In a joint statement, Ward rounds in medicine: Principles for best practice, the Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) are united in calling for ward rounds to be made the cornerstone of patient care, and for a ‘concerted culture change’ with clinical staff, managers and hospital executives engaging with, and focusing on, improving the quality of ward rounds.
Ward rounds have often been a neglected part of the planning and organisation of inpatient care. There remains considerable variation between hospitals in both how and why ward rounds are conducted, and their clinical importance to patients is often underestimated.
A ward round is the key vehicle for coordinating care for every hospital inpatient; the information gained and shared is crucial to the ongoing care of the patient. Restoring the ward round is essential for patient safety and for being able to deliver safe, effective patient care. Ward rounds are also critical to developing a rapport and building trust with patients.
Nurses provide the hub of patient care, and their involvement in a daily bedside clinical review is central to the effectiveness of the ward round. Doctors use ward rounds to form the basis of their decision-making for a patient’s care - the failing presently is not having other members of the multidisciplinary team present. The current pressures of capacity and staffing levels mean that ward rounds happen while nurses, for example, are engaged in constant care delivery. The principles in the statement aim to address the common problems affecting the prominence of ward rounds.
With competing priorities for both time and staff, teams (including managers and executive boards) must ensure that ward rounds remain a top priority. The breakdown in patient-centred care characterises the current system which doesn’t allow doctors and nurses to gain a full understanding of a patient’s care needs. Reinstating ward rounds will facilitate the delivery of compassionate care, enabling doctors and nurses to plan for care jointly.
The recommendations include:
- preparation for the ward round should include a pre-round briefing
- consultant-led ward rounds should be conducted in the morning to facilitate timely completion of tasks during the working day
- a nurse should be present at every bedside as part of the ward round
- patients, carers and relatives should be provided with a ‘summary sheet’ clearly presenting information discussed in the ward round
- patients with dementia and learning disabilities should be supported as far as possible to make decisions about their care
- patients’ records should be kept centrally to promote effective communication and teamworking
- ward-round teams should utilise locally adapted checklists to reduce omissions, improve patient safety and strengthen multidisciplinary communication
Recent serious reports have highlighted the breakdown in relationships between nurses and doctors, something both colleges’ members have raised concerns about. This guidance from the RCP and RCN is an example of how the two professions can work together to produce effective patient-focused solutions to day-to-day challenges. There is still work to be done to determine how best to adapt the traditional ward-round process to suit a continually evolving, complex NHS system.
For further information, please contact Hannah Bristow, Clinical Standards communications officer, on +44 (0)20 3075 1447 / 07584 303 784, or email Hannah.Bristow@rcplondon.ac.uk
To arrange an interview with a nurse please contact Harriet Anderson, RCN Media Officer, on +44 (0)20 7647 3633, or email Harriet.Anderson@rcn.org.uk
- To access a copy of the best practice principles please visit the RCP website or the RCN website