Deder General Hospital: Multidisciplinary Round Team (MDT) format

Pt Name: ___________________ Age_____ Sex___ MRN________

Direction in using the sheet

Client evaluation finding and decision from the MDT round should be transcribed by any of the team physicians
Ward name: Bed no: -
Morning Evening
Time (local time only) Time (local time only)
Multidisciplinary team member Sign Multidisciplinary team member Sign
Senior: - Senior: -
GP:- GP:-
Nurse/Midwife: - Nurse/Midwife: -
Clinical Pharmacy: - Clinical Pharmacy: -
Others: - Others: -
Progress Round Note
Current Problem: - Current Problem: -

Current management summary: - Current management summary: -

Update in the history (“same” if no change from recent Update in the history (“same” if no change from recent
admission and progress note) admission and progress note)

Suggestive investigation Suggestive investigation

Suggestive management Suggestive management

Name of Physician: Signature: Name of Physician: Signature:

Deder General Hospital Clinical Audit format

Senior evaluation recommendation

______________________________________________________________________________
__________________________________________
On daily progress note and different finding:
______________________________________________________________________________
______________________________________________________________________________
________________________
Any added or revised order:
______________________________________________________________________________
______________________________________________________________________________
______________________
Was appropriate nursing care provided?
______________________________________________________________________________
__________________________________________
Conclusion:
______________________________________________________________________________
______________________________________________________________________________
________________________
Documentation completeness by the following parameters ((identification ( full name, age, sex,
MRN, date & time), physician name & sign, scope of the stated physician is appropriate,
consultation documented and done by scope)).

__________________________________________________________________
__________________________________________________________________
________________________________________________
Audit done by: __________________________ signature_______________
1. ______________________
2. ______________________
3. ______________________
4. ______________________
5. ______________________