Hello
I’m Vicky Richardson,
I’m one of the senior nurses in Care of the Elderly here at The Royal Infirmary.
As a unit we are regularly faced with caring for the dying and their families.
Because of this we have been looking at various ways that we can improve our own practice.
Initially we felt that we should be making sure that relatives were able to contact the team easily.
As many of our patients families are elderly themselves, we had to make sure that the information supplied was easy to read.
We developed a double- sided card in bold print, with contact telephone numbers of the key team members.
Also including the consultant secretaries, contact details.
Making them more accessible to concerned families.
The card is the size of a credit card and will conveniently fit into a purse or wallet.
All of our wards already have information leaflets and we have just made sure that all of the information provided is up to date and relevant contact details included.
These cards and information leaflets are handed out freely to patient’s families and carers and they are always grateful for the information they contain.
We next turned our attention specifically to ways of improving our bereavement service.
We were aware that other departments within the Royal, and places like Marie Curie centres routinely sent out cards to bereaved relatives a few week after a family member has died.
At first I was slightly sceptical about the benefits of doing it and felt that I needed to know much more about it.
Initially I spoke to Pat Dees who is one of the Ward Sisters in Cardiology at the Royal. They have been sending out cards now for some time and she explained what they did and why.
I also spoke to staff from ICU at the Royal and Staff from The Marie Curie Centre as well as trawling the Internet for information.
The more I researched, the more I was convinced that this was a good thing to do.
Current research shows that good after care of patients families can significantly reduce complaints, in some areas by up to 50%.
As things stood, we relied a heavily on forming good relationships with patients and their families, in what is an extremely stressful and worrying time for them.
Increasingly these days, patients are not with us long enough to accomplish this.
Often now due to pressure of beds, if there is a side room available it will be filled with a T.L.C. patient and there is little time to gain the confidence of distraught families.
If families have any issues with the patients journey through hospital, or care that they have received.
Often the first that staff will hear about this. Would be when a complaint is received after the death of the patient.
In the past grieving relatives left the hospital with some kind words, a medical certificate and a blue plastic bag, containing their loved ones belongings.
And that was pretty much that!
I really felt that sending families a bereavement card would help to improve things.
We set up a steering group with representatives from the multi disciplinary team to discuss things along with Caroline Pretty, our Bereavement specialist within The Trust. Then I tried to develop a system where we could send out cards to families and audit their effect.
First of all I introduced bereavement packs across acute Stroke care and Medicine of the elderly. Which are stored in a box file in the wards.
These packs keep everything handy in one place and contain all relevant documentation that the nurses need when a person has died.
They contain: - A bereavement checklist (that is a tick box
Document that ensures that everything gets
Done.
For example GP, DN, Nursing homes
Informed)
- Mortuary ID cards
- Patient Identity bands
- Infection control forms
- White card for the porters
- What to do after a death in Scotland booklet
(Relevant information for Families)
- Indemnity form
- And most importantly, our new form that
I have developed to obtain NOK address
This is crucial, as it became very apparent that since the popularity of the mobile phone. The NOK address was not regularly recorded in patients case notes like it used to be.
I have also collected as much related information as I can. EG –Info on ethnic and religious beliefs
-Final act of care
-Giving bad news
-Death registration
- Spiritual services
-Post mortem information
etc, etc
Basically
All information that staff may need to obtain quickly rather than having to look on the intranet.
This gets stored in the box file alongside the bereavement packs
So most importantly now we have the paperwork in place to ensure that if at all possible we can easily obtain NOK contact details.
We can usually tie this in with the hospitals indemnity form which relatives need to complete on collection of their relatives valuables and belongings.
This contact information is then filed in each wards Bereavement folder and we use a diary system to organise the sending out of cards.
Any information I could obtain about the most appropriate time to send out a sensitive card like this was at best sketchy.
So I decided to stagger the sending of them from ward to ward and monitor any change in effect.
We chose a lovely card to send and after obtaining the correct copyright we were ready to go.
But deciding what to say caused a few headaches and I’m still not sure that we have got it exactly right.
At the moment it reads: -
Dear Mr…………,
We offer our sincere sympathy on your recent loss and understand that this is a difficult time for you and your family.
You may still have some unanswered questions and if it would be helpful to discuss things, we would like to offer you the chance to meet with the Consultant and myself.
If you would like to take this opportunity then please contact the ward receptionist on (0131)………………..
The ward Charge Nurse signs the card. Then the housekeepers and myself make sure that they are sent out at the correct time.
We record any correspondence from relatives on their details sheet in our Bereavement folder.
As you can imagine auditing something like this is very tricky.
Mostly you never hear from the people again
Sometimes you get a phone call or a card saying thanking us for the card we have sent them.
Occasionally we have been called up and asked about small worries or questions that families have.
Very occasionally families have made an appointment to come in and see us.
These are the people we are aiming to catch, as these are the people who are most likely to complain if they have any unresolved issues.
They may not put pen to paper immediately but perhaps after a lonely Christmas, or after the birthday of there loved one. This may be the time they decide to write.
Obviously something as delicate as this is full of pitfalls and we have been finding this out and modifying things as it happens.
-There is always the risk of human error – so we make sure that all cards are double checked before sending them out.
We treat them like a controlled drug.
-There is also the possibility of a stranger picking up the phone and giving an inappropriate response.
We have considered using an answering machine but this seems a bit impersonal.
So we are now looking at taking the calls through the bleep holder as they could genuinely say that ‘they didn’t personally know the patient but they would arrange for an appropriate person to call them back to arrange a meeting’.
This would buy the ward Charge Nurses a little bit of time. As I feel at the moment they can sometimes be put on the spot.
-There is also the danger that the nurses will not remember the patients who has died. As with 36 beds and a high turn over of patients plus 12 & 1/2 hour shifts, holidays etc. It is very difficult to remember everyone.
We almost need a photo on their case notes to remind us!
Even getting a hold of deceased case notes at the moment is problematic, and we are looking into ways that we can improve this.
But even going over all of these pitfalls it still seems like a worthwhile thing to do.
We have only been doing this for a few months now,
We have had a couple of people come in for meetings with very positive outcomes.
We have possibly fielded a couple of potential complaints.
We have certainly been able to allay people’s fears and anxieties as they worry about silly things sometimes. Things that you wouldn’t necessarily guess.
And it has enabled us as a team to reflect on our own practice as we keep detailed records of all meetings and conversations.
For me personally it is going to be a very tough thing to audit but I will carry on with detailed record keeping and possibly in the future survey the staff about their own personal experiences.
Overall though I do think that it is a good thing to be doing and I am now so motivated to improve our bereavement service that I am looking into other things to do.
Mainly trying to establish the trial of the Liverpool care pathway into one of our wards.
This is a pathway specifically designed to help improve documentation around patients who are in the last stages of life.
Thank-you