Download Good Practice Guidelines for Ward Rounds and Case Conferences

MULTIDISCIPLINARY WORKING CONFERENCE
23rd March 2009
Good Practice Guidelines for Ward Rounds and Case Conferences
Introduction
These good practice guidelines and standards have been developed following
observations of case conference & ward round practice and in conjunction with all
members of the multidisciplinary teams. This took place in the Elderly Care Unit of North
Staffordshire Combined Healthcare NHS Trust. This is a summary of the key information
produced in the original guidance. For further information please contact
[email protected]
The clinical teams undertake both case conferences and ward rounds, in which each
member of the multidisciplinary team feels able to contribute effectively to the planning of a
patient’s discharge home or to an alternative care environment and that their contribution
in doing so, is valued.
Core Members of the Multidisciplinary Team attending Case Conferences
Nursing Staff
Consultant
Staff Grade Physician
Physiotherapist
Occupational Therapist
Social Worker
Elderly Care Liaison Nurse
Role of Multidisciplinary Team Members at Case Conference
As well as representing their professional group and following the standards, the following
roles should be allocated from within the team.
Chairperson
Notetaker
These roles can be rotated within the multidisciplinary team. It is the responsibility of the
clinical teams to decide how these roles are allocated.
The Role of the Chairperson
The Chairperson will undertake the following responsibilities:
-
Keep the case conference focused and to time
Ensure each professional viewpoint is considered
Ensure each action is allocated to a specific individual
Ensure a consensus decision is reached regarding patient treatment plans and future
care arrangements.
Ensure that the case conference follows a structured format
Ensure that that at the end of a patient discussion, a clear plan of action is evident.
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Consensus Decision Making (TTI Developments 1994)
A consensus decision has the following characteristics:
- Uses all the resources of the group
- All group members must participate actively
- Power must be distributed evenly among them
- Consensus decision making productively resolves controversies and conflicts
- All group members must contribute their views and their reactions to proposed
alternatives; no one should be allowed to remain silent.
- For a group to achieve consensus, time must be allowed for everybody to state their
opposition to the decision and to state it fully enough to get the feeling that others
understand them.
- Consensus decision making requires careful listening and effective communication by
the group members.
- If consensus is gained, the commitment to implementing the decision will be greater
than with other decision making methods, e.g. by majority
The Role of the Notetaker
It is difficult to both participate and contribute to a case conference at the same time. The
accurate recording and documentation of the discussion and the decisions reached is
important for the continuity of patient care and to support timely and appropriate discharge.
The documentation within the progress notes of the CCP document should be as follows:
Date Case conference
N (Nurse) P (Physio) OT Med (Medical) SW (Social Worker) Other (please specify) Agreed action and by whom:
The records should reflect the contribution of each professional and the agreed action that
is determined following the multidisciplinary discussion.
Responsibilities of the Notetaker
-
To accurately record the contributions of each team member and the agreed actions.
To ensure that the documentation can be easily understood by individuals who were
not present at the case conference.
To summarise the agreed actions, if needed.
Original source – North Staffordshire Combined Healthcare NHS Trust
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This document can be adapted for use in NHS Wales as long as the original source is acknowledged
The Role of all Participating Professionals
-
Be prepared.
Have up to date information for all your caseload and those of your colleagues, if
appropriate.
Ensure actions agreed previously have been followed through.
Ensure effective communication with patients and their carer’s and ensure that their
views are represented at the case conference.
Be clear on your own actions for each patient and ensure follow through.
Ensure adequate support for colleagues new to the case conference process.
Good Practice Guidelines for Nursing Staff
-
-
Ensure off duty is allocated to provide adequate cover and support for ward rounds and
case conferences.
Ensure that Nursing Staff know in advance that they will be participating in the ward
round/case conference and which patient groups (teams) they will be representing. If
possible, involve nursing staff from individual teams / sides.
Ensure off duty is allocated to Nursing Staff participating in the case conference / ward
round to allow preparation time and follow up time for actions and communication.
Team Leaders/Named Nurses, if not participating, to provide adequate and up to date
information for the case conference/ward round.
Team Leaders / Named Nurses to take responsibilities for follow up actions.
Consider the involvement of H.C.S.W.s in the case conferences.
