Overcoming “Just another week-itis” – Effective Multidisciplinary Team Meetings Lynn Turner Workforce Modernisation Manager (North Wales)

Introduction  Previous role as “Patient Pathway Improvement” (2003)  North Staffordshire Combined Healthcare NHS Trust, in Stoke on Trent  Elderly Care Unit - Acute and Rehabilitation Wards

The Situation  Long lengths of stay, particularly in Rehabilitation Wards  Ward rounds and case conferences – variable quality and effectiveness  Good Multidisciplinary working – but could be better

What we did?  Observations of Practice on Ward Round and Case Conferences  16 Ward Rounds and Case Conferences across 8 wards  Feedback and discussions with Patients & Multidisciplinary Teams

The Sinners 7. Non – attendance 6. Lack of preparation 5. Actions not completed 4. Total admission not considered 3. Discharge not planned early enough 2. Poor off duty (Nursing) 1. “Just another week-itis!”

The Winners 7. Clear and realistic goals set and evaluated 6. Order of patients varied 5. Complex patients discussed first 4. Everyone’s opinion considered 3. Patients and family views represented 2. Effectiveness of the Case Conference reviewed 1. Preparation! Preparation! Preparation!

Good Practice Guidelines  Role Clarification - Chairperson - Note taker - Multidisciplinary Team Members  Good Practice Guidelines - For Nursing Staff - Goal Setting

The Standards  All core members and associate members of the multidisciplinary team will attend the case conference and at the agreed time.  Cover is provided for professionals not able to attend case conferences.  All members of the clinical team are adequately prepared for the ward round/case conference and have a good understanding of the patient’s condition and current status.  All actions from the previous week have been carried through.  All results/investigations have been seen prior to the ward round and are filed within the patient’s notes.  The multidisciplinary team plan realistic timescales for the patient’s anticipated recovery and at an early stage agree a discharge date and this plan is communicated to the patient.  The patient’s recovery is measured against this plan and adjustments made accordingly.  At each case conference, any developments during the preceding week are discussed and evaluated.  Any decisions made at the ward round and case conference are fully explained to the patient and/or their relatives/carers depending upon the patient’s conditions and wishes.  The decisions made and actions for each professional are accurately recorded in the patient’s notes in a standardised format.

Reviews and Continuous Improvement Reviews and Continuous Improvement  Self Audit  Patient Review Update  Standards are still being used  Spread to other areas  Audit being undertaken Ward: Date:

The Way Forward  Guidelines and Standards can be adapted for use in NHS Wales  Original source to be recognised

Doing Things Differently

Any Questions