HOW TO PERFORM A DAILY REVIEW OF PATIENT PROGRESSION Dr Vicki Ibbett (LTFT FY1)

WHY DO A DAILY REVIEW OF PATIENT’S PROGRESS? To optimise patient care…  Are they clinically improving / stable / deteriorating?  Are changes to clinical interventions required?  Are there any other concerns / issues? (e.g. with medications) …& thus guide your daily jobs

THE BASICS Ward rounds vary  Often you’ll be with a senior … so your job will be providing info & documenting  But in medical posts you may be alone! Know who your patients are!  Make sure you’ve got a patient list (& keep it updated!) Have a structured approach  Stick to it so that you don’t forget anything!

WHAT ARE THE KEY THINGS TO COVER IN A DAILY PATIENT REVIEW?

Reminder of reason for admission + working diagnosis Progress & events since last review Read the entries in the notes! Investigation results Trends in blood tests & obs Current patient concerns Speak to the patient & ask them! Current nursing, other HCPs or social concerns Current clinical state Obs Input/output, stools Symptoms & examination findings Current interventions Medications Day of antibiotics Review the drug cardex Any ‘devices’ in-situ (e.g. catheters) Impression & plan

MEDICATIONS  Daily review of drug kardex  Interactions?  Side effects?  Thromboprophylaxis  Allergies  Does the cardex need re-writing?  Antibiotics  Indication  Duration  Use Trust guidelines  Warfarin  Monitor INR  Ensure prescribed (pre-plan, if possible, for weekends / bank holidays)  Manage over / under anticoagulation (see Trust Guidelines)  Insulin  Monitor blood glucose  Make use of the diabetes specialist nurses (DSNs)!

WHERE TO FIND TRUST GUIDELINES PRINT SCREEN Key guidelines: Antibiotics Warfarin Refeeding VRII Hyperkalaemia

DOCUMENTATION - BASICS NB. This is a legal document…it should be legible Date & time (24 hr clock) Top left hand WR + name & grade of most senior doctor present Add speciality if outlier / joint care Title Name + grade/ signature / GMC number / bleep number Bottom right hand

DOCUMENTATION – CLINICAL INFO Age & gender Presenting complaint / reason for admission Patient background Working diagnosis …problem list for more complex pts Current treatment (inc. day of abx) Active problems / issues Recent & pending investigation results Any nursing concerns Concerns from other members of MDT Clinical review:  Patient concerns  EWS score + abnormal results / temp spikes  Input / output  Bowel movements  Examination findings Impression …better than ∆, you can change your mind later! Plan + EDD

ABBREVIATIONS & COMMON SYMBOLS Abbreviations EWS TWOC EDD BNO OE SNT ATSP PTWR Common symbols ↑↓↔ ∆ ♂♀ ˜ (previous blood test result) Only use if understood by other clinical staff in that setting

FINAL TIPS Make sure you understand what’s going on with the patient Update your patient list as you go along Don't write anything you couldn't defend in court… …If you didn't document it, it didn't happen Discuss / clarify plans with seniors as needed

ANY QUESTIONS?