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Call for closer working between doctors and nurses on wards

Joint RCP/RCN advice says make ward rounds cornerstone of care

Adrian O'Dowd

Thursday, 04 October 2012

Doctors and nurses need to work more closely and make ward rounds the cornerstone of good care in hospitals, according to new guidance published today.

The joint guidance Ward rounds in medicine: Principles for best practice from the Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) says there needs to be a “concerted culture change” with clinical staff, managers and hospital executives all working to improve the quality of ward rounds.

The colleges said that ward rounds have, in some places, become a neglected part of the planning and organisation of inpatient care.

There was considerable variation between hospitals in how ward rounds were conducted, they said, and their clinical importance to patients was often underestimated.

Ward rounds were crucial for coordinating care for every hospital inpatient, they said, due to the information gained and shared during them. They were also critical to developing a rapport and building trust with patients.

Doctors use ward rounds to form the basis of their decision-making for a patient’s care, but currently, all too often other members of the multidisciplinary team are not present, says the guidance.

This happens because staff shortages mean nurses are busy doing other things, making it difficult for them to take part in the rounds.

The authors said nurses provided the hub of patient care, and their involvement in a daily beside clinical review was central to the effectiveness of the ward round.

Despite competing priorities for time and staff, teams (including managers and executive boards) had to ensure that ward rounds remained a top priority, they concluded.

The guidance recommends that preparation for the ward round should include a pre-round briefing and that consultant-led ward rounds should be conducted in the morning.

A nurse should be present at every bedside as part of the ward round, it adds, and patient, carers and relatives should be provided with a ‘summary sheet’ clearly presenting information discussed in the ward round.

The guidance also recommends that patients’ records should be kept centrally to help have effective communication and team working, and patients with dementia and learning disabilities should be supported as far as possible to make decisions about their care.

Steve Jamieson, head of the RCN’s nursing department, said: “There is considerable variation between hospitals in both how and why ward rounds are conducted, and their clinical importance to patients. But the information gained and shared during a ward round is crucial to a patient’s ongoing care.”

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