MULTIDISCIPLINARY WORKING CONFERENCE
23rd March 2009
Good Practice Guidelines for Ward Rounds and Case Conferences
Introduction
These good practice guidelines and standards have been developed following observations of case conference & ward round practice and in conjunction with all members of the multidisciplinary teams. This took place in the Elderly Care Unit of North Staffordshire Combined Healthcare NHS Trust. This is a summary of the key information produced in the original guidance. For further information please contact
The clinical teams undertake both case conferences and ward rounds, in which each member of the multidisciplinary team feels able to contribute effectively to the planning of a patient’s discharge home or to an alternative care environment and that their contribution in doing so, is valued.
Core Members of the Multidisciplinary Team attending Case Conferences
Nursing Staff
Consultant
Staff Grade Physician
Physiotherapist
Occupational Therapist
Social Worker
Elderly Care Liaison Nurse
Role of Multidisciplinary Team Members at Case Conference
As well as representing their professional group and following the standards, the following roles should be allocated from within the team.
Chairperson
Notetaker
These roles can be rotated within the multidisciplinary team. It is the responsibility of the clinical teams to decide how these roles are allocated.
The Role of the Chairperson
The Chairperson will undertake the following responsibilities:
-Keep the case conference focused and to time
-Ensure each professional viewpoint is considered
-Ensure each action is allocated to a specific individual
-Ensure a consensus decision is reached regarding patient treatment plans and future care arrangements.
-Ensure that the case conference follows a structured format
-Ensure that that at the end of a patient discussion, a clear plan of action is evident.
Consensus Decision Making (TTI Developments 1994)
A consensus decision has the following characteristics:
-Uses all the resources of the group
-All group members must participate actively
-Power must be distributed evenly among them
-Consensus decision making productively resolves controversies and conflicts
-All group members must contribute their views and their reactions to proposed alternatives; no one should be allowed to remain silent.
-For a group to achieve consensus, time must be allowed for everybody to state their opposition to the decision and to state it fully enough to get the feeling that others understand them.
-Consensus decision making requires careful listening and effective communication by the group members.
-If consensus is gained, the commitment to implementing the decision will be greater than with other decision making methods, e.g. by majority
The Role of the Notetaker
It is difficult to both participate and contribute to a case conference at the same time. The accurate recording and documentation of the discussion and the decisions reached is important for the continuity of patient care and to support timely and appropriate discharge.
The documentation within the progress notes of the CCP document should be as follows:
DateCase conference
N (Nurse) -
P (Physio) -
OT -
Med (Medical) -
SW (Social Worker) -
Other (please specify) -
Agreed action and by whom:
The records should reflect the contribution of each professional and the agreed action that is determined following the multidisciplinary discussion.
Responsibilities of the Notetaker
-To accurately record the contributions of each team member and the agreed actions.
-To ensure that the documentation can be easily understood by individuals who were not present at the case conference.
-To summarise the agreed actions, if needed.
The Role of all Participating Professionals
-Be prepared.
-Have up to date information for all your caseload and those of your colleagues, if appropriate.
-Ensure actions agreed previously have been followed through.
-Ensure effective communication with patients and their carer’s and ensure that their views are represented at the case conference.
-Be clear on your own actions for each patient and ensure follow through.
-Ensure adequate support for colleagues new to the case conference process.
Good Practice Guidelines for Nursing Staff
-Ensure off duty is allocated to provide adequate cover and support for ward rounds and case conferences.
-Ensure that Nursing Staff know in advance that they will be participating in the ward round/case conference and which patient groups (teams) they will be representing. If possible, involve nursing staff from individual teams / sides.
-Ensure off duty is allocated to Nursing Staff participating in the case conference / ward round to allow preparation time and follow uptime foractions and communication.
-Team Leaders/Named Nurses, if not participating, to provide adequate and up to date information for the case conference/ward round.
-Team Leaders / Named Nurses to take responsibilities for follow up actions.
