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Nurse led ward rounds and combined baby record

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Nurse led ward rounds and combined baby record. 2 complimentary advances in neonatal nursing practice ... Discharge planning often disjointed. The solution ... – PowerPoint PPT presentation

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Title: Nurse led ward rounds and combined baby record


1
Nurse led ward rounds and combined baby record
  • 2 complimentary advances in neonatal nursing
    practice
  • Debbie Beaumont Neonatal Unit Manage
  • Bradford Teaching Hospitals NHS Trust
  • 8.10.03

2
Nurse led ward rounds the problems
  • Consultant ward round daily, often not led by
    consultant
  • Conflicting advice
  • Babies not moved on in feeds, reducing morphine
    etc.
  • Junior and less experienced staff were not
    supported with difficult decision making
  • Discharge planning often disjointed

3
The solution
  • Senior nurse in special care responsible for
    undertaking ward round 5 days a week
  • Criteria for undertaking role, and an educational
    component to be met
  • Nurse develops a plan of care in conjunction with
    the nurse caring for the baby and the parents if
    possible
  • Plan documented, includes parental signature to
    indicate discussion with them

4
  • At the end of the round any issues which match
    set guidance or which have raised concerns are
    discussed with Consultant or registrar
  • Consultant still does rounds on Monday and
    Thursday, the day after weighing to ensure issues
    picked up including problems with weight gain.
  • In essence this just formalised what was already
    happening

5
Benefits
  • Continuity
  • Senior staff know babies very well
  • Any problems with social services are highlighted
  • Babies are moved on more quickly
  • Discharge planning has improved as have
    communications with outreach team
  • Parents feel included in planning of care
  • Better job satisfaction for nursing staff

6
Issues still to address
  • What are doctors doing when nurses doing their
    work
  • Nurse doing ward round often still has her share
    of babies to care for, if she is busy some of her
    workload falls on other staff

7
Combined baby record
  • Why?
  • Pressure from DOH, NMC, other statutory bodies to
    have 1 record
  • Care pathways not suitable for complex neonatal
    care provision
  • Core care plans used needed revision
  • Seemed like a good idea at the time

8
  • How?
  • Wrote to Dr. Ward-Platt in Newcastle
  • Visited RVI
  • Borrowed their documentation
  • Devised a record which covered best aspects of
    old and included new
  • Discussed move with all staff
  • Went through Chief Nurse
  • Introduced on 21st July 2003

9
Anticipated problems
  • Confidentiality
  • Reluctance of multidisciplinary teams to write in
    combined record
  • Would people alter their style of documentation
  • Getting staff to record relevant information and
    use charts as a source of information
  • What would go where

10
Real problems
  • No one knew what went where
  • Sample copies of lay out placed in nurseries
  • Became bulky very quickly
  • Overflow placed in a safe place

11
What happens next
  • Evaluation has been ongoing, with audit and
    requests for staff opinions.
  • Full evaluation about to start
  • Trust legal department to look at sample notes to
    ensure legal validity
  • Standard saying if it is not documented then it
    did not happen remains unchanged
  • Often poor at documenting what is not
    procedural/concrete
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