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Nurse Present During Consultant Led Ward Rounds Only 59% of the Time

Gordon Caldwell; Consultant Physician’s team has published an article in Nursing Management showing that in the last 2 years during 1921 patient reviews on 146 Consultant led ward rounds, a nurse was present at the bedside on only 59% of case reviews. (Nursing Management July 2011 Volume 18 pages 32 to 35). These were General Medical rounds in a DGH, and a mixture of routine and post take rounds.

So 41% of the time there was no nurse to contribute to the decisions making, understand the management plan, implement care, understand the need for observation, able to explain their decisions to patients etc. On 16% of reviews the team were unable to find a nurse to talk with about the patient at all, during the time we were on the ward.

Gordon’s team believe that the doctors’ daily rounds are crucial to the planning, organisation and delivery of high-quality safe care. Their professional nursing colleagues are responsible for the minute by minute implementation of those plans, and for alerting the team when it goes wrong.

Maybe this is a root cause of many of the ills in our processes? Maybe “participant nurse at the bedside during the daily patient review” should be a Key Performance Indicator?

The solutions to improving this are complex. Consultants need to have patients on as few wards as possible; they need to be prompt and organised on rounds, need to welcome, acknowledge and actively involve nurses in the review, decisions on and implementation of clinical care.

We seem to have developed a culture and belief in the NHS that safe, effective, timely, compassionate clinical care can be delivered without the key professional workers communicating face to face with the patient and with each other.

We seem to be asking nurses to do non priority work before participating in rounds – one day the senior nurse on Gordon’s ward was conducting a single sex bay audit – that audit could be done by any adult capable of differentiating the male of the species from the female, whereas only a highly trained skilled and professional nurse was capable of effective contribution to the round. See also Gordon’s posting on about nurses on ward rounds. Why not rate the posting and also comment on this blog?

Published 1st November 2018