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Ward Information Sheet For completion at the beginning of each ward visit.

Ward Information Sheet For completion at the beginning of each ward visit. The purpose of this sheet is to collect information that gives context to the feedback obtained. This sheet can be adapted to suit the information you want to collect. Hospital: Ward:.

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Ward Information Sheet For completion at the beginning of each ward visit.

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  1. Ward Information Sheet For completion at the beginning of each ward visit. The purpose of this sheet is to collect information that gives context to the feedback obtained. This sheet can be adapted to suit the information you want to collect. Hospital: Ward: Date: Author: (e.g. “1pm – 5pm – visit captured the end of lunch, afternoon visiting and afternoon tea round”) (e.g. whether ward seemed very busy, calm, chaotic, well ordered, cluttered, tidy, Doctor round in progress etc) Page 1

  2. (State who you fed back info to e.g. verbal feedback to staff on duty and anyone you emailed this information to. Ask how the feedback is shared / displayed / discussed with staff. Ask if staff are aware / seen feedback report) Page 2

  3. Patient Experience Questions and Response Data Collection Tool Hospital / ward: Data: Male / Female / Relative Page 3

  4. Page 4

  5. Patient Experience Feedback Report Hospital: Ward: Date: Author: Page 5

  6. Patient Experience Feedback Report (Additional comments) Page 6

  7. Page 7

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