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Ward rounds should not be neglected, warn colleges


A nurse should be present at the bedside during every hospital ward round as a key aspect of inpatient care, clinical leaders have stated.

Ward rounds should be the “cornerstone” of care but pressures on staffing and capacity have led to them often being “neglected”, according to the Royal College of Nursing and the Royal College of Physicians.

There remains considerable variation between hospitals in how they are conducted and their clinical importance is often underestimated, they warned last week.

The colleges argue that multi-disciplinary ward rounds are a “key vehicle” for coordinating the care of patients, improving both safety and continuity.  

In a joint statement, they said: “Reinstating ward rounds will facilitate the delivery of compassionate care, enabling doctors and nurses to plan for care jointly.”

They also published best practice guidelines (see attached document, right), which call for a nurse to be present at every bedside as part of the ward round.

The guidance recommends that a pre-round briefing should take place with the entire multi-disciplinary team, that a locally adapted checklist be used and that ward rounds should be undertaken during the morning to minimise patient anxiety and aid discharge planning.

Steve Jamieson, head of the RCN’s nursing department, noted that good ward rounds were happening in some places already and the guidance was an attempt to spread best practice everywhere.

RCP clinical vice-president Dr Linda Patterson added: “We want the ward round to become the cornerstone of care for inpatients.”

Dr Mark Temple, acute care fellow at the RCP’s medical workforce unit, highlighted the importance of freeing up nurses’ time so they could be fully involved.

“From a physician’s perspective, nurses are in a unique and privileged position because they are present on the ward round the clock, 24 hours a day, caring for patients.

“It’s really importance that a patient is not seen in isolation by consultant, that we’ve got a system which allows nurses to join the ward round.”

Dr Temple acknowledged that the NHS was currently facing “huge pressures” in terms of staffing, financial constraints and a “rising tide” of inpatients and emergency admissions.

“We are all under pressure to save money – we’re saying that a ward round is key to patient care and getting it right will save resources in the long term,” he said.

Dr Temple told Nursing Times that clinicians should spend around 15 minutes at the bedside of each new patient and 5-10 minutes for those already known to them. He estimated the round pre-briefing should take around 25 minutes in total.



Readers' comments (52)

  • I cannot remember the last time I or anyone else on the ward went on a ward-round with the consultant. It used to be something that the sister or nurse-in-charge did, afterwards they would sit in the office having tea and cakes which the sister bought in.

    It is a shame that we don't have time now, we miss crucial information and it is all because of being over-worked and under-staffed - ultimately the patient misses out, the nurses get their fingers rapped for not doing something they didn't know needed doing.

    The profession is going down the pan.

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  • It is not just about being given jobs, a good wad round is also an opportunity to be your patient's advocate and ensure they are lsitened to.

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  • Yes But

    Today's papers are calling this a 'joint report' but I can't spot its title if it is a report.

    The Daily Telegraph added a few other commetns apparently from Dr Temple, including-

    A recent survey found only 13 per cent of gravely ill patients were asked whether they wanted to be resuscitated, he said.
    There have been instances where "do not resuscitate notices" have been applied to patients without the consent of them or their families, but Dr Temple said it was more common for terminally ill patients to be given "futile" treatment because their wishes were not known.
    "I feel very strongly that these decisions, where possible, should be taken with the patient or their relatives," he said.

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  • Florence

    There is always a Nurse on our ward round.There has to be in order to update the Doctors and act as the patients advocate. Our Doctors would not communicate to us what had been decided on the round. Also many of our Patients have some degree of cognitive impairment and sometimes need a liitle more explanation of what the Doctor may have said to them.
    Also one of our Consultants is so arrogant and offensive. There is no way we would leave him alone with Patients. He usually manages to upset Patients on a weekly basis.

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  • Oh dear, something else that nurses should be doing but can't. Has anyone actually ever tried to spend time seeing 20 patients with a consultant when they are the only staff nurse available?

    If a consultant is so arrogant and offensive that he upsets all his patients then this should be reported.

    Nurses are not deliberately 'neglecting' to attend ward-rounds as this article suggests, they simply don't have the time to do this.

    Please can we start accepting that nursing is crap, staffing levels are dangerous, patients don't get the care they deserve and staff have just about had about enough of being constantly put down.

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  • this article, like so many, makes me laugh. have these people got any idea what is going on in the wards these days?

    10 minutes seeing each patient? what a joke, our consultant has over 50 patients just on the wards, let alone those who are newly admitted to A&E.

    I guess doctors are also expected to work continuously for at least 14 hours a day, not take any breaks, not be given time to make phone calls, dictate letters etc.

    Pre-briefing? - what, you mean there is some chance that we can co-ordinate to have a physio, OT, social worker, nurse and the medical team all available at the same time?

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  • When will people realise that there are just NOT ENOUGH STAFF any more to maintain standards and keep patients safe. One staff nurse can't do the drug round, the IV's, the neuro obs, answer relatives queries/phone calls, update the matrons, check the charts are completed, support HCA's and students to deliver care, teach and mentor juniors and attend the ward round. And that's assuming nothing else happens like an arrest, violent patient, upset patient or nurse to deal with .....

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  • That is the problem isn't it?
    Not ehough qualified staff to go round is there?
    So what is the answer then, pile on the work for the nurses. Make them at fault for the sins of the government and the management.

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  • there is a crisis coming, it's on it's way.... there is another 'mid-Staffs' disaster looming. The NHS is in real trouble, staff cannot manage but no-one cares and no-one is listening. What exactly do we have to do to make people sit up and take notice of what is really going on in the NHS.

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  • I totally agree with all of the above! That is why I'm going to London on the 20th, becuase at least I feel like I will have tried instead of being apathetic, and make all aware of what is really going on in the NHS!!! We should be proud and stand up for all the millions of postive things that we all do each and every day.

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