Senior staff to attend case conferences in a supportive/monitoring capacity.
Original source – North Staffordshire Combined Healthcare NHS Trust
3
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Guidelines for Goal Setting
For the wards, where goal setting is carried out, the goals should meet the SMART
philosophy.
Specific
Measurable
Agreed
Realistic
Time Related (use dates rather than timespans)
In addition, when reviewing goals in a multidisciplinary forum, the following should be
discussed:
-
When the goal was originally set in terms a date
Progress towards goal achievement
How long has the goal being in place for, is the progress as expected?
Any modification of the goal or the interventions
Is the goal likely to be achieved and if so, in what timespan?
Does this fit in with the anticipated discharge date and outcome
Decide whether goals should be reviewed as part of case conference.
For the reviewing of the goals to be effective, then team members must be:
- proactive in communicating the goals to colleagues, to patients and their carers
- for the goals to be accurately monitored
- prepared for goal setting in terms of knowledge of progress
Original source – North Staffordshire Combined Healthcare NHS Trust
4
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
The Standards
1.0
All core members and associate members of the multidisciplinary team will attend
the case conference and at the agreed time.
2.0
Cover is provided for professionals not able to attend case conferences.
2.1
If cover is not able to be provided, relevant and up to date written information
is provided in advance of the case conference.
2.2
It is the responsibility of the individual professional team to provide this
cover/information.
3.0
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.
4.0
All actions from the previous week have been carried through.
5.0
All results/investigations have been seen prior to the ward round and are filed within
the patient’s notes.
6.0
The multidisciplinary team plan realistic timescales for the patient’s anticipated
recovery and at an early stage agree a discharge date and this plan is
communicated to the patient.
7.0
The patient’s recovery is measured against this plan and adjustments made
accordingly.
8.0
At each case conference, any developments during the preceding week are
discussed and evaluated.
9.0
Any decisions made at the ward round and case conference are fully explained to
the patient and/or their relatives/carers depending upon the patient’s conditions and
wishes.
10.0
The decisions made and actions for each professional are accurately recorded in
the patient’s notes in a standardised format.
Original source – North Staffordshire Combined Healthcare NHS Trust
5
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Information update in the absence of Professionals
Name of Patient
Progress since last Case
Conference
Report made by:
Update on Agreed actions
from last Case Conference
Date:
Issues/ Prognosis for
recovery/ goal attainment
Original Source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
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Case Conference Review for Clinical Teams
Ward:
Date:
1.0
1.1
Preparation
Did all staff feel adequately prepared for the ward round / case
conference?
1.2
Were the majority actions carried out from the previous week?
1.3
Are notes and x-rays available and readily accessible?
1.4
Were the majority of investigation reports available and filed in the
patient’s notes?
1.5
Are investigation request cards readily accessible?
1.6
Overall assessment of preparation.
2.0
2.1
Participation and Decision Making
Did all professionals feel that they participated adequately in the case conference?
2.2
Was consensus reached by the team as to the key actions / decisions?
2.3
Were the professionals present who needed to provide information / make decisions? If not, was the relevant information available?
3.0
What did we do well?
4.0
What could we improve?
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
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Patient Centred Case Conference Review
Patient:
1.
Ward:
Unit No:
Date:
Was there a clear understanding of patient’s previous abilities to enable effective and realistic goal planning?
2.
Was information available relating to:
3.
Were the following areas covered in relation to the patient’s current progress?
The patient’s social history;
Washing
Continence
Psychological needs
Type of house;
Dressing
Pressure areas
Barthel score
Lifting
and
handling
Carers / services involved;
Lifting and Handling
Waterlow Scale
Medication
Pressure
Patient’s views about the future;
Mobility areas
Falls
Resuscitation
Nutrition
Relatives / carers views about the future.
Nutrition
Falls Score
4.
Was the progress of the patient over the previous 7 days 5.
Are the patient’s needs reflected on a 24-hour basis?
discussed?
6.
Were all staff clear about the key decisions / actions?
7.
Were all actions clearly allocated to an individual
professional?
8.
Was the involvement of the patient adequate?
9.
Were the patient’s views fully considered?
10.
Was there a clear plan for the next 7 days?
11.
0
Were the timescales for discharge reviewed?
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
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