RNOH PPI Forum Duke of Gloucester Report
Subject: Date: Fact finding visit to Duke of Gloucester 14th August 2007, 10.30am – 12.30 pm
Forum members: Ruth Marcus & Maryam Habibzay Staff interviewed: Fiona Fitzgerald, Deputy Ward Manager Introduction Duke of Gloucester is a bone tumour ward, but can be used by orthopaedic patients. It is composed of 24 beds; 12 male and 12 female beds, which are separated. The ward is separated into two halves. There are two side rooms for infection control. They have approximately 5 cases from Ireland a year. They also take E112 overseas cases, where treatment is not available in their home country. Background The ward provides highly specialist care for patients with bone tumour. ‘Staging’ for bone tumours is provided by the ward. Staging includes scanning, biopsies and amputations. There is good cancer support from Mcmillian nurses and patients who have amputations receive good care from specialist therapists. Good pain/symptom support is also provided. RNOH specialises in limb salvage (saving the limb) operations e.g. if a bone cancer breaks it can effect the limb. They have a visiting oncologist from UCLH. The ward is fully staffed. Observations One of the side rooms was not in a good condition but was still occupied, despite a recommendation that it should not be used. This is due to the number of patients requiring isolation and the lack of side rooms. The Day room is in good condition and is used for pre-operative counselling. Laundry facilities would be appreciated but is not available due to infection control issues. 2 male shower rooms and 3 male toilets. 2 female shower rooms and 2 female toilets. 1 small gymnasium, 1 linen and 1 assessment rooms in adequate condition. 1 staff toilet for 30 people and it had no hot water for a year. Terrible carpet in staff room and corridor. 1 room for clinical nurse specialists. Ward reception (nurse’s station) is in the centre of the ward and confidentiality is an issue, when patients and visitors nearby can overhear telephone calls and conversations. P/C screens can also be observed.
Patient 1: The patient had total knee replacement in 2005. She now has secondary bone tumour. Its primary origin is breast. She also received intravenous general antibiotics for infection in her leg. She had requested to be moved from Margaret Harte to Duke of Gloucester because she was previously treated in this ward and is more specific to her condition, and was very pleased with
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RNOH PPI Forum Duke of Gloucester Report
the care she had previously received. She described the pain control nurses and support as excellent. Duke of Gloucester team is caring, humours and knowledgeable. She highlighted that the Coleman Day Unit was being used a reception for patients to register before they are told what ward they are going to. She was not happy with this arrangement as anyone could walk into with their luggage into a day surgery. Patients who find walking difficult have to walk from Coleman Unit to their allocated wards. She likes to see the food menu change with more vegetable dishes e.g. on many occasions macaroni cheese is on the menu but unavailable. She thinks everyone is struggling with the menu. On day of discharge there is often, a delay in getting medicines from the pharmacy. She is happy with the after care and has access to Hillingdon social services. Patient 2: He has come from north of England. He had his leg amputated. He was happy with the surgical care and nursing care. Tough, he found the food dry and would like some headphones and access to a radio, which we did highlight to the deputy manager. Conclusion Fiona Fitzgerald provides good support for her team. The ward is fully staffed and has a low turnover. The bone tumour ward needs highly skilled staff who can deal sensitively with difficult and heartbreaking situations as well as providing excellent medical and nursing care. There is concern that, in the future, a manager may be asked to manage 2 wards, Fiona is very concerned that due to the nature of the work with bone tumour they need one experienced manager for this ward. Recommendations 1. There is a urgent need for at least 2/3 beds to be available for relatives as patients can come from all over the country, and need to be near their loved ones and bed and breakfast can be expensive and a distance away at times of crises. 2. More single rooms should be available for privacy and more patient dignity, as well the increased need for isolation wards. 3. Due to limited budget money is unavailable for blinds, which are needed for patient comfort. 4. Patients are often given gowns and many would prefer pyjama, for increased dignity and should not cost much more. Could this be addressed? 5. There is an urgent need for another staff toilet; at present there is only one for approximately 30 members of staff (male and female), previously they were 2, but one was disconnected so Medicare could use the cubicle. Could Medicare be offered space elsewhere and the second toilet re-installed? This problem was of great concern by all staff. 6. The carpet for staff rooms and corridor is in a very poor condition, and unhygienic, could this be replaced? 7. More variety food for patients – more vegetables. 8. Patients do not have any laundry facilities for personal items. Many patients come from a long distance, and with few or no visitors to take home their laundry. This why some patients are wearing gowns unnecessarily. This has been an issue on many of RNOH wards. Could this problem be addressed, could Friends of the Hospital help? Report compiled by Ruth Marcus & Maryam Habibzay.
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