Moyale General

Hospital
Round Protocol

January, 2025 EC
By Siraj A.A (CG& QI Head)
Table of Contents
Introduction..................................................................................................................................................2
Overall objective of Ward Round Policy & Procedure: -................................................................................4
Specific Objectives of Ward Round Policy & Procedure: -.........................................................................5
Types of ward round.....................................................................................................................................5
Major round..................................................................................................................................................6
Team composition of major round............................................................................................................6
Principles of major round..........................................................................................................................6
Frequency of major round........................................................................................................................6
Business Round (Intentional round)..............................................................................................................7
Hourly round.................................................................................................................................................7
Grand round (teaching round ).....................................................................................................................7
Roles of the Ward Round Teams...................................................................................................................7
Doctor’s role: -..........................................................................................................................................7
Nurses’ role: -............................................................................................................................................8
Clinical Pharmacist role.............................................................................................................................8
Patient and caregiver’s:.............................................................................................................................8
Summary by doctor after finishing ward round: -.....................................................................................9
Managing decisions and tasks during Ward round...................................................................................9
Moyale general hospital patient discharge process...................................................................................11
References..................................................................................................................................................13
Introduction
There is no single agreed definition of a ‘Clinical ward round’. However, it can
be described as a complex clinical process during which the clinical care of
Hospital inpatients is reviewed. Ward rounds are critical to the smooth flow of the
patient journey as they are the key method by which patients in Hospital are
systematically reviewed by the multidisciplinary team. During a ward round, the
current status of each patient is established and the next steps in their care planned.

In the Hospital setting the range of professionals involved in the ward

round/care of individual patient varies across clinical specialties. It largely depends
on the way in which the service is organized in a given inpatient environment. Ward
rounds should be conducted by a multi-professional team (e.g. doctors, nurses,
Clinical pharmacists, dietician, related health professionals, patient and caregivers).
It creates an opportunity to review the patient’s condition and develop a coordinated
plan of care and action, strengthens communication channels and builds a team
culture, sharing information and joint learning through active participation of all
members of the multidisciplinary team. In contrast, failure to communicate actions
and information could result in discontinuity of care or unnecessary repetition of
efforts. So Ward rounds are an important and common form of teamwork in the
hospital setting, which provide a forum for reviewing and planning patient care

Despite being a key component of daily Hospital activity, ward rounds remain
a much neglected part of the planning and organization of inpatient care (mainly
documentation). There remains considerable variability in both the purposes and
conduct of ward rounds, with nurses often invisible in the process. The importance
of these clinical events to patients is often underestimated, along with the direct
impact ward rounds have on clinical and emotional outcomes for patients.

Senior Physician, General Medical Practitioner, Nurses and Clinical Pharmacist

that requires communication and coordinated teamwork to deliver safe, quality and
cost effective patient care. Patients involved in decision-making processes facilitate
a more effective and transparent clinician-patient relationship. The active inclusion
of patients in care processes results in changes to the traditional clinician-patient
relationship.

Having a defined purpose and structure to health care such as team coordination,
care planning and ward rounds is important, so that participants understand their
role and those of other participants. This facilitates the development of a cohesive
and appropriate treatment plan and safe delivery of care. They need to be clearly
defined at the ward level to ensure clinicians are working with a mutual
understanding of the task. Accordingly, Moyale Hospital develops Policy &
Procedure for Ward Round that can guide us to deliver safe, quality and cost
effective patient care. However, success of the approaches outlined by this
document requires a concerted cultural change, with all clinical staff and Hospital
SMT all fully engaged and focused on improving the quality of rounds
Overall objective of Ward Round Policy &
Procedure: -
 To improve Patient safety, Patient experience, shared learning,
Collaborative working and efficient use of resources through effective
ward rounds.

Specific Objectives of Ward Round Policy &

Procedure: -
1. To have Multi-Disciplinary team involving at Ward round with common
understanding
2. To improve team working on ward rounds
3. To improve the standard of care provided to patients and patient safety
4. To ensure drug charts meet minimum safe prescribing standards
5. To decrease ALOS, costs, patient harm and readmission
6. To facilitate GP's to have an access to the opinion from Seniors
7. To provide Patient expectation of access to appropriate and, skilled
clinicians and information
Types of ward round
1. Major Round
2. Business round
3. Hourly round
4. Grand round
5. Nursing round

Major round
Team composition of major round
1. One Senior Physician
2. One GP
3. One Clinical Pharmacy
4. All Ward Nurses

Principles of major round

 Ward rounds should be seen as a priority by all members.
 Lead by the Senior Physician.
 All Vital Signs including O2 saturation & Pain assessment should be taken
at least for critical clients prior to Round starting time.
 Intentional round should be taken to assess any critical patient prior to
MD ward round.
 Responsible Nurse should be present at her/his bedside patient review as
part of the ward round.
 All nursing team should be informed of all key decisions made on the
ward round.
  Planned, dedicated time should be set aside for multidisciplinary ward
rounds.
 Good communications (Ward rounds require strong leadership, with all
members of the team aware of their individual roles and responsibilities,
and engaged in the ward-round process).

