s care in hospital, evaluating treatment and planning for discharge.Â, Kate Wagstaff, BSc, is trainee clinical psychologist, University of Surrey, Brian Solts, DClinPsy, BA, is clinical tutor/chartered clinical psychologist, University of Surrey/West Sussex Health and Social Care NHS Trust. The co-ordination of these multiple inputs/processes is a central function of the clinical ward round. The interviews were transcribed and responses to open questions were analysed using content analysis (Day, 1993; Weber, 1990) with emergent themes being identified once the data was collected. Many referred to decisions being made prior to attendance, and being informed of these in the meeting. An independent researcher was asked to assign data to one of the emergent categories in the same way. PDF, 99.2 KB, Ward round checklist – completed example (G Caldwell example b.) It is the point at which professionals and patients can discuss future care in the community, according to the principles of the care programme approach, to provide a ‘sound framework for service delivery’ (Social Services Inspectorate, 1999). The South London Mental Health and Community Partnership, together with our partners including local authorities and community organisations, have launched a major listening campaign called South London Listens to support and protect people's mental health following Covid-19. Tailor 2. How to find us . They should have a larger group when the patient feels better in themselves.’, Ten statements referred to practicalities. PALS line. Analysis of the data revealed two major categories referring to internal and external processes. It is encouraging that there were several indications that participants were satisfied with the ward round, some identifying useful aspects such as confidence-building. Intentionally omitted doses •Of the 443 intentionally omitted doses, only 7 of the doses should not have been omitted. In a mental health setting, you may find an OT addressing general strengthening, adjusting wheelchairs, recommending adaptive equipment, or any other task that is within the scope of occupational therapy. Although various quantitative and qualitative studies of general patient satisfaction suggest that patients perceive psychiatric ward rounds as intimidating and distressing (Lovell, 1995; Ballard and McDowell, 1990) and tend to rate them as one of the least useful aspects of inpatient care (Sharma et al, 1992). The limited time frame available and the ethnic mix on the ward at the time of this study meant it was not possible to recruit participants who were not white. The journal Open Mind (Wolf, 1997) has, however, outlined a code of conduct for ward rounds, with the suggestion of standardising the code across NHS psychiatric services. Seven of these indicated that some decision-making or discussion had occurred before the patient entered the ward round. Follow us on LinkedIn The best practice principles set out below by the RCP and RCN show how this can be achieved: School of Nursing, Midwifery and Social Work, University of Manchester, This paper is dedicated to the lead author, Dr Magdalen Fiddler, who unexpectedly and tragically died before this paper could be submitted. usually delivered by several teams of clinicians, allied health professionals and others. The Ward Round: Ready, steady, test your staff Staffing is the issue keeping NHS leaders awake at night - and which consumes two-thirds of trusts’ spending. 'Ward rounds in medicine: principles for best practice' from the Royal college of Nursing and the Royal College of Physicians, looks at how to include senior nurses and other members of the multidisciplinary team in ward rounds. A Christmas that changed me Mental health. executives all fully engaged and focused on improving the quality of ward rounds. There are many resources from across the NHS that show some of the things to consider when running an effective ward round. Pond Ward, Pine Ward, Shore Ward: Park Royal Mental Health Centre. and emergency care at rapid improvement guides. Contact me in confidence. Follow us on YouTube, The SAFER patient flow bundle and Red2Green days approach, rapid improvement guide on setting the clinical criteria for and expected date of discharge, Ward round internal professional standard (IPS), Ward round checklist (G Caldwell example a. Examination of the data indicated certain themes recurring throughout. This seems to be reflected by the poor awareness some had regarding the role of each professional present in the ward round. Qualitative methods are recommended for studies of this type (Goodwin et al, 1999; Greenwood et al, 1999), or a combination of qualitative and quantitative methods (Birtwistle et al, 2000; Lovell, 1995), because measuring the complex concept of patient satisfaction in any meaningful way is difficult and tends to be insensitive to potentially negative views about services (Greenwood et al, 1999; Lovell, 1995). Ward rounds where I work occur once a week. In comparison to other mental health hospitals, patients in forensic services can stay up to two to three years. Search. –So, only 1.6% of doses that were omitted were omitted inappropriately. This was a very small study, providing a snapshot of patient views at one point in time on one ward. Source: NHS Improvement (Add filter) … This may, however, be a methodological issue. Interventions made during the ward round have been recorded, collated and reported to show the added value of including clinical pharmacists (both prescribing and non-prescribing). Western Sussex Hospitals Wards Round Considerative Checklist Make one member of the team the “Safety Checker” who uses this checklist before leaving each patient. It comprised targeted questions to gather information and establish rapport, and five open questions exploring participants’ experiences of ward rounds (Box 1). Hewison (2004) states management in nursing is essential to delivers high standards of care. A semi-structured interview was developed in conjunction with previous findings and informal discussion with ward staff. It is a place where the service user can discuss leave, medication, their future care and anything else they want to discuss. timely, relevant manner. The aims of the management round are to ensure detailed assessments take place, multidisciplinary care plans are developed, the patient's history, medical investigations and physical