-Consider the involvement of H.C.S.W.s in the case conferences.
-Senior staff to attend case conferences in a supportive/monitoring capacity.
1
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Guidelines for Goal Setting
For the wards, where goal setting is carried out, the goals should meet the SMART philosophy.
Specific
Measurable
Agreed
Realistic
Time Related (use dates rather than timespans)
In addition, when reviewing goals in a multidisciplinary forum, the following should be discussed:
-When the goal was originally set in terms a date
-Progress towards goal achievement
-How long has the goal being in place for, is the progress as expected?
-Any modification of the goal or the interventions
-Is the goal likely to be achieved and if so, in what timespan?
-Does this fit in with the anticipated discharge date and outcome
-Decide whether goals should be reviewed as part of case conference.
For the reviewing of the goals to be effective, then team members must be:
-proactive in communicating the goals to colleagues, to patients and their carers
-for the goals to be accurately monitored
-prepared for goal setting in terms of knowledge of progress
The Standards
1.0All core members and associate members of the multidisciplinary team will attend the case conference and at the agreed time.
2.0Cover is provided for professionals not able to attend case conferences.
2.1If cover is not able to be provided, relevant and up to date written information is provided in advance of the case conference.
2.2It is the responsibility of the individual professional team to provide this cover/information.
3.0All 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.
4.0All actions from the previous week have been carried through.
5.0All results/investigations have been seen prior to the ward round and are filed within the patient’s notes.
6.0The 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.
7.0The patient’s recovery is measured against this plan and adjustments made accordingly.
8.0At each case conference, any developments during the preceding week are discussed and evaluated.
9.0Any 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.
10.0The decisions made and actions for each professional are accurately recorded in the patient’s notes in a standardised format.
1
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Case Conference Review for Clinical Teams
Information update in the absence of ProfessionalsReport made by:Date:
Name of Patient / Progress since last Case Conference / Update on Agreed actions from last Case Conference / Issues/ Prognosis for recovery/ goal attainmentWard:Date:
1.0 / Preparation1.1 / Did all staff feel adequately prepared for the ward round / case conference? / 1.2 / Were the majority actions carried out from the previous week?
1.3 / Are notes and x-rays available and readily accessible? / 1.4 / Were the majority of investigation reports available and filed in the patient’s notes?
1.5 / Are investigation request cards readily accessible? / 1.6 / Overall assessment of preparation.
2.0 / Participation and Decision Making
2.1 / Did all professionals feel that they participated adequately in the case conference?
2.2 / Was consensus reached by the team as to the key actions / decisions?
2.3 / Were the professionals present who needed to provide information / make decisions? If not, was the relevant information available?
3.0 / What did we do well?
4.0 / What could we improve?
1
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged
Patient Centred Case Conference Review
Patient:Ward: Unit No:Date:
1. / Was there a clear understanding of patient’s previous abilities to enable effective and realistic goal planning?2. / Was information available relating to: / 3. / Were the following areas covered in relation to the patient’s current progress?
The patient’s social history; / Washing
Dressing
Lifting and handling
Pressure areas
Nutrition / Continence / Psychological needs
Type of house; / Dressing / Pressure areas / Barthel score
Carers / services involved; / Lifting and Handling / Waterlow Scale / Medication
Patient’s views about the future; / Mobility / Falls / Resuscitation
Relatives / carers views about the future. / Nutrition / Falls Score
4. / Was the progress of the patient over the previous 7 days discussed? / 5. / Are the patient’s needs reflected on a 24-hour basis?
6. / Were all staff clear about the key decisions / actions? / 7. / Were all actions clearly allocated to an individual professional?
8. / Was the involvement of the patient adequate? / 9. / Were the patient’s views fully considered?
10. / Was there a clear plan for the next 7 days? / 11.0 / Were the timescales for discharge reviewed?
1
Original source – North Staffordshire Combined Healthcare NHS Trust
This document can be adapted for use in NHS Wales as long as the original source is acknowledged