The educational value of ward rounds for junior trainees.
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ABSTRACT:
SUBMITTER: Laskaratos FM
PROVIDER: S-EPMC4408315 | biostudies-literature | 2015
REPOSITORIES: biostudies-literature
Publications
The educational value of ward rounds for junior trainees.
Laskaratos Faidon-Marios FM Wallace Deirdre D Gkotsi Despoina D Burns Aine A Epstein Owen O
Medical education online 20150421
The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality o ...[more]
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Project description:ObjectivesTo ascertain parental views regarding taking part in neonatal unit ward rounds.DesignA service evaluation project.SettingTertiary neonatal intensive care unit.PatientsParent(s) of infants receiving care on the neonatal unit.InterventionsStructured interviews conducted at the cot side.Main outcome measuresParents were asked if they knew when ward rounds occurred, whether they had attended ward rounds and if they had not what were the factors inhibiting them from doing so, their experience of attending ward rounds and whether they were concerned about issues of confidentiality.Results23 of 24 consecutive parents agreed to be interviewed. The median age of their infants was 14 (range 3 - 123) days when they were interviewed. Eighty-five per cent were able to identify when a nursing handover or doctor's ward round occurred. Seventy-five per cent of parents had attended at least one ward round and the median score in terms of usefulness was 5 out of 5. Reasons for not attending included time and cost to travel to the unit, their partners were working and having other children. Parents volunteered that the nurses proactively updated them as soon as they arrived, hence making regular attendance less important. Regarding confidentiality, 85% were not concerned if other people overheard information about their baby, unless the news was bad.ConclusionsParents recognised the value of attending ward rounds and generally found it a positive experience, but emphasised limitations on their ability to attend.
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Project description:BackgroundWard rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates.MethodsA cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory).ResultsTeaching of clinical skills and bedside teaching received the lowest overall mean score (Mean +/- SD 2.48 +/- 1.02 and 2.49 +/- 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean +/- SD 3.71 +/- 0.72). For their desired ward rounds, management of patients received the highest score (Mean +/- SD 4.64 +/- 0.55), followed by bedside examinations (Mean +/- SD 4.60 +/- 0.61) and clinical skills teaching (Mean +/- SD 4.50 +/- 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds.ConclusionsThis study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees.
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Project description:IntroductionClinical pharmacists' participation in ward rounds (WRs) has been a great chance to contribute to team-based care in the hospital setting and significantly improve patient outcomes and quality of life. Hence, the objective of this investigation was to explore the perceptions of clinical pharmacists in Yemen regarding their participation in WRs and the factors influencing their involvement.MethodsAn online survey of Yemeni clinical pharmacists was conducted and lasted for two months. Descriptive statistics were used to analyse the survey responses.Resultsa total of 120 participants were involved. About 3 out of 10 pharmacists had not previously participated in WRs, with only 30% having always or most of the time participated in word rounds alongside physicians. The results showed a positive perception of WR participation, with a median and IQR of 5(4-5). However, a lack of awareness of WR roles and the time-consuming nature of participation were the reasons for non-involvement.ConclusionThe study highlights the positive perceptions of Yemeni clinical pharmacists towards ward rounds, but emphasises the need to address awareness and time constraints. Emphasising patient-centered care and longer internship durations can improve clinical pharmacist involvement. Future research should focus on optimising clinical pharmacist participation for better patient outcomes and care quality.
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Project description:ProblemMedication management in the NHS has been highlighted by the UK Department of Health as an area for improvement. Pharmacist participation on post-take (post-admission) ward rounds was shown to reduce medication errors and reduced prescribing costs in the USA and in UK teaching hospitals, which can contribute to improved medication management. We sought to demonstrate the problem in our hospital by collecting data on prescribing practice from three consecutive general medical post-take ward rounds.SettingNorthwick Park Hospital, a district general hospital in north-west London, which provides acute medical services to a population of 300,000.Strategy for changeA pharmacist was invited to become a member of the post-take ward round team that reviewed medical patients admitted within the preceding 24 hours. Patients also continued to receive care from a ward based pharmacist. Patient notes were analysed for cost of drugs on admission and discharge, discrepancies between admission drug history and pharmacist history, number of admission drugs stopped before discharge, and pharmacist recommendations. Pharmacist recommendations and actions were classified using a National Patient Safety Agency risk matrix.Effects of changeDiscrepancies between the admission and the pharmacist derived drug history were noted in 26 of 50 in the pre-intervention group and 52 of 53 in the intervention group. The annual drug cost per patient following discharge increased by pounds 181 in the pre-intervention group and by pounds 122 in the intervention group. Five pre-admission drugs were stopped in three pre-intervention patients saving pounds 276 per annum, while the 42 drugs stopped in 19 intervention patients saved pounds 4699 per annum. No ward based pharmacist recommendations were recorded in the pre-intervention group. Recommendations regarding drug choice, dose, and need for drug treatment were most common; 58 minor, 48 moderate and four major risks to patients were potentially avoided.Lessons learntThe presence of a pharmacist on a post-take ward round improved the accuracy of drug history documentation, reduced prescribing costs, and decreased the potential risk to patients in our hospital. As a result of this work a full time pharmacist has now been funded to attend daily post-take ward rounds on a permanent basis.
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