Frequency of major round

s/n Type of ward Frequency Remark

1 Medical ward, surgical ward, pediatrics, Once a day

gynecology ward
2 Emergency Twice per day

3 NICU and AICU Twice per day

Business Round (Intentional round)

 Team Compositions: - 1. One GP
2. Ward Nurses
 The frequency of business round will be as needed

Hourly round
 The nurse should round hourly by using nursing hourly assessment sheet

Grand round (teaching round)

 teaching round is round with students to teach the student
Roles of the Ward Round Teams
Doctor’s role: -
 Leads the round and introduces the team to the patient
 Provides an update of recent history, clinical examination and review of
patient
 Reviews drug chart
 Provides update: - current problem, responses to treatment, test results,
medication and information from patient and/or family and nurses

Nurses’ role: -
 update vital signs
 control pain
 Council on nutrition and rehydration
 Council on elimination of urine and bowels
 Support on mobility
 clarify any confusion or delirium
 check quality and safety checks: - urinary catheter, IV line and prevent
pressure ulcer

Clinical Pharmacist role

 reviews patient’s medications
 Checks VTE prescription
 drug chart review
 Check for drug-drug interaction and any Allergy.
Patient and caregiver’s:
 Discuss openly their concerns
 discussions with other health professionals
 provide information to health providers
 prepare themselves for discharge

Summary by doctor after finishing ward round: -

 anticipate discharge needs
 place of discharge (eg home, rehabilitation)
 discharge date and time
 follow-up arrangements
 Provides patient with information relating to plan of care and checks
patient understanding

Managing decisions and tasks during Ward round

1. Reviewing essential care needs: - Ward rounds must include a holistic
assessment of the patient’s needs, reviewing & appropriate management of
nutrition, hydration, mobilization, pressure areas, & mental status.
2. Record keeping: - Reviews and decisions need to be properly recorded,
not only for medico-legal reasons, but also to ensure continuity of care.
 Patients’ records should be kept centrally to promote effective
communication and team working.
 All key decisions and actions made on the ward round should be
clearly documented.
3. Using Safety checklists: - Ward rounds should prioritize quality, patient
experience and patient safety.
4. Discharge planning: - Discharge planning is an integral part of ward
rounds and patient involvement should be encouraged. This includes setting
an estimated date for discharge. Taking a planned approach to discharge
helps to prevent readmission.
 Patients and caregivers should be involved in discharge planning at an
early stage.
 Teams should use a structured approach to discharge.
 Medications and outstanding issues should be carefully reviewed, using a
checklist method.
 Hospital teams should ensure clear verbal and written communication of
the discharge plan.
 Post-discharge follow-up arrangements should be clearly communicated
to the patient.
Moyale general hospital patient
discharge process

S.N Time Point of Activities to be done Date/Sign

Care
1 At admission Transcribe admission orders to the Hospital record
Reconcile the medication list
Identify caregivers who will be at home with the patient
Elicit the patient’s and family’s goals for the Hospital stay
Inform the patient and family about steps toward
discharge
2 Daily during Manage the patient’s condition
Hospital stay Assign a case manager or discharge planner to the patient
Educate the patient and family about the patient’s
condition at every opportunity using teach back
Explain medications to the patient and family using teach
back
Discuss progress toward goals and discharge
Involve the patient and family in care practices to prepare
for home care
3 Prior to discharge Coordinate home-based care
Prepare the patient and family for transition to home

Offer to make follow up appointment for the patient

4 On day of Write discharge orders and dictate the discharge summary
discharge (physician only)
Reconcile the medication list
Give written discharge instructions to the patient and
family
 Use teach back to assess how well providers have
explained diagnosis, condition, and discharge instructions
to the patient and family

Review the reconciled medication list with the patient and

family
Write down the follow up appointment times for the
patient and family
Write the name, position, and phone of the Hospital
person to contact if there is a problem after discharge

References
1. A joint publication of the Royal College of Physicians and Royal College of
Nursing October, 2012
2. International Journal of Health Care Quality Assurance, Vol. 29 Iss 4
pp. - http://dx.doi.org/10.1108/IJHCQA-03-2016-0024
3. Clinical Medicine 2011, Vol 11, No 6: 524–8, Aftab Ahmad, Tejpal S
Purewal, Dushyant Sharma and Philip J Weston,
https://www.researchgate.net/publication/221769303
4. Ethiopian Hospital Services Transformation Guidelines