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					PPI Forum for Hull & East Yorkshire Hospitals VISIT REPORT: WARD 5 CASTLE HILL HOSPITAL. TUESDAY 12TH JULY 2005, 10AM.

FORUM MEMBERS: RUTH MARSDEN SUE MORGAN REPORT INPUT – BOTH

LEAD - RUTH MARSDEN Staff in Attendance: -Sandra Forsyth, Nurse Manager -Sally Yearnshire, Junior Ward Sister -Linda Naylor, Ward Housekeeper

A) Physical Environment. General Observations: 1. Patient lounge was shared by staff as they have no staff room. Room was spacious well and proportioned. The décor was good. There were plants and book, TV and video and a drinks machine for patients and visitors with an ‘honesty box’ for the 20p. The room was clean and well presented, but one of the upholstered chairs was shabby. 2. The linen store was sizeable, and had generous access doors. Ample supplies were available, and pyjamas and nighties, traditionally a reserve from donated items, were now replaced by new green pyjamas, and pink nighties. Unused linen of the day was removed and fresh supplies came next day. The shelves of the store were cleaned in rotation. The floor was done weekly. 3. Staff had lockers for their personal items and uniform/clothes. There was a shower in the locker room, but it was full of boxes/doubled as storage and was not used. 4. Portable floor fans were in use at the entrances to patient-bays to assist the flow of fresh air. 5. The controlled-drugs room contained locked cupboards and the only key was on Sister’s belt.

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6. Leaflet racks, of plastic coated wire, were a little flakey, but well stocked with leaflets. 7. The food storage, fridge, freezer in the ward kitchen were all adequate and organised. There was adequate crockery etc. and special accessories were available to assist patients’ eating. 8. We talked to all the patients who were not very ill/asleep/in the loo. There were only four male patients in the ward at the time, all in their own bay. All the patients were well cared for, clean and with clean, dressed hair. Some were in their night clothes, some in day clothes. Most were positive about the care they had received. 9. One lady said the food was as good as being in a hotel. 10. One gentleman was very concerned about care when he got home. Members conducting the visit considered the following to be Good Practice: 1. Windows of patient-areas overlooked by works/construction traffic had ‘film’ on windows so patients could still see out but people could not look in and patients’ privacy was preserved We have concerns about the level of noise when the construction traffic intensifies. 2. There was a dedicated Visitors’ Toilet 3. Washing bowls were dedicated to each bed and colour coded and tagged. Bowls, lockers, beds were cleaned ‘as seen’ and regularly had a ‘terminal clean’. 4. Treatment and Clean Utility Room was busy, much trafficked but orderly. 5. Sister’s Office was available as a ‘private room’ for discussions with relatives. It was adequate in space and seating, and pleasant and well kept. 6. Ward routines allowed for beds to be changed as necessary and always at least once a week. 7. Patients were bathed at least once a week. Many bathed, showered independently. Those who could not be bathed in the bathroom were bedbathed –special wipes were used, one for each part of the patient. This is hygienic and evaporation is rapid so there was no drying/manhandling needed and the patient was left clean and fresh. 8. All the call-systems were functioning and the controlled-entry/ security phone was positioned so that the entry door could be seen and the would-be entrant vetted.

