CLINICAL INVESTIGATION UNIT & INFUSION BAY
ORIENTATION PACK
WELCOME TO THE CLINICAL INVESTIGATION UNIT & INFUSION BAY
Welcome to the Clinical Investigation Unit & Infusion Bay currently located in ward 31 Ninewells Hospital. This pack is designed to enable you to settle into our Unit.
We hope it is helpful.
Please note that handbags & personal belongings MUST be locked away and not left lying in the coffee room. A locker is provided for your use. Anything not locked away will be your own responsibility.
HISTORY
The original CIU unit on level 5 was opened in February 1997.
The purpose of CIU is to expedite investigations, tests and treatments requested by all specialities with in the Medicine Directorate and work flexibly to accommodate other specialities out-with Medicine and to prevent/delay admission to Acute Wards by treating and managing long term conditions. The Clinical Investigations Unit provides a less stressful more peaceful setting without the conflicts and challenges found in an acute setting.
Before the unit opened some of these non-urgent investigations had to be postponed due to bed
shortages as emergency admissions naturally took precedence.
The unit started to take 12 short stay medical patients (SSM) from approx 2013 and a separate Infusion Bay was set up to accommodate day case therapies which did not require a bed. This was located in a bay within ward 33.
In winter 2015 the SSM beds were temporarily transferred to ward 16 to create a SSM ward which could flexibly increase the number of patients from 12 – 18 dependant on capacity. CIU remained in level 5 where the infusion bay was reintroduced which freed up a further 4 beds for use by stroke. After the initial winter pressures resolved it was agreed for SSM and CIU to remain and operate as separate wards for the immediate future. This allowed a higher number of beds being available for medicine and a dedicated ward space for CIU.
At present CIU & Infusion Bay is to remain in ward 31 for approximately 9 months (approx May/June 2017).
THE UNIT
Bay 1 accommodates 8 chairs and is used for the Infusion Bay. Typical infusions include Iloprost, Infliximab and Ferinject. Specialties treated by the infusion bay include rheumatology, renla, GI, respiratory and pre-assessment patients.
Bay 2 comprises 4 chairs and 2 trolleys. This bay is used for cardiac catheter patients, lung biopsies, battery changes and day case tests/investigations.
Bay 3 contains 6 beds and the 6 single side rooms are used for patients requiring overnight stays from 1 – 4 nights. Examples include colonoscopy, 48 hour fasts and iloprost.
We function as CIU & Infusion Bay from Monday 0730 until Friday 1930. We close at weekends and public holidays.
We have one treatment room that we use to assess patients and insert PIC/grippers etc.
Patients are admitted from waiting lists and fast track clinic. They are booked in by the ward Secretary although some negotiation can be used with the nurse in charge to accommodate urgent cases.
THE NURSING STAFF
The Senior Charge Nurse is Fiona Kennedy.
Cath Meldrum – SN
Suzy Ferguson – SN
Sue Moir – SN
Cat Davidson – SN
Emma Curry – SN currently on M/L
Janet Bell – SN
Lori Clark – SN
Jimmy Etchels – SN
Lacey McKenna – SN
Fiona McCluskey – SN currently on S/L
Laura Hay – SN
Vikki Murray – SN currently on M/L
Lesley MacDonald – SN
Blaire Small – HCSW
Christine Smith – HCSW
Pamela Armit – HCSW
Carly Petrie – HCSW
Sheila Welsch – HCSW
Arlene Leahy – HCSW
Gill Williams – Ward Assistant
Louise Devine – Ward Secretary
The team are extremely well experienced with many advanced skills. The nursing staff are responsible for cannulation, phlebotomy, gripper needle insertion and port a cath care, PIC line insertion and care and we have one non medical prescriber (SCN). The nursing staff monitor blood results and undertake some clinical assessments of patients. Alongside this, the HCSW's within the CIU team also have extended skills such as venepuncture, NEWS monitoring, 12 lead ECG taking etc.
It is unlikely that you will come across such a team in other areas. Please use this to your full advantage and consider the skills of the team and how you can learn from all the team members.
You will be allocated a mentor during your placement and it is your responsibility to ensure you have learning objectives ready to discuss with them. Please take the time to give some thought to your objectives and how you plan to achieve them. Please respect the time and experience available to you to ensure you get the most out of this placement.
The role of the mentor is broken down into 3 main components
1) ORIENTATION
2) SUPPORT/GUIDANCE -Through the experience of the mentor you will be given support and education.
3) OBJECTIVE SETTING / APPRAISAL - The mentor should facilitate the setting and achieving of both core and specific objectives. Teaching by the mentor is important but you will be encouraged to decide on your own personal learning objectives as this shows initiative and drive.
Mentorship is a partnership to allow a good and productive working relationship between both preceptor and colleague.
YOUR MENTOR IS.:……………………………..
THE MEDICAL STAFF
CIU is predominantly a nurse led unit. Patients have been seen at clinic and invited to attend for an elective procedure. Infusion bay patients are either on a rolling programme or referred via clinic.
The CIU patients are under the care of their named consultant and it is the medical staff in their consultants appropriate wards who undertaking clerking/prescribing. Some patients have no need to see medical staff whilst here but are admitted, cared for pre/post procedure and discharged all by the nursing team. There is currently one nurse prescriber within the unit and all staff are encouraged to escalate concerns or issues to the parent ward team if unable to resolve themselves.
THE UNIT SECRETARY
Louise Devine- she is responsible for appointing patients into the weekly schedule. She liaises with the team to determine whether patients can be fitted in to the planner or not. Louise is responsible for ensuring all appropriate medical notes are requested for patients and liaising with patients on the phone.
PHILOSOPHY
The Clinical Investigations Unit & Infusion Bay is a unique area.
Our purpose is to create a relaxed and caring environment. We strive to reduce fears and anxieties by providing support and information therefore promoting informed choice.
As a team we believe in respecting individuals’ rights and the decisions they make. As partners in care we aim to mutually identify and assess individual needs, which will allow us to deliver high quality patient centred care, which is evidence based.
Our goal is to encourage a comfortable and friendly atmosphere.
CLINICAL INVESTIGATIