Do ward round stickers improve surgical ward round? A quality improvement project in a high-volume general surgery department

Abstract

Introduction: Increasing pressure and limitations on the NHS necessitate simple and effective ways for maintaining standards of patient care. This quality improvement project aims to design and implement user-friendly and clear ward round stickers as an adjunct to surgical ward rounds to evidence standardised care.

Project design and strategy: Baseline performance was measured against the recommended standards by the Royal College of Physicians, General Medical Council and a study performed at the Imperial College London. A total of 16 items were studied. All members of staff in surgery department were informed that an audit on ward round entries would be implemented but exact dates and times were not revealed. In the first cycle, ward round sticker was implemented and results collected across three random days for use and non-use of sticker. Feedback was collected through the use of questionnaires. In the second cycle, the ward round sticker was redesigned based on feedback and results collected for use and non-use of sticker.

Results: Baseline performance noted in 109 ward round entries showed that checking of drug chart, intravenous fluid chart, analgesia, antiemetic, enoxaparin, thromboembolic deterrents ranged from 0% to 6%. With the introduction of ward round stickers in both cycles, there was noticeable improvement from baseline in all items; in ward round entries where stickers were not used, performance was similar to baseline.

Conclusion: This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards. Constant efforts need to be made to promote compliance and sustainability. Commitment from all levels of staff are paramount in ensuring standardised patient care without overlooking basic aspects.

Keywords: audit and feedback; checklists; compliance; quality improvement; surgery.

Figure 1

Baseline performance of 109 ward round entries. TEDs, thromboembolic deterrents.

Figure 2

Ward round sticker in the first PDSA cycle. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.

Figure 3

Comparison when stickers were used (n=51) and when stickers were not used (n=20) during first PDSA cycle. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.

Figure 4

Summary of results from feedback questionnaire.

Figure 5

Fisher’s exact p value of a number of measures during first PDSA cycle. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.

Figure 6

Redesigned ward round sticker for second PDSA cycle following feedback. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.

Figure 7

Comparison when stickers were used (n=40) and not used (n=36) during second PDSA cycle. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.

Figure 8

Fisher’s exact p value for a number of measures during second PDSA cycle. PDSA, plan, do, study, act; TEDs, thromboembolic deterrents.