Linda Allan

1. Every post-operative patient should be seen by an ANP or a doctor and their presentation recorded in the observation notes on a daily basis. As part of that daily review, the medication prescribed to the patient should be considered and adjusted if appropriate. The observation record should narrate that the medication prescribed has been considered and narrate any changes. 2. Any patient who records a low pain score and at the next observation check records a high pain score should be the subject of an immediate referral to an ANP or a doctor. 3. The Fife Early Warning System Observation Chart should be revised to allow the site of pain to be recorded. Pain scores should be recorded from the point of admission into hospital until discharge. 4. A Fluid Balance Chart should be maintained for every post-operative acute patient until they are ambulant. 5. Refresher training on the action points referred to in Mr Chesney's email of 4 November 2020 should be given annually to all medical practitioners in orthopaedic wards. Records should be kept of who has received this training to ensure that all relevant employees receive it annually. 6. The lead trauma surgeon should continue to review a random selection of records on a monthly basis to ensure that ward rounds are being documented. Any failure to record a ward round should be raised with the doctor responsible for recording it to ensure that good practice is achieved and maintained. 7. Annual refresher training should be given to all employees who implement the Boarding Policy on how it works, how patients should be assessed in relation to it and how the paperwork for the Boarding Policy should be completed. Records of who has received this training should be kept to ensure that all relevant employees receive the training annually. 8. Annual refresher training should be given to the members of the Hospital at Night team on the escalation process. Again, records should be kept of who has received the training to ensure that all relevant employees receive this training annually.