Ward Survival Checklist

The following points are areas you should try to get your head around if you want to be a useful member to the ward team as a junior doctor. Some of these are easier to achieve than others, but as time passes and you become more experienced, hopefully all these will be second nature to you. This article serves to provide a rough outline to what you should aim for.

---

Orientation

-Knowing your way around the wards

-Number codes through doors and to changing rooms and doctor's mess

-Getting ID access for relevant areas (e.g. theatres for surgical placements)

-Learning to use the computer system (if your trust uses electronic records)

Identifying Key Contacts

-learn the names of your colleagues

-who and where to seek help from i.e. the chain of escalation

-create a group chat

-consider making a list of bleep numbers and important emails, placing it somewhere easily accessible e.g. the board in the doctor's office/on the Whatsapp group

-download the induction app for bleeps/extensions for various departments in your trust (https://induction-app.com/)

Patient Lists

-ensure someone is allocated for compiling lists

-learn your way with tables in Microsoft Word (e.g. alt+shift+up/down to move rows)

-include at least 2 patient identifiers on top of their location, as patients can be regularly moved

-information to include: diagnosis, up-to-date investigations and outstanding jobs

Ward Round Documentation

-use a template (consider creating one as a QIP if not yet available)

-separate content by headings: main diagnosis/issues, NEWS score, examination findings, investigations, plan

-learn specific points for your department e.g. surgical rounds will tend to pay attention to drains/stomas input and output, and whether patients are to stay nil by mouth, or to be kept on clear liquids only

-for Friday rounds, consider include a plan for the weekend team

Job Lists

-after rounds, consider making a job list compiling the actionable points within patient's plan

-cross each job off after completing them

-this also makes it easier for you to identify the most pressing jobs and prioritize accordingly

Discharge summaries

-similar to ward round documentation, use a template to provide structure

-it is a summary, so include only key points during patient's stay

-headings should include: presenting complaint, investigations, diagnosis, treatments, changes to medications, follow-up, actions for GP

Making referrals/asking for advice

-use a one-sentence summary as a headline to capture the person's attention

-adopt the SBAR structure/allow the conversation to be guided by their questioning

-if a referral is declined, offer to get a senior colleague to speak to them, or document the discussion in the notes including the reason for refusal

-repeat back the agreed plan to confirm that you have got the right information

-ensure you get their last name and grade, document these in the notes

Useful tools to have

-British National Formulary (BNF) app- for all things prescribing e.g. doses

-MicroGuide app- local antibiotic guidelines (selected trusts only)

-MDCalc- for scoring systems

-encrypted chat app(s)- e.g. Pando/Siilo, allows sharing of confidential information within selected staff groups

Ward life can be tough, and things may get chaotic at times, but this should serve as a starter guide when transitioning from student life to your first day on the wards as a fully-fledged doctor.

Share your thoughts below on your personal tips for the wards.