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9. All the ward-bays and patient-areas were spacious, clean, and fresh, without any odour, human or artificial. Air fresheners were plugged in to sockets at intervals around the ward. Everything was in good decorative order. All electrical fittings, sockets were modern and in good repair. All the loos (there were lots of them) were clean and all the bathrooms and showers were clean, fitted with grab-rails etc, and the pull-cords were accessible and appropriate. Soap dispensers were full. Mirrors were clean. All strip-lights had diffusers and these were clean and free of flies. Windows were clean, opened as required, and the window and cubicle curtains were correctly hung and functioning. 10. The notice announcing the visit of PPI F was displayed on the door of the ward. Notices within the ward were professionally presented and displayed on appropriate boards. The ward has a laminator to make notices. 11. Alco-gel was available in all the right places. The dispensers for rubber gloves and plastic aprons were sensibly placed, and well stocked. 12. Several patients were self-medicating. This would enable them to cope with their own medication when they went home. 13. The nurses’ station was busy but well organised. The ward-layout and location of patients was mapped but no patient names were visible to visitors, Patient confidentiality was maintained. A sample care-plan was displayed for visitor information. 14. All hoists (x4) were clean and in good order and had reserve batteries for rotational charging. Members would welcome Trust comments on the following issues: Comment from the Trust: We appreciate the detail and frankness of the report and the opportunity it gives us to see the ward objectively and therefore take any action necessary. Please find listed below our comments and intended actions on the various issues highlighted. 1. The room for assessing patients’ independence with kitchen tasks etc doubled as storage. The ‘stairs’ were in the hall way. Work has been done on an alternative for this once we can manage the reduced bed capacity. 2. Cot-bumpers were stored on the top shelf of the linen store and these were not in good repair. The waterproof covers had come un-stitched and the foam was exposed. The Charge Nurse has been asked to address this. 3. The Ward Clerk’s desk was situated between two patient bays. It gets very busy. The clerk works flexible hours, starting from between 7.0 am and 9.0
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am. The telephone, very busy after 9.0am, must be a nuisance to patients. Apparently, bed buzzers are as noticeable. We will endeavour to ensure telephones are on the lowest ring tone. All new nurse calls would be required to have a mute and light system. This will be considered when replacing any of our systems, as a matter of course. 4. The ward kitchen looked rather dated and the décor was not maintained to the standard of the public areas. a) The cutlery drawers appeared to have bare wood interiors and be hard to keep clean. Some liners would improve things b) The windows in the kitchen were dirty. c) The composition floor had suffered heavy use and had tape over joins and splits. d) Walking frames stored there (x5) had dusty rails e) The sink splash-back was incomplete and there was bare wood behind the taps. f) A sharps-bin was used to hold the door open for circulation of air. Comments made here have been passed on to the relevant Facilities Managers to be assess appropriately to consider upgrading and the Charge Nurse and Housekeeper have been asked to look at checking the general standards of hygiene, cleanliness and repair. 5. The cleaner’s room for buckets, Hoover etc. was not kept to the standard of the public areas. a) The trolley for conveying polish, dusters etc was very soiled, lower trays were grubby. b) The white sink for emptying pails was half blocked with wet paper. c) The cotton mop-head was very grey and did not inspire confidence. The Ward Housekeeper is to monitor this area and report to the domestic manager if no improvement. 6. One stool was broken. 7. Odd items, such as extra cushions on chairs, were tatty. 6&7: The Ward Housekeeper instructed to take out of use and consider replacement if necessary. 8. The bed-tables with metal frames had chipped and rusty legs Some of them were positioned at the bed end, where the patient could not reach the drinks on them. Bed tables are old and a system of gradual replacement is to be implemented by the Charge Nurse and Ward House-keeper. 9. One patient’s locker had a large number of Fortisips on it. These should have been in the fridge, with a couple available on the locker. The patient was self-administering via a Peg tube and therefore needed a supply by the bed. But it was discussed on the day that the volume stored on the bed locker was too great and addressed on the day.

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10. One patient’s locker was bulging with a white, dirty-laundry bag. Apparently, some patients have no-one who can take their laundry for them It is possible to wash personal laundry in the system, but things do get lost. This is usually picked up by staff but the Charge Nurse has reiterated this to all. 11. Patients in from their own home, who depend on a home help, find that the home help is re-assigned. Patients in from care-homes often mean the ward staff have to ring and ask if anyone will come in and collect the patient’s washing. Some will do. Others won’t. 12. One patient said that the female staff were less overtly caring, though’ efficient, but that the male staff were excellent and very caring. This patient was anxious that I should not be seen to be writing this down. 11&12: Both of these issues are discussed with our Social Services colleagues to help resolve if encountered. 13. If staff get soiled (vomited over) where do they shower and change? There is a staff changing area. It would be rare that the situation described would be to such an extent that a full shower is required. If a need in those circumstances required a shower it would be likely that full change was needed and therefore we would need to offer some theatre scrubs and allow the nurse to go home and get a complete change of clothes and shower. If considered to be infected the nurses would assist each other to facilitate a change in the most appropriate area which may not be a staff change room. B) Staffing: General Observations: 1. Staff rotas were obtained for the last month. 2. Shifts (x3) day 2 trained +5 evening 2 trained + 3 night 2 trained +2 3. Two consultants oversee, Dr. Farnsworth and Dr. Beardsworth, both male, both long serving within the trust, so they know the ropes. After the consultants’ rounds, there is a multi-disciplinary staff meeting – physio, OT, nurses etc to keep everyone in the loop. We felt there was plenty of relevant expertise on hand. 4. The Ward Housekeeper has responsibility for seeing the cleaning is appropriately done. She is in the employ of the Trust.