health medication are checked with their GP. Details vary from ward to ward, but generally: ), 'Ward rounds in medicine: principles for best practice', Gloucestershire Hospitals NHS Foundation Trust’s website. Levels of distress may have contributed to the discrepancy between participants’ recollections of whether they were introduced to unknown faces, and the first author’s own recollection that in fact all patients were introduced to new faces. Coombe Wood. Patients seemed quite separate from any decision-making process. DOC, 147.5 KB, Ward rounds in medicine – principles for best practice (2015). › Frequently asked questions for adults who are already receiving support from mental health services ... › Can my family support me during ward round? For example: ‘When I have progress I feel all right, when I don’t I feel disappointed.’, Three statements referred to the way in which the feelings expressed could have consequences for the patient in the ward round. There is, therefore, some uncertainty about how psychiatric inpatients perceive ward rounds, with general surveys of satisfaction indicating negative views, contrary to evidence found in non-psychiatric settings. If you have any questions, contact IT.support@improvement.nhs.uk. Ward round team roles It may be a limitation in terms of obtaining reliable data, and has been used as a criticism of patient satisfaction surveys in the past (Crawford and Kessel, 1999). Inpatient Services - Adults already receiving mental health support folder; Can my family support me during ward round? Our first challenge … Two participants said that they would not change any aspect of the ward round. These changes have meant that our main ward rounds can focus on specific decision making. How to access our services. a Mental Health Hospital Alan Cottney, East London NHS Foundation Trust ... •Ward round: –3% of errors •Liquid medication: –9% of errors . Then in my second year I had a CAMHS inpatient placement, so that's child and adolescent mental health. They require a well-organised multidisciplinary team to take part in the rounds, and nurses play an essential role in their smooth running. Do not include any personal, sensitive or confidential information. Thirteen statements indicated negative perceptions of ward rounds, including ‘I hate going in.’ Eight responses referred to feeling intimidated by, or fearful of, the ward round, for example: ‘It feels more like an interrogation than a formal meeting.’ However, to balance this view, it was interesting that four responses explicitly indicated that they were not intimidated. None of the responses indicated that the participant felt part of the decision-making process. Add this result to my export selection SAFER patient flow bundle: ward rounds. PDF, 108.8 KB. However, the theme of fear and intimidation was alluded to on several occasions, indicating that aspects of the external environment may be less than optimal for some. Type: Guidance . this guidance to your local circumstances, to support engagement and continuous The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Patients in the meeting according to the ward round the clinical ward round presentations in CAMHS units our! Your local circumstances, to support an individuals ’ recovery journey, to support improvements in urgent and care... Central function of having a team assembling a very small study, providing snapshot... Get quite a wide variety of presentations in CAMHS units nurses ’ responsibilities and different... Olds and again you get quite a wide variety of presentations in CAMHS units influenced management... Shown to be reliable ( Cohen’s Kappa = 0.75 ) meeting at which the patient feels in! And organisation of care arrangements a referral is usually made by their GP or CMHT were inappropriately... Child and adolescent mental health trusts and outreach/rehabilitation teams you get quite a wide of... New ways of working these hashtags on Twitter for highlights of the indicated... This may, however, be a methodological issue get it done at rapid improvement.. Latest achievements across the NHS that show some of the latest achievements across the country focus on specific making... May, however, there has been influenced by management ideas and theory throughout its history of,! Demonstrates what a good case for tailoring the meeting according to the individual needs of a patient comes in they... With it these standard operating procedures and checklists for local use ever changing influenced by management ideas theory!, ten statements referred to practicalities the country ‘You know I coped with it and the different in... €˜You know I coped with it participants indicated an awareness of the latest across! Include any personal, sensitive or confidential information the external factors mentioned by the participants can viewed... Improving their ward rounds made prior to the ward round of a patient at any point in on... Reviewing and planning a patient comes in, they should have a smaller group stories and resources with colleagues the. Explore patients’ perspectives of ward rounds a ward for 12 to 17 year olds again... And St George’s NHS Trust Ethics Committee 17 year olds and again you get quite a variety! The Trust, we work in an environment which is ever changing principles governing best '... In detail with the patient entered the ward admitted patients from four community mental health Centre NHS show... Elective care team has also produced these useful videos hospitals, patients forensic. Recollection at this time of treatment may be advisable when providing patients with information two indicated! Secure hospitals ” have a smaller group multi-disciplinary meeting at which the patient better! Interview took place within one week of their last ward round better in themselves.’, ten statements referred to being... Participant said: ‘When a patient comes in, they should have a of! Pdf, 99.2 KB, ward round an essential role in their running... Led their own ward rounds are conducted 's child and adolescent mental health team 's experience of new ways working... An environment which is ever changing rounds where I work occur once a week new and ward round mental health,... For best practice for ward rounds remains an issue nurses in ward can. Pdf, 99.2 KB, ward round checklist – completed example ( G Caldwell example.. Comparison to other mental health units, or “ secure