RNOH PPI Forum
Margaret Harte Report
Subject: Fact finding visit to Margaret Harte Ward
Date:20th November2007, 10.00 am – 11.45 am
Forum members:Angela O’Halloran & Ruth Marcus
Staff interviewed: Clare Cassidy Ward Sister
Introduction
Margaret Harte is an 18-bedded ward for female patients. Admissions are mainly for complex orthopedic surgery i.e. reconstructed surgery (especially shoulders and knees), and spinal deformities.
Patient’s length of stay vary from overnight to a month or more, but on average are usually a week or two. The ward is usually 100% occupied.
There is a single room used for patients requiring screening for infections, occasionally the room is used for male patients when wards are full elsewhere in the hospital. Unfortunately the room does not have its own toilet which can create problems for the ward.
Although the ward is fully staffed (17 full-time equivalent), only 2 trained nurses and one assistant staff are usually on duty due to an increase in more complex surgery, more staff are required especially at night and at weekends.
The ward is piloting (as is the Duke of Gloucester ward) a new rota system for nurses, that involve 12+ hours per shift (long days), 13 shifts over 4 weeks and a rotation on nights. It is half way through a three-month trial. The sister is concerned that it has reduced continuity of care and some staff have increased stress which could also increase sick leave. Other staff find it difficult to fit their shifts in with childcare arrangements. Some staff (including Clare, the ward sister, have been able to remain on normal shifts by negotiation with HR. Perhaps this could be made available to all staff who cannot manage long shifts.
Training (including mandatory) is often not completed on time, or cancelled by the Training Department. The sister has made a request to the training department to organizetraining on 1 or 2 complete days, rather than staff trying to fit around their shifts.
Clare is particularly pleased how her team have enjoyed working on the Essence of Care Initiatives.
Another new initiative is the use of electronically produced handover notes. The staff’s computer competency varies and it can take time to complete, and Clare is concerned that important information regarding a patient’s clinical care could be missed. Clare prefers the previous system, discussing the handover face to face with the staff concerned. This pilot scheme has not yet been evaluated.
Special information on a patient e.g. allergies, heavy patients are emailed to the ward before admission. Allergies are noted on the drugs file. They do not use “red bands” on the patient’s wrist, but Clare thought this might be a good idea to introduce.
Meals have improved since the introduction of Steamplicity, although choice can be limited if patients are in for several weeks.
Observation
The ward has been recently refurbished and is therefore brighter and appears cleaner than some other wards previously visited.
The toilets and showers were clean, but the sister would like to have an additional shower room, but there is no space available.
Staff rooms are very small, but they did have lockers. Kitchen, sluice room and storage rooms were clean.
The patients day room is very cluttered and being used as a storage area (apparently due to lack of storage space elsewhere on the ward). The television has a poor aerial connection and an annoying noise was noted due to interference.
The day room did not seem to be a restful or an inviting room for patients or their visitors.
The ward is bright and there appears to be adequate space between the beds.
The bedside lockers were observed to be in good condition and patient’s medication is locked in the top drawer, and therefore a drugs trolley is not required, all medication is administered by the nursing staff.
Confidentiality is an issue with the nurses’ station as it is so near the patients’ beds.
Interviews
Patient 1
Mrs V
Mrs V was interviewed in the day room. Mrs V has had rheumatoid arthritis for many years and due to the illness and medication side effects, she stated(to use her words) “….my body is crumbling”. Mrs V is in the ward for spine surgery and wears a brace. She has had many reconstruction operations at RNOH and other hospitals, including 5 shoulder operations and is awaiting knee replacement.
Mrs V was generally unhappy with her care, and seemed very low. She wanted to go home and try and manage, rather than be transferred to a local hospital. Mrs V said although the surgeons were very good, she felt the nurses did not respond to her needs. Mrs V reported that the toilets were not clean and she tried to clean them herself. She was upset that the patient’s room was cluttered and the TV did not work. She was generally unhappy that the NHS was not as it used to be.
Patient 2
Mrs A
Mrs A had been on the ward since early November for a knee reconstruction. This was her fifth operation on her knee. Previous operations had been at her local hospital in Hackney, and she was glad to be in RNOH. She is very pleased with the medical care and said the nurses were very good. Mrs A said that she never had to wait long for attention, either to go to the toilet or for a cup of tea. She would have liked a sink nearby, so she could wash her hands. Mrs A thought the meals were not too bad, but not tasty enough, and limited choice. Generally Mrs A was pleased with her care on Margaret Harte ward.
Conclusions
Clare appears to be a good leader. Clare and her team work hard to provide good care to their patients. The atmosphere on the ward appeared very positive.
Concerns and Recommendations
1The Day Room needs attention; can any other storage space be found? Can the TV be repaired?
2Clare would like a new workstation, with space for printer and fax, at the moment the printer and fax are in the manager’s room and the PC on the workstation in the ward.
3Confidentiality is a concern, due the proximity to the patients, and the sister has raised this issue.
4An extra shower room is required, but may need to wait for a hospital rebuild.
5Although fully staffed, the allocation of staff needs reviewing, due to the increased complexity of surgery and dependency of the patients, especially at weekends and nights.
6There are concerns from the sister that the pilot scheme regarding long day-shifts has reduced continuity of care, increased stress and created child care problems, can this be reviewed?
7The pilot scheme regarding electronic handovers has increased the possibility of incomplete information, which could compromise patient care. Can this be evaluated?
8Could there be a review how allergies are managed. Could the introduction of red wristbands be piloted?
9Could training be organized on whole day (s), which would be beneficial to staff and ward. Staff could absorb information without worrying about returning to their shift. This has been previously raised by Clare.
Report compiled by Ruth Marcus and Angela O’Halloran.
Margaret HartePage 1 of 3November 07