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Members would welcome Trust comment on the following issues: 1. Continuity of care (same nurses on every morning etc) is a difficulty. No continuity of care is possible due to WTD (Working Time Directive) and IWL(Improving Working Lives).. Lack of continuity of care from clinicians, too, due to WTD/A for C. These issues impact on communication. A different/better system is required but this presumes a big cultural change. General Comments: Regarding continuity of care were that both WTD and IWL had affected the continuity which affects all areas of the Trust. However, the Department of Medicine for the Elderly has done a considerable amount of work and audit to look at this as we discussed. It is piloting a number of different ways of working, to improve communication and processes, which is intended to help overcome some of the problems this has cuased. This is being monitored by the Trust and the work shared with other areas. C) Feeding and Weight Checks: General Observations: 1. All patients are weighed on arrival. Any concerns about their consumption of food or adequacy of nutritional intake has them put on ‘food chart’ regime. This is a nursing staff decision. It involves keeping a chart at the end of the bed to log what is eaten and what is left. All food to such patients is served on a yellow tray and the domestics do not remove the tray until a nurse has assessed and recorded. There is the option to refer on to the dietician. 2. A nutritional assessment chart is kept for all patients and is filled in twice a week. 3. Patients on a ‘food chart’ regime are weighed twice a week. Others are weighed weekly. 4. Though it is reassuring to hear that weight-checks are done, we wondered how faithfully this was carried out. We did not ask to see the charts. Some patients would lose weight because of their illness – e.g. cancer. Perhaps weighing with frequency might alarm the patient in such cases? 5. In the rare eventuality of there being a shortfall in food delivered to a ward, all staff know how to get further food to ensure everyone is fed. D) Wounds/pressure sores: General Observations: 1. There are few instances of patients with pressure sores. Should one be encountered, the wound is documented for size and depth. The woundassessment chart is kept up at each dressing-change. A pressure-mattress
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can be got routinely from stock or via leasing. The tissue-viability nurse rates acceptable percentages. Of all the link-nurses, the role of Tissue-Viability Nurse is the best developed and strongest. 2. Patients can bring their own pillows, bed clothes, if they are more comfortable with these. E) Re-admission rates: General Observations: 1. These are monitored by the consultants. Any regular re-attenders are referred to the Chronic Disease Management team. F) Discharge procedures: General Observations: 1. If a patient is going to her own home, the ward arranges transport, medication, contacts relatives, ensures access to the house via key/key code, will provide food parcel as starter pack, provides dressings, anything a diabetic would need, any modifications to the home or re-arrangement of furniture, like getting a bed downstairs. The ward contacts the District Nurse. 2. There are only three Discharge Nurses for the Trust. If the patient is going to a care-home, the ward liaises with this home. If it is obvious on admission that the patient will need a care home on discharge, the ward liaises with Social Services, who are given regular updates. 3. There is a Discharge Board and Checklist which enables each stage of the discharge plan to be tracked and signed off. These stages are also recorded in the patient’s notes. G) Information given to relatives on admission of patient: General Observations: 1. A leaflet details the ward phone number ,who’s who, visiting times, laundry arrangements, and what food can be brought in. No-one was sure if the leaflet explicitly said that relatives were welcome to come and assist feeding, despite the ward being designated for Protected Mealtimes. Conclusion: Overall, we were re-assured by what we saw. The impression was of a clean, fairly spacious, pleasant environment, with adequate staff, working in a calm and efficient manner.

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Members would like to thank Ms Sandra Forsyth, Nurse Manager, Ms Sally Yearnshire, Junior Ward Sister and Ms Linda Naylor, Ward Housekeeper for showing them around. Distribution to: H&EYH NHS Trust Staff: Ms S Forsyth, Nurse Manager. Mr S Greep, Chief Executive. Ms B Osborne, Director of Nursing. Dr D Hepburn, Medical Director. Ms E Thomas, Quality & Clinical Governance Manager. Ms L Girardier, Director of Clinical Effectiveness. Ms S Yearnshire, Jnr Ward Sister, Ward 5. Ms L Elrick, Nurse Manager Medical Division. Mr M Howell, Communications Manager. Media: Hull Daily Mail. Radio Humberside. For further information on the work and remit of the Patient and Public Involvement forum for Hull & East Yorkshire Hospitals, please contact: Forum Support Organisation, North Bank Forum, Titus Salt House, Newland, Cottingham Road, HULL HU6 7RJ. Tel.No. 01482 499043. e-mail: cppih@nbforum.org.uk

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