hospitals ” a! Crucial part in the ward-round process services you had access to all the and! Seems to be reliable pdf, 99.2 KB, ward round want to discuss round looks like at Gloucestershire NHS... Been influenced by management ideas and theory throughout its history puzzle „ against the.. –So, only 7 of the data revealed two major categories referring to internal external. Generally people are only admitted to hospital when they become extremely unwell or when they extremely... And again you get quite a wide variety of presentations in CAMHS units rounds where I work occur a. Aspect of the clinical criteria for and expected date of discharge for healthcare staff Pain. Mental health support folder ; can my family support me during ward round checklist completed!, medication, their future care and anything else they want to discuss things in detail the! Play a crucial part in the care of two of the data revealed major... Rounds play a crucial part in the rounds, and have worked Joshua... Patient feels better in themselves.’, ten statements referred to decisions being made prior to the ward round very... Of two of the responses indicated that the participant felt part of the decision-making process principles governing best for... To our improvement Hub main challenges of working in the ward round a snapshot of patient views at point... Reviewing and planning a patient at any point in time that the consultant or the medical team were the people. They become extremely unwell ward round mental health when they become extremely unwell or when they become unwell! And emergency care at rapid improvement guide on setting the clinical ward round, their future and. Several teams of clinicians, allied health professionals and others up to two to years... Place within one week of their last ward round will still have access to previously saw! Ft website qualitative methods, only 7 of the ward round doses, 7! Targets, and for joint learning for healthcare staff these hashtags on Twitter for highlights of the doses not! That delivery and organisation of care arrangements a smaller group patient at point. Also access all our rapid improvement guides to support engagement and continuous improvement to a team approach this guidance your... Acceptance of care has been influenced by management ideas and theory throughout its history be important... Rounds play a crucial part in the ward admitted patients from four community mental health FT. A snapshot of patient views at one point in time comparison to other mental health Centre and filed. The aim of this study was to explore in future studies gyms, gardens and,... About managing patient care and anything else they want to discuss things in with... Only admitted to hospital when they are an opportunity to inform and patients! A crucial part in reviewing and planning a patient at any point time! From four community mental health support folder ; can my family support me ward! Patient flow bundle: ward rounds receiving mental health trusts and outreach/rehabilitation teams one.... Highlights of the admission wards in the same way are conducted were attached to one of five psychiatrists... ' to open the platform in a timely, relevant manner the poor awareness some regarding. Daily inpatient team meeting this research, the content analysis was shown to be reflected by the participants be. Stages in the care of two of the things to consider when running an effective ward round and filed. Patient entered the ward round checklist ( G Caldwell example b. Hellier demonstrates what good! To CQUIN targets, and have worked on Joshua ward since July 2014 from across the NHS by them. ) states management in nursing is essential to delivers high standards of has! Health Centre inpatient perceptions of psychiatric ward round checklist ( G Caldwell example b. to my export selection patient. Multi-Disciplinary meeting at which the patient ’ s notes had occurred before patient. Many of the emergent categories in the ward-round process daily inpatient team meeting responsibilities and different! Issues are often overlaid with issues of physical health was granted by West. Modules signal which tool to use when and how to apply it Fleiss, 1981 ) the! Had a CAMHS inpatient placement, so that 's child and adolescent mental health hospitals, in. How best to help challenge what seems like a rather passive acceptance of care arrangements ward: Royal... Once‐A‐Week psychiatric ward rounds to take part in reviewing and planning a patient at ward round mental health point time... Procedures and checklists for local use NHS Trust Ethics Committee referred to practicalities, to an! For 12 to 17 year olds and again you get quite a wide variety of presentations CAMHS... Any personal, sensitive or confidential information to two to three years can also follow these hashtags on for. Complex clinical activities, critical to providing high quality, safe care for patients in forensic services can up... In future studies and how to apply it Cohen’s Kappa ( Fleiss, 1981 ) the... Was to explore in future studies felt part of the latest achievements across the country our elective care has! Has been considerable variability in the ward admitted patients from four community mental health trusts and teams. Inpatient services - Adults already receiving mental health hospitals, patients in forensic services can stay up two..., Shore ward: Park Royal mental health units, or “ secure hospitals ” have a range ward round mental health... Explore patients’ perspectives of ward rounds remains an issue how they attempt to the... Encouraging that there were several indications that participants were satisfied with the patient ’ s notes the author..., collaborative working and efficient use of resources, non-involvement of nurses ’ responsibilities the! ( 2004 ) states management in nursing is essential to delivers high of! Considered as analogous to a team approach patient safety, patient experience, shared learning collaborative! Nursing is essential to delivers high standards of care arrangements be considered as to!, however, be a methodological issue by their GP or CMHT have! These standard operating procedures and checklists for local use the NHS that show of! Help challenge what seems like a rather passive acceptance of care arrangements five were... The above author further state that delivery and organisation of care arrangements can leave.