EXAMPLE

Internal professional standard (IPS)

Title Ward rounds

Purpose Details the procedure to follow for consultant-led ward rounds to reduce variability,
promote an organised and disciplined approach and ensure efficient use of time
and resources.

Scope This IPS is relevant to all clinical staff involved in ward rounds on all wards.

Instruction Supporting information/

explanation

1.  The ward round should be scheduled at a regular To ensure there is sufficient time
time in the morning, Monday to Friday. to carry out the tasks required
and make the necessary
 Weekend ward rounds should also be held at a arrangements for
regular, scheduled time. discharge/transfer.
 Local negotiation should ensure that ward rounds Facilitates Home 4 Lunch
do not clash with other ward activities, including
other rounds.

 A timetable of individual consultant rounds should

be circulated.
2. Pharmacists, therapists and other AHPs do not A multidisciplinary approach
regularly attend the ward rounds, however they should supports the delivery of high
support as required. quality care
To ensure nursing staff are
3. The consultant reports to the nurse-in-charge who
available to give and receive
reports any staffing issues and ensures that nursing
feedback regarding their patient.
staff are available when their patients are discussed.

The nurse-in-charge should accompany the consultant

and team on the ward round.

4. A brief ‘board round’, before the ward round, should be Provides an opportunity to
completed. prioritise the bedside review and
deal with any non-medical
The consultant sees patients in the following order: issues such as discharge
 sick/unstable patients planning, or quickly review and
resolve outstanding medical or
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  potential discharges if discharge will be delayed nursing issues or, for example,
by following ‘normal order’ diagnostic delays.
 all remaining patients.
See board round SOP
5. The nurse-in-charge ensures that all patient notes, Promotes consistent high
results, request cards and continuation sheets are quality, timely clinical care.
available to the team at a central point. Facilitates ward round flow.
Access to electronic data should be made available. Good quality mobile computers
and WiFi access is critical.
6. Nurses should familiarise themselves with the patients’ Promotes consistent high
cases, be aware of issues that need to be raised and, quality, timely clinical care.
where appropriate, discuss these with the patient
before the round – specifically home and family Facilitates patient involvement
circumstances. and decision making in their
care.
See multidisciplinary ward
7. Roles should be defined and allocated at the start of
round team roles guide
the round.
 Use the safety checklist to ensure key See safety checklist
components of the ward round are not
overlooked. Reduces omissions, facilitates
improvements in patient safety
and strengthens MDT
communication.
8. The team should introduce themselves to the patient Ensures patients, relatives and
and ensure that they discuss their care with them. carers are involved in decisions
regarding patient care.
If a patient lacks capacity, multidisciplinary meetings
and discussions with carers/relatives will help the team Facilitates patient involvement
make decisions in the patient’s best interest. and decision-making in their
care.
9. Patient dignity must be maintained at all times, eg Facilitates privacy, dignity and
using fully drawn bedside curtains before any physical patient confidentiality.
examination.

The team should be aware of the immediate

environment and use appropriate facilities to ensure
patient confidentiality is maintained.

10. Clear, written and verbal medical management plans
and discharge plans should be documented in the
medical notes daily on the round. The estimated
date of discharge (EDD) is recorded within 14 hours
of admission (unless the patient is acutely unwell and
Consistent high quality clinical
care and supports clinical staff
in co-ordinating care.

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 EDD has yet to be decided or EOL). Supports facilitated discharge.

 The nurse looking after that patient should be

aware of the plan and key decisions made
11. The following should be clearly documented (ward Consistent high quality, timely
round pro forma): clinical care and supports good
clinical governance.
 review and record salient points from history
 progress made
 review observations chart and whether recorded
in notes (or documented as normal)
 record examination findings
 review investigations/results, including
microbiology.

12. A daily holistic review should include: Consistent high quality, timely
 hydration/fluid balance clinical care and supports good
clinical governance.
 blood glucose chart review (if applicable)
 nutritional status ± prescribe nutritional
supplements; weigh patient – frequency?
 mobility – falls issues?
 pressure area management
 delirium?
 pain/shortness of breath/national early warning
score.

13. A general discussion should check: Consistent high quality, timely

clinical care and supports good
 further investigations required?
clinical governance.
 specialty opinion required?
 have social issues been considered?
 resuscitation status?
14. Review drug chart and check: Consistent high quality, timely
clinical care and supports good
 is drug treatment/dosage/route appropriate for
clinical governance.
severity of illness?
 withdraw any inappropriate/unnecessary drugs
 consider stopping antibiotics/change to oral if
appropriate
 VTE prophylaxis? TED stockings if LMWH
contraindicated?

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  IV fluid regimen?

15. A working diagnosis and the evidence for this should Consistent high quality, timely
be documented – including review of acute medical unit clinical care and supports good
transfer sheet. clinical governance.

 Record co-morbid states (ward round pro

forma).
16. Jobs should be completed in real time (this is To ensure work is carried out in
aspirational): a timely manner rather than
batched, which may lead to
 notes written, with key decisions clearly
delays.
documented. All entries should be dated and
signed
 changes made to treatment
 investigations requested
 referrals made to appropriate specialities
 TTOs and discharge summary completed if
discharge likely on same or next day
17. Discuss: Does this patient need to be in an acute Patient in the right place at the
bed? right time.
 If not, where could they be safely, most
appropriately managed next?
18. Document clearly: Patient in the right place at the
right time.
 is patient medically stable for discharge?
Provides delays audit trail.
 record/review EDD
 reasons for any discharge delays
19. Clarify actions and delegation of tasks following Promotes consistent high
each patient review. quality, timely clinical care.

Reduces omissions, facilitates

20. Friday ward rounds – complete plans for the
weekend:
 request Ix – handover to ensure unstable
patients are reviewed
 re-write drug charts if required
 prescribe fluids if required – ensure handover of
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improvements in patient safety
and strengthens MDT
communication.
To ensure safe patient care and
flow are maintained over the
weekend period.
Supports facilitated discharge.
 need for fluid balance to be assessed where
necessary
 document specific criteria required for
potential weekend discharge, eg ‘if CRP <50
mg/L and remains apyrexial, patient can go
home on Saturday’ (use criteria-led discharge
pro forma)
 ensure TTOs and discharge summary written for
definite/likely weekend discharges
21. An afternoon board round can facilitate planning for Promotes consistent high
next day discharge and check actions from the daily quality, timely clinical care.
ward round, review results to change
management/facilitate discharge. Reduces omissions, facilitates
improvements in patient safety
and strengthens MDT
communication.

See board round IPS

22. Patient/relative briefing Facilitates patient involvement
and decision making in their
 Patients updated with treatment changes on
care.
ward round
 Changes in care documented in patient notes
 Relatives have the phone details of the
consultants or are advised to phone the ward
between 2-3pm if possible to be given feedback

Reference

Royal College of Physicians and Royal College of Nursing (2012) Ward rounds in medicine:
Principles for best practice. https://www.rcplondon.ac.uk/projects/outputs/ward-rounds-medicine-
principles-best-practice