Context and Problem Paediatric junior doctors within our hospital perform ward rounds at the weekends independently, on wards they are not usually based on and often with no previously documented weekend plan. This meant weekend rounds were taking a long time and there were concerns from trainees and consultants that key elements of management may be missed.
Assessment of problem and analysis of its causes Feedback to our Junior Doctors Forum reported that there was often no documented plan for the weekend written in the patient’s notes and that weekend rounds were lengthy as they had to spend time reviewing the patient’s case notes to summarise their current issues. This led to concerns from trainees and consultants that key elements of management could be missed.
Aims The aim of this project was to create a validated tool to enable clear documentation of the Friday ward round with plans for the weekend and to demonstrate that implementation improves the quality of patient care and makes junior doctors feel more confident when managing these patients.
Intervention We designed a single sided A4 sized pro forma on coloured paper to be used for Friday ward round documentation. There were allocated boxes for patient demographics and clinician details as well as those for diagnosis, current issues, progress, medications, observations, examination and plan for Friday and the weekend. Completing the pro forma at the point of the Friday rounds, meant there was no increase in paperwork or retrospective form filling.
Study of intervention We performed two Likert scale trainee questionnaires, the first to analyse current practice, followed by a four week trial of a Friday ward round proforma on all six paediatric medical wards with prospective data collection during this perIod. A second Likert scale trainee questionnaire was performed at the end of 4 weeks to review the improvements in practice following the implementation of the ward round proforma.
Results Pre implementation questionnaire (response rate 93% n = 39/42) confirmed previous concerns; junior doctors were expected to manage ward patients who were unknown to them (92%) and with no clearly documented weekend plan (82%). This meant doctors were spending extra time looking through the patient’s notes to summarise their current issues (97%).
Over the four weekends, a total of 84% of patients had a completed Friday ward round pro forma in their notes (n = 183/218). Post implementation questionnaire (response rate 100%, n = 23/23) showed improvement in their self-rated knowledge of the patient’s current management plan (87%), reduced time spent looking through notes to summaries current issues (83%) and improved their confidence when conducting ward rounds and reviewing patients over the weekends (83%).
Lessons learnt A written pro forma for weekend handover improves the quality of patient care and the confidence of the doctors managing them. Free text comments revealed added benefits, the pro forma being useful for those on night shifts over the weekends when reviewing unwell patients, as a structured weekly summary for long stay patients and an aid to discharge letter writing. Following user feedback we have since adapted the pro forma to become double sided and have included a box for later changes in the day/sub speciality review. It is now in continued use with plans for re-audit in 3 months.
Message for others A written proforma for weekend handover improves the quality of patient care and the confidence of the doctors managing them.
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