Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma

Niall Brown, Joseph Horne and Andrew Low
Download PDF
DOI: https://doi.org/10.7861/clinmed.21-2-s17
Clin Med March 2021
Niall Brown
ABristol Royal Infirmary, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joseph Horne
ABristol Royal Infirmary, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew Low
ABristol Royal Infirmary, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Introduction

This project developed and analysed the impact of a ward round pro forma across three wards of a large tertiary hospital containing positive or high-risk COVID-19 patients. Templates and checklists have improved patient outcomes in medical, surgical and high-care settings.1,2

The daily consultant-led ward round entry serves as the primary communication between the multidisciplinary team (MDT) and acts as the medicolegal record. There are barriers in junior doctors scribing complete ward round entries using blank sheets. As a result, pertinent information might be missed and patient care may suffer due to incomplete records.

The primary aim was to increase the amount of information documented during ward rounds (20% increase in number of parameters) and increase junior doctor confidence in documenting (1 Likert point). The second aim was to make it easier for the MDT to find relevant information (1 Likert point). Aims were to be achieved after 2 weeks of use, aiming for 75% uptake.

Methods

One closed-loop plan, do, study, act (PDSA) cycle was performed. Respiratory consultants and registrars determined 11 key parameters that should be documented daily for COVID-19 patients.

Baseline objective data collection analysed all high-care ward round entries (n=15) on 1 day, recording key parameters as present or absent. Baseline subjective opinions on documentation were collected with an MDT questionnaire.

The ward round pro forma was trialled for 2 weeks for all COVID-19 ward inpatients; repeated subjective and objective analysis was performed. All (n=12) inpatient notes on the COVID-19 high-care ward were analysed.

Results and discussion

Compliance rate for pro forma use was 100%. The mean number of key parameters documented on each ward round entry increased from 5 to 9, representing an 80% increase. Eleven (100%) of the key parameters showed an increased completion rate (Fig 1).

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Documentation rates of key parameters pre- and post-implementation.

Junior doctor confidence in documenting increased 1 point on the Likert scale, corresponding to a change from ‘average’ to ‘confident’ (Fig 2). Ninety-seven per cent (n=31) of respondents reported that the pro forma saved time. Information finding and swab result tracking both increased by a median of 1 point on the Likert scale, corresponding to an improvement from ‘average’ to ‘easy’ (Fig 2).

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

Multidisciplinary team opinions on COVID-19 documentation pre- and post-implementation.

The pro forma itself likely acts as a prompt. Documentation of venous thromboembolism (VTE) prophylaxis increased from 0% to 67%, giving evidence of consideration according to the prothrombotic nature of the disease.3 Antibiotic documentation increased by 52% suggesting that the indication was reviewed and altered accordingly. From a medicolegal perspective, documentation of basic information (ie date and time) improved by 13%. COVID-19 patients can deteriorate quickly; it is essential that their ceiling of care has been reviewed by consultant. This project shows not only a 60% increase in ceiling of care documentation, but also improved ease in accessing such information.

The principle pro forma drawbacks were space limitation and low patient numbers limiting firm statistical conclusions.

Conclusion

The pro forma designed and implemented in this project is a simple and acceptable intervention to improve documentation, giving junior doctors more confidence in their role. Further PDSA cycles are limited by reducing COVID-19 admissions.

Conflicts of interest

None declared.

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. Gilliland N
    , Catherwood N, Chen S, et al. Ward round template: enhancing patient safety on ward rounds. BMJ Open Quality 2018;7:e000170.
    OpenUrl
  2. ↵
    1. Sparkes D
    , Rylah B. The World Health Organization surgical safety checklist. Br J Hosp Med (Lond) 2010;71:276–80.
    OpenUrlPubMed
  3. ↵
    1. Kollias A
    , Kyriakoulis K, Dimakakos E, et al. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol 2020;189:846–7.
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma
Niall Brown, Joseph Horne, Andrew Low
Clinical Medicine Mar 2021, 21 (Suppl 2) 17-18; DOI: 10.7861/clinmed.21-2-s17

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma
Niall Brown, Joseph Horne, Andrew Low
Clinical Medicine Mar 2021, 21 (Suppl 2) 17-18; DOI: 10.7861/clinmed.21-2-s17
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Methods
    • Results and discussion
    • Conclusion
    • Conflicts of interest
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The Macklin effect in COVID-19
  • Acute management of suspected vaccine induced thrombocytopenia and thrombosis
  • Pneumothorax and pneumomediastinum in COVID-19
Show more COVID-19

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians