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Introducing matrons' ward rounds to improve care

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VOL: 101, ISSUE: 27, PAGE NO: 26

Heather Sud, RGN, is modern matron (surgery) at Mayday University Hospital, Surrey

Most people who have experience of hospitals, either as nurses or patients, will be familiar with ward rounds. But why exactly should modern matrons wish to incorporate ward rounds into their new role? Anecdotal evidence suggests that with a degree of modification, ward rounds can perform a number of useful functions.

Most people who have experience of hospitals, either as nurses or patients, will be familiar with ward rounds. But why exactly should modern matrons wish to incorporate ward rounds into their new role? Anecdotal evidence suggests that with a degree of modification, ward rounds can perform a number of useful functions.

Background
Matrons and other health care professionals face the new challenges of The NHS Improvement Plan (DoH, 2004a), which puts people at the heart of public service. New targets place a strong emphasis on choice and include:

- Patients to be offered the choice of four to five hospitals in which to receive treatment by 2005;

- Patients to be able to choose any health care provider by 2008;

- An expert patient programme by 2008;

- PCTs to commission integrated care between primary, secondary and social services.

It is part of the role of modern matrons to move this vision into clinical reality.

The challenge in a busy acute district general hospital is integrating the role of matron at a grassroots level and adapting to a post that is being reintroduced to the NHS after 30 years.

Modern matrons are expected to act as patient advocates, with emphasis on user involvement and improving the patient experience as detailed in The NHS Plan (DoH, 2000). The Modernisation Agency advocates focusing on patients and their carers and stresses that they must be involved in improvement programmes and projects from the beginning (Modernisation Agency, 2004).

The role of the modern matron is key to the nursing strategy for quality improvement and patient-centred care. Understanding what users want is essential to ensuring that improvements are based on their needs.

Introducing ward rounds
At Mayday Hospital we sought patients' views on services and how they could be improved. A document was then put together to identify how modern matrons would impact on the patient journey. This has resulted in the introduction of a number of new initiatives including matrons' ward rounds.

Before deciding how to structure these rounds we looked at how a good ward round should be conducted. It was agreed that it should allow individuals to discuss their health and care in an unrushed manner, and give everyone an opportunity to participate.

We also identified the importance of working with the ward managers. As the modern matron role is new, its success depends on support from ward managers.

Through a reflective practice exercise we identified the following positive elements and areas of concern around ward rounds:

- Ward managers valued our support and role in staff development;

- They thought we could have a positive impact on staff motivation;

- Ward rounds could be used to monitor care and ensure safe practice;

- Some managers were concerned that the ward rounds might be viewed as intimidating;

- Some managers thought there needed to be clarification of the purpose of ward rounds.

Ward rounds in practice
Matrons' ward rounds are undertaken on a weekly basis and meet several criteria. For patients they:

- Ensure matrons remain visible on the wards;

- Promote the modern matron role;

- Enable patients and relatives to have access to matrons in a non-threatening environment.

For nurses they:

- Promote staff development and help embed team nursing at ward level;

- Allow discussion with patients;

- Help map patients' progress and plan of care;

- Prompt nurses to begin discharge planning;

- Empower nurses to become more involved with decision-making and team liaison;

- Increase nurses' and patients' control over what is going on and offer an opportunity to participate in the decision-making process.

Patient feedback has been positive, expressing confidence in the ability of matrons to solve problems and support for the reintroduction of the role.

Vulnerable adults
The introduction of matrons' ward rounds identified a group of patients who did not appear to be well served by the acute hospital service. We describe this group as vulnerable adults. They are patients with challenging behaviour, cognitive impairment and learning difficulties. The National Patient Safety Agency (2004) has also recently identified this group as being poorly served and has identified five areas of concern, one of which is care in the acute general setting. At a local level we suggest that key issues include:

- Continence care;

- Communication;

- Increased length of stay;

- Patient safety.

Modern matrons are well placed to monitor this group of patients as they are able to have a 'helicopter view' of a whole unit whereas ward managers may be more involved in their own area. Work with vulnerable adults also fulfils two of the main components of the role of modern matrons - assuring the highest standards of clinical care and having the authority to ensure that the fundamentals of care are correct (DoH, 2003).

Matrons can act as advocates to oversee that care for these patients is quality driven. By setting up a collaborative programme we have looked at improving patients' experience and have produced best practice goals for vulnerable adults that are implemented on their admission to hospital. These care goals are based on an Essence of Care framework and incorporate recent NICE guidelines for self-harm (NICE, 2004). They also reflect many elements of National Standards, Local Action (DoH, 2004) such as safety, clinical and cost effectiveness and partnership with patients and carers.

All patients identified as vulnerable adults will automatically have a set of care goals attached to their nursing records, with team leaders on each ward coordinating and reviewing progress. Each of the Essence of Care factors is listed in these along with a series of targets to prompt and assist staff in making referrals and initiating best practice (Box 1). These care goals should achieve the following measurable outcomes:

- Reduced length of stay;

- Reduced number of complaints;

- Increased partnerships and integrated care;

- The highlighting of this group as in need of additional support.

Conclusion
The introduction of ward rounds has been effective in raising standards and ensuring equity of care across the trust. It has ensured evidence-based care that demonstrates effectiveness of the modern matron's role and translated government policy into clinical reality.

Matrons' ward rounds have proved very popular with patients who see us as their advocates and as people with the ability to instigate change that impacts directly on them.

- This article has been double-blind peer-reviewed.

For related articles on this subject and links to relevant websites see www.nursingtimes.net

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