This article aims to cover the salient points about ward rounds that you will need to know for F1/PRHO interviews in the UK.
I have been asked prepared this for those of you who have concerns about demonstration of ward round skills during your interview for PRHO/Foundation Posts.
I have prepared this for those of you who have concerns about demonstration of ward round skills during your interview for PRHO/Foundation Posts.
In the UK there are different types of round. After a patient is admitted to hospital, they are usually clerked in by a junior doctor on the ward (or admissions unit). Within 24 hours, they will be seen by a consultant on a ward round - known as a Post-Take Ward Round.
On the wards, patients are usually seen on a round every day by junior doctors (ie PRHO/SHO/Reg). These rounds usually monitor management and progress of the patients condition. Most consultants have a Consultant Ward Round twice per week where all the important decisions regarding management are made.
So.... We know about ward rounds, but who does what?
A Ward Round usually will consist of a consultant and his team (Medical Students, PRHO, SHO, Registrar) & nurses (ward sister, plus the nurse looking after the patient). In some hospitals, other members of the multidisciplinary team are also in attendance (specialist nurses, physiotherapists, social care). Take note of everything everyone says. A multidisciplinary approach is important and the nursing and allied staff will have valuable input into the patients care.
The Paper Work
This bit is important!!! It is a legal requirement that during an inpatient stay, a doctor makes an entry into the patients notes at least every 3 days!! It is good practice, however, to write something every day!
Junior Doctor Rounds
These usually monitor progress of the patient. When writing in the notes, consider the following points
1) Do the notes give enough information that another person could treat the patient if you were not there?
2) Will the notes be legally covered if they were ever taken to court?
There is a useful acronym for daily notes (junior rounds) - C.R.A.P
This stands for:
Change in condition - ie how is the patient doing
Results - blood results, radiology etc
Asessment - of the physical and psychological state of the patient (ie - your examination)
Plan - what the plan is for the next few days.
Consultant Ward Rounds
Slightly different - more information is exchanged here, but essentially the paper work is the same.
The consultant will see each patient in turn and report his/her findings as he/she goes along. It is the job of the junior medical staff to document what they say and do.
A useful way of doing this is to use the S.O.A.P acronym.
This stands for:
Subjective - what the patient says (ie brief history and progress notes)
Objective - what you find out from the patient (ie the examination findings and results of any investigations
Assessment - the diagnosis and how things are progressing
Plan - future managment, investigations to be ordered, referrals, plans for discharge.
You will also have a seperate book (or sheet of paper) with a list of all your patients on it. If anything needs doing (ie: blood forms, changes in Rx, referral, discharge letters etc), then you write it on this list in addition to the notes, so you know what jobs need doing later on.
I have given two examples of what to write in the notes below.
Important General Points for Notes
- Always write the date and time of your notes!
- Consider writing the location (ie A&E, Admissions Unit)
- Write the name of the most senior doctor leading the round
- Write your notes clearly and legibly
- Sign your entry
- Print your name
- Print your designation
- Write your bleep number
- Each page should have the patients name, date of birth and hospital number at the top!!
3 day post operative patient - appendicectomy.
07/07/06 - 10:00
SHO Ward Round - Dr Smith
Patient is in good spirits today. Not experiencing much pain and now only using paracetamol. Wound site healing well. No signs of infection. Eating and drinking without any problems. Passing urine. Passing faeces.
Wound swab cultures negative.
On examination, chest clear, heart sounds normal, abdomen soft and not tender.
Plan - Continue management. Consultant to review tomorrow. Home monday.
HUDSEN - PRHO
Here is an example of a medical patient seen on the consultant post take round with plueritic chest pain.
07/07/06 - 13:00
PTWR - Dr Packard. Admissions Unit.
Left sided pleuritic chest pain for 2 weeks with associated cough.
Long term smoker. No previous history of chest problems.
Temp 38.1C Sats 100% on oxygen. BP 130/80, pulse 84 reg.
Chest - crepitations on the left lung base.
CXR - Consolidation at the left base. No pneumothorax present.
Cardiac enzymes normal
Impression - L basal pnuemonia
Continue oxygen and monitor sats.
Culture blood and sputum today.
Amoxicillin 500mg TDS orally.
Not for V/Q - unlikely to be PE.
Speak to physio - re: chest percussion to remove sputum.
PRHO to Dr Packard
For the interview you will either
- be invited to attend a mock round and make notes
- watch a video and make the notes