Ward rounds (WRs) are an important part of hospital clinical practice: they set priorities, coordinate care, and develop management plans for each patient; supporting timely, safe, efficient care. The Modern Wardrounds report (Royal College of Physicians and Royal College of Nursing, 2021) and Francis Inquiry (Francis, 2013) concluded, to support safe care, WRs should be interprofessional and given central importance in the working day. Wider research reports that nurses' contributions to WR discussions support high quality care, arguing their absence (or even physical presence but lack of engagement) has adverse consequences for communication, WR efficiency and patient safety (Paradis et al., 2015, Shaughnessy and Jackson, 2015,). Worryingly, research studies from several contexts report that many nurses lack the willingness and ability to participate in WRs (Liu et al., 2013, Manias and Street, 2001, Merriman and Freeth, 2021, Paradis et al., 2015).

Wider analysis of the study site’s WR practices (Merriman and Freeth, 2021), found bedside nurses did not contribute as much to WRs as WR leaders hoped, which risked suboptimal clinical decision-making. Senior nurses and doctors wanted to support bedside nurses’ ability and willingness to contribute to medically led interprofessional WR discussions and decisions. Bedside nurses wanted to contribute but requested more support to do this more often and effectively. First, bedside nurses need to be present to contribute, necessitating greater predictability in the touring WR arrival time, reported elsewhere (reference withheld for anonymity). Here, we report another intervention: interprofessional development and implementation of a mnemonic to guide and support bedside nurses’ WR contributions.

Standardised approaches and tools, such as mnemonics, may improve the quality and efficiency of clinical communication and prevent medical errors (Vincent, 2005). A mnemonic is a pronounceable phrase or words where each letter represents an item that is remembered in the order given by the phrase (Radovic and Manzey, 2019). The Situation-Background-Assessment-Recommendation (SBAR) tool was an early example, originally introduced to help structure communication primarily between nurses and physicians in acute care (Leonard et al., 2004). The popularity and international uptake of SBAR in acute and community hospitals, quickly made it a ‘best practice’ for rapid transmission of information (NHS, 2018). Other mnemonics followed to support ward round communication in intensive care. For example, Shaughnessy and Jackson (2015) MINDERS checklist and Alamri and colleagues (2016) adhesive proforma stickers found a mnemonic checklist, primarily to structure junior doctors’ contributions, could improve communication during intensive care WRs. Furthermore, mnemonics can aid communication for less experienced or less confident staff (Boaro et al., 2010, Vincent, 2005). Preexisting mnemonics did not cover all the aspects of care that the unit multidisciplinary team felt nurses should cover during the ward round, so we developed and piloted a new mnemonic. The aims of the new mnemonic were to provide a structure to follow, to help WR participants remember the aspects of care the unit had agreed bedside nurses should normally report during the WR due to the foci of their work and their up-to-date knowledge, and to increase bedside nurses willingness and ability to make succinct well-focused contributions to WR patient reviews.

Objectives:

To co-develop and pilot a WR mnemonic, focused on improving the frequency and quality of bedside nurses’ contributions to WR patient reviews.

To evaluate pilot implementation of the new mnemonic to discern its usability in the practice setting and its potential impact on the willingness and ability of bedside nurses to contribute to WR patient reviews.