Ward Rounds
General responsibilities
Attend all rounds in the Unit, including Parent Unit rounds, and present the patients.
Make notes in the DMR of all decisions taken during rounds, including:
Attend all rounds in the Unit, including Parent Unit rounds, and present the patients.
Make notes in the DMR of all decisions taken during rounds, including:
- Management plan
- Laboratory investigations
- Feeding plan and fluid plan
- Antibiotics
- Procedures & investigations ordered
Hand-over 0800 – 0830 (Monday to Friday)
At 08:00-08:30hrs the day and night registrars conduct a supervised handover round, attended by the day consultant, the ANUM, (+/-bedside nurses) and allied health (dietician and physio). The tasks for the handover are allocated as follows:
Any urgent tasks will then be done immediately post-handover.At 20:00 the night and day registrars conduct a handover round.
The rolling paper handover sheet (G:\ICU\1) ROLLING HANDOVER ICU REGISTRAR\ Handover Sheets) must be updated prior to each shift handover, unless clinical commitments during your shift prevent this. DO NOT leave these in the meeting room at the end of the handover.
During 2019 we will be transitioning to use Patient Flow Manager as our sole handover resource. This is updated during the morning handover and whenever a patient is cleared for discharge to the ward.
At 08:00-08:30hrs the day and night registrars conduct a supervised handover round, attended by the day consultant, the ANUM, (+/-bedside nurses) and allied health (dietician and physio). The tasks for the handover are allocated as follows:
- Night registrar – presents the handover
- Day registrar – documents any required actions
- Day HMO – makes pathology and imaging results available
- Intensivist updates Patient Flow Manager
Any urgent tasks will then be done immediately post-handover.At 20:00 the night and day registrars conduct a handover round.
The rolling paper handover sheet (G:\ICU\1) ROLLING HANDOVER ICU REGISTRAR\ Handover Sheets) must be updated prior to each shift handover, unless clinical commitments during your shift prevent this. DO NOT leave these in the meeting room at the end of the handover.
During 2019 we will be transitioning to use Patient Flow Manager as our sole handover resource. This is updated during the morning handover and whenever a patient is cleared for discharge to the ward.
Consultant round (0830 – 1100)
All major management decisions will be taken and communicated on this round. Ensure that a definite plan has been decided upon, and is understood by the ICU medical team and bedside CCRN before moving on.
Clinical examination (registrar)
Management plan (consultant)
All major management decisions will be taken and communicated on this round. Ensure that a definite plan has been decided upon, and is understood by the ICU medical team and bedside CCRN before moving on.
Clinical examination (registrar)
- A thorough examination of all systems and lines will be performed by the registrar
- The findings will be documented by the HMO in the DMR.
- This will take 5 to 10 minutes per patient.
Management plan (consultant)
- Documented on the ICU observation chart by the consultant
- Documented in the DMR by the HMO.
- The plan should be communicated to patient and/or family as able and ICU team.
- Decide upon any referrals, procedures and family meetings.
Parent Unit rounds
Administration rounds (07:00, ~12:30, 19:00)
Registrar driven rounds to check patient progress and ensure orders are current and signed. No documentation is expected unless clinically indicated. Use your discretion.
- Join all parent unit rounds and encourage the team to “talk (and document) before they walk”.
- Ensure adequate documentation of any suggested alterations in management plan or treatment made by the Parent Unit. This is the responsibility of the parent unit.
- Parent Units are not to write drug and fluid orders.
- Parent Units are encouraged to offer opinions and suggestions about the patient’s current and future management.
Administration rounds (07:00, ~12:30, 19:00)
Registrar driven rounds to check patient progress and ensure orders are current and signed. No documentation is expected unless clinically indicated. Use your discretion.
Other documentation
Microbiology results
Microbiology results for all patients prior must be checked before the afternoon round. This includes screening for VRE, which occur on admission and every Monday morning for all patients.
All microbiology should be entered on the pink microbiology forms.
Dr Andrew Mahoney attends ICU at 1430 (after the M&M) on Mondays to discuss any complex microbiology cases.
Resuscitation plan
Each patient must have a resuscitation plan (MR85) documented as soon as is practicable. Each patient’s resuscitation status must be entered into Patient Flow Manager (PFM).
The rationale for this is so that it is clear to everybody that we have considered the patient’s resuscitation plan, even in the young and fit.
Microbiology results
Microbiology results for all patients prior must be checked before the afternoon round. This includes screening for VRE, which occur on admission and every Monday morning for all patients.
All microbiology should be entered on the pink microbiology forms.
Dr Andrew Mahoney attends ICU at 1430 (after the M&M) on Mondays to discuss any complex microbiology cases.
Resuscitation plan
Each patient must have a resuscitation plan (MR85) documented as soon as is practicable. Each patient’s resuscitation status must be entered into Patient Flow Manager (PFM).
The rationale for this is so that it is clear to everybody that we have considered the patient’s resuscitation plan, even in the young and fit.
Afternoon and/or evening round (16:00/21:30)
Consultant ward round to monitor progress against morning goals and to confirm ongoing management through the night.
Consultant ward round to monitor progress against morning goals and to confirm ongoing management through the night.