Transcript Weekend Plan - Clinical Audit Support Centre

Does a Friday ward round plan provide enough
information for timely discharges and care of
patients over a weekend?
Dr. Philippa Mourant & Miss Sabina Barbur
[email protected], [email protected]
Royal United Hospital Bath NHS Trust, Combe Park, Bath, Somerset, BA1 3NG
Background
•
•
The Problem
Only 50% of patients had clear weekend plans documented
in the patient notes.
Weekends in hospitals are critical times for inpatients, especially as
daily reviews happen less frequently and the usual team of doctors
responsible for a patient’s care are often not available.
An effective patient handover is essential to protect patients’ safety
and provide a standard of care – this means improving communication
between outgoing and incoming teams.
•
The introduction of the European Working Time Directive caused
increasing shift work and the need for improved clinical handover.
•
It is the duty of every doctor to achieve an effective handover as
inadequate handover may result in devastating consequences.
•
Thompson A. et al previously published that post-take ward round
standard forms improve communication and influence quality of care
however after admission communication between on call teams,
especially over the weekend period could be improved 5.
There was a distinct lack of relevant clinical information in
the weekend plans.
Poor communication between healthcare professionals.
Methods
• Data collection from patient’s notes on a Friday identified a lack of
relevant clinical information and plans for the weekend to enable
optimum patient care.
• A weekend plan proforma was created in the form of a sticker for the
responsible team to fill out and place in patient’s notes on a Friday.
• A second proforma for senior handover was also implemented to
allow highlighting of the most critical patients to the on-call registrar.
The Solution
The Introduction of a FRIDAY WARD ROUND sticker and a ‘SICK
PATIENT’ proforma for senior to senior handover
FRIDAY WARD ROUND STICKER: Weekend Plan
SURGICAL WEEKEND HANDOVER
Patient Name /DOB…………………………………
DIAGNOSIS & OPERATION _____________________________________
FOR REG/CONSULTANT REVIEW ONLY
DATE : Friday___/___/___
Patient name:
Hospital number:
Date of Birth:
Ward and bed:
DATE OF ADMISSION: ___/___/___ DIAGNOSIS
___________________________________________________________
OPERATION & DATE (and Background if applicable)
________________________________________________________________________________________________
_________________________
WARFARIN: Y ☐ N ☐ DALTEPARIN: Y ☐ N ☐
REASON FOR WEEKEND REVIEW :
WEEKEND PLAN:
Saturday: Bloods requested FBC ☐ U+Es ☐ LFTs ☐ CRP ☐ G+S ☐ Other (please specify) ☐
________________________________________________________________________________________________
________________________________________________________________________________________________
__________________________________________________
Sunday: Bloods requested FBC ☐ U+Es ☐ LFTs ☐ CRP ☐ G+S ☐ Other (please specify) ☐
________________________________________________________________________________________________
________________________________________________________________________________________________
__________________________________________________
Are there any investigations which need reviewing ?
Y ☐ N ☐
If yes, please specify
_____________________________________________________________________________________________
CURRENT ANTIBIOTIC THERAPY: Y ☐ N ☐
If yes, please specify
_____________________________________________________________________________________________
Saturday: Bloods required FBC ☐ U+Es ☐ LFTs ☐ CRP ☐ G+S ☐ Other (please specify) ☐
Sunday: Bloods required FBC ☐ U+Es ☐ LFTs ☐ CRP ☐ G+S ☐ Other (please specify) ☐
Pending Investigations: CXR ☐ AXR ☐ USS ☐ CT ☐ OTHER___________________________________
Reasons for requested investigations:____________________________
Which of the following have been completed so that a safe discharge could be considered over the weekend:
Passing urine ☐
Opened bowels☐
Adequate pain control☐
Eating and drinking☐
OT/PHYSIO assessments completed☐
TTA/ Discharge summary completed☐
Audit Standards
1. 100% of In-Patients have a clear weekend plan
2. Friday ward round plans must include the following clinically relevant information
Background, Reason for current admission, type and day of antibiotic, pending investigations, bloods required & why,
discharge criteria, TTA or discharge summary completed, concerns for the weekend
Which of the following have already been completed?
☐TWOC
☐Stoma functioning / bowels opening
☐Adequate pain control
☐E&D
☐Mobilization
Bar chart illustrating information found within the Friday ward round plan
FY1 completing form:
Senior approval:
Results
• Results of the original audit (50 patients): 25 had a clear
weekend plan, 7 had their operation documented, 5 had a
short background, 6 had the type and day of antibiotic
• Questionnaires pre and post change illustrated the following:
 That HCP felt that the safety of handover had improved from
36% to 86% with implementation of the proformas
 Prior to the proforma 78% of HCP felt there was a lack of
communication (compared with 28% after)
 Post proforma, 88% of all HCP felt pending bloods,
investigations, TTA & discharge summaries were more
clearly documented compared with 36% previously.
Conclusions
• Most healthcare professionals, when questioned about the form, found it
straightforward and user friendly. It was regarded as a useful adjunct to
clinical practice, thus illustrating the benefits of the introduction of the
weekend plan sticker and purple registrar form.
• Healthcare professionals felt that there was a wider spread of
communication methods between doctors on call and the staff on the
wards.
• There was a better understanding of what was required over the
weekend and which investigations were still pending.
• The purple proforma allowed the sickest patients to be flagged up to the
most senior members of the team.
References
1. Safe handover: Safe patients. Guidance on clinical handover for clinicians and managers. British Medical Association, 2004.
2. Safe Handover: Guidance from the Working Time Directive Working Party. The Royal College of Surgeons 2007.
3. Grainge C, Traer E and Fulton J. Do weekend plan standard forms improve communication and influence quality of patient care? Postgrad Med J
2005;81:524-525.
4. Robinson S, Harrison B, Lambert M. Effect of a preprinted for on the management of acute asthma in an accident and emergency department. J
Accid Emerg Med 1996;13:93–7.
5. Thompson A, Jacob K, Fulton J, et al. Do post take ward round proformas improve communication and influence quality of patient care. Postgrad Med
J2004;80:675–6