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. Analysis of the data revealed two major categories referring to internal and external processes. activities, critical to providing high quality, safe care for patients in a It comprised targeted questions to gather information and establish rapport, and five open questions exploring participants’ experiences of ward rounds (Box 1). None of the responses indicated that the participant felt part of the decision-making process. Each interview lasted approximately half an hour. Once‐a‐week psychiatric ward round or daily inpatient team meeting? The external factors mentioned by the participants can be viewed in terms of power differentials within the ward-round process. 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 best practice principles set out below by the RCP and RCN show how this can be achieved: Examination of the data indicated certain themes recurring throughout. I had the time of my life! I was five and visiting a psychiatric hospital. One participant said: ‘When a patient comes in, they should have a smaller group. An important part of the routine in our hospitals is the regular rounds by the senior medical professionals in charge of each patient's care. team to come together to review a patient’s condition and develop a co-ordinated Only two participants indicated an awareness of the function of having a team approach. Ethical approval for this research was granted by South West London and St George’s NHS Trust Ethics Committee. Patients seemed quite separate from any decision-making process. PDF, 108.8 KB. 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. Add this result to my export selection SAFER patient flow bundle: ward rounds. These resources will help you understand and adopt the principles governing best practice for ward rounds. usually delivered by several teams of clinicians, allied health professionals and others. The ward rounds vary in nature from a phone call to discuss all the patients with a focus on those highlighted by the care home, to a video ward round. 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. The term is taken from medical/surgical practice. The above author further state that delivery and organisation of care has been influenced by management ideas and theory throughout its history. Five of the patients had a diagnosis of schizophrenia; two had depression; and one had a variety of diagnoses still under discussion by the psychiatric team. Western Sussex Hospitals Wards Round Considerative Checklist Make one member of the team the “Safety Checker” who uses this checklist before leaving each patient. Ward rounds where I work occur once a week. timely, relevant manner. can also access all our rapid improvement guides to support improvements in urgent The ward round template would include important patient safety parameters, as decided by Trust and National guidance, and could easily be added into the patient’s notes. 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. plan of care, while facilitating full engagement of the patient and/or carers This also had an impact on the layout of the room, with the most effective arrangement for the team being to have the chairs in a circle, but one participant said this felt like an interrogation. It was a ward for 12 to 17 year olds and again you get quite a wide variety of presentations in CAMHS units. Learn Services. Yet, non-involvement of nurses in ward rounds remains an issue. Our first challenge … Advocate for Safe Independence . 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). 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. principles will improve patient safety, patient experience, shared learning, Ward rounds may have become too institutionalised in terms of how they attempt to meet the needs of the patient. The co-ordination of these multiple inputs/processes is a central function of the clinical ward round. For example: ‘I’ve never been to a ward round where anyone, or very few, other than the consultant or charge nurse actually speak.’ One participant expressed the wish to change this focus on the medical team as the main communicators in the ward round, saying: ‘If they’re all making a decision on my treatment, I’d expect that they’d all come and talk to me.’, Nine statements referred to the number of people present. The ward environment is busy and complex as are the needs of the patient; re-establishing the multi-disciplinary Ward Round will ensure the delivery of quality, safe, efficient, compassionate patient care. Advanced options. If you have any questions, contact IT.support@improvement.nhs.uk. Magdalen Fiddler. Eleven statements indicated feelings of satisfaction with ward rounds. Special Care In Mental Health Nursing Practice Word Count In Total: 5458 Word Count Reflective Practice Paper: 4372 Action Plan: 1086 The purpose of this assignment is to reflect upon my personal and professional development. Scheduling regular nurse bedside ward rounds (called ‘intentional rounding’) may not improve nurse-patient communication, as most interactions occur outside of these rounds. Once‐a‐week psychiatric ward round or daily inpatient team meeting? FAQs for inpatients. Ward rounds are an established, but sometimes fragmented, core activity of inpatient care during which decisions are made and tasks allocated that aid the daily running of wards. In most cases, virtual ward rounds are carried out by the Practices’ lead GP for the care home and the senior nurse or carer at the home. Patients were attached to one of five consultant psychiatr… Coombe Wood. They provide an opportunity for the multidisciplinary What Is Comorbidity? Pond Ward, Pine Ward, Shore Ward: Park Royal Mental Health Centre. 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. Mental health issues are often overlaid with issues of physical health. Ultimately, your OT will seek to assist you in … improvement. No studies have focused solely on inpatient perceptions of psychiatric ward rounds. It seems there is a good case for tailoring the meeting according to the individual needs of a patient at any point in time. All members of the clinical team are adequately prepared for the ward round/case conference and have a good understanding of the patient’s condition and current status. Adopting these Two participants said that they would not change any aspect of the ward round. There are many resources from across the NHS that show some of the things to consider when running an effective ward round. Five women and three men were interviewed, ranging in age from 18 years to 70 years (mean = 43.5 years, standard deviation = 19.12). It is encouraging that there were several indications that participants were satisfied with the ward round, some identifying useful aspects such as confidence-building. To get started read our rapid improvement guide on setting the clinical criteria for and expected date of discharge. Our services . collaborative working and efficient use of resources. Medical ward rounds are complex clinical 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. It's an opportunity for them to discuss things in detail with the patient and with the nursing and other staff. 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