Making a plan for the weekend
Writing a brief, clear management plan on a Friday greatly improves communication between all clinical staff over weekends.
The plan should contain:
•A diagnosis
•A short one to three line summary of progress since admission
•A mention of any important medical history—however, the majority of this will be in the initial clerking
•Any investigations required and a note if they have been ordered
•Details of any procedures to be done, when, and by whom
•An idea of what the consultant’s thinking is on the patient
•Resuscitation orders clearly documented
•If a patient is to be discharged a discharge letter should be written in advance but left for an on-call clinician to date and sign. This letter should include when sutures are to be removed and by whom, a list of prescribed medications to be taken away, and a date for review.
Preparation prevents problems:
If problems are expected over the weekend then the Friday on-call team should be contacted and informed as well as the ward nurses. They then pass on this information to the next on-call team the following day. Check that drug charts do not require re-writing.
Implementation:
All staff are informed of this policy at the hospital induction. Consultants should monitor how well staff adhere to it and give appropriate feedback. On-call staff handing back on a Monday should be asked if they had any problems with the weekend plans.
Benefits:
Patient care is improved and good note keeping reduces litigation. On-call staff can be more confident about patient management and therefore less stressed. Writing plans helps develop the skills to summarise the histories and treatment plans needed in examinations, ward rounds, and when discussing patients on the telephone.
This is an adaptation of a column which appeared in BMJ Career Focus 2005;330:220 (28 May) written by:Andy Gibbons, Consultant in oral and maxillofacial surgery, Peterborough Hospitals NHS Trust and O Khattak, senior house officer in oral and maxillofacial surgery
