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

pjmourant@doctors.org.uk, sabina.barbur04@imperial.ac.uk Royal United Hospital Bath NHS Trust, Combe Park, Bath, Somerset, BA1 3NG

Background• 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.

• 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.

Conclusions

References1. 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

Audit Standards

1. 100% of In-Patients have a clear weekend plan2. Friday ward round plans must include the following clinically relevant informationBackground, 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

SURGICAL WEEKEND HANDOVER 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 _____________________________________________________________________________________________  Which of the following have already been completed? ☐TWOC☐Stoma functioning / bowels opening☐Adequate pain control☐E&D☐Mobilization FY1 completing form:

 Senior approval:

FRIDAY WARD ROUND STICKER: Weekend Plan

Patient Name /DOB………………………………… DIAGNOSIS & OPERATION _____________________________________

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☐

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.

• 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.

The ProblemOnly 50% of patients had clear weekend plans documented

in the patient notes.

There was a distinct lack of relevant clinical information in the weekend plans.

Poor communication between healthcare professionals.

The SolutionThe Introduction of a FRIDAY WARD ROUND sticker and a ‘SICK PATIENT’ proforma for senior to senior handover

Methods

Bar chart illustrating information found within the Friday ward round plan