Patient safety

Introduction: Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round. 

Method: Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54. 

Results: The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration. 

Conclusions: The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process. 

Introduction  

The weekend on-call team attends ward emergencies and front door new assessments. The extra routine ward work results in delay in the new assessments and add further exhaustion for the on-call team, impacting on junior doctor’s well-being and patient safety.  

Objective  

Aim to improve patient safety by facilitating the continuity of patient care over the weekend 

Method 

Group discussions among junior doctors, nurses, pharmacists, and ward managers were done to understand the challenges that impact communication. The average time spent on a ward by on-call team was 60 minutes. Plan-do-study-act (PDSA) cycles were introduced. The key measurement used was the time taken to complete the ward task. 

Results 

Team agreed to focus on improving communication over weekends based on the number of times nurses contacted junior doctors 

Friday morning ward round was made mandatory for every patient and a check-list sticker was introduced to test the change for 15 patients. Results were assessed and showed 3 patients did not require review and saved 6 minutes of on-call team over the weekend.  

The second PDSA included 30 patients which showed 11 minutes of time saved. But change was not sustained. Awareness sessions were introduced, and the plan was to add A4 sheet titled Mandatory Friday Round (MFR). Next PDSA cycles showed saving on-call team but not all the on-call team and nurses reviewed MFR.  

The team reviewed the results of the 5th PDSA cycle and agreed to use the green colour MFR A4 sheet and included prompts for the team to complete all the usual tasks. This saved about 28 minutes of on-call team.  

Discussion  

28 minutes saved from one ward were used for the new assessment. The team feels extending the good practice to all 5 elderly care wards will save approximately 2 hours 

Conclusion  

Effective communication using MFR has enabled on-call team to assess extra new patients and have adequate rest.  

Background

Effective communication is a vital attribute in the healthcare profession. Ineffective communication between healthcare professionals and patients can impede patient safety. The three most common complaints received by GMC were related to medical treatment, communication problems and perceived lack of respect for the patient¹. In a study undertaken across three NHS trusts in England between May 2013 and September 2014, 22% of the incidents reported were associated with communication². Inefficient record-keeping related to communication was the issue.

Methods

To evaluate the effectiveness of current communication, data was collected for 40 patients from 1^st December 2022 to 31^st January 2023. The inclusion criteria consisted of inpatients with a stay of 3 days or more. Recorded data involved the total number of times a NOK was contacted by different healthcare professionals. The main objective was to record the number of patients’ NOK who were updated within 72 hours of ward admission.

Data and Statistics

The results concluded, only 32.5% of the patients’ NOK were updated by doctors within 72 hours of admission, whereas if other healthcare professionals were included; 62.5% of the patients’ NOK were updated. The data further showed that almost 40% of the patients’ NOK did not receive any updates during their ward admission.

Conclusion

To conclude, the data collected has shown doctors only update 32.5% of patients’ NOK within 72 hours of ward admission. The intervention would be a sticker which is filled whenever communication between NOK and a healthcare professional occurs. The aim is to improve documentation; record-keeping and encourage updates within 72 hours. The aim is to re-collect in 2^nd cycle and assess, eventually comparing the number of communication-related complaints received through PALS before and after the implementation of stickers.

References 

1. Abdelrahman, W. and Abdelmageed, A. (2017) Understanding patients complaints, The BMJ. British Medical Journal Publishing Group.

Available at: https://doi.org/10.1136/bmj.j452 (Accessed: March 25, 2023).

2. O’Hara, J.K. et al. (2018) What can patients tell us about the quality and safety of hospital care? findings from a UK multicenter survey study, BMJ Quality & amp; Safety. BMJ Publishing Group Ltd.

Available at: https://qualitysafety.bmj.com/content/27/9/673 (Accessed: March 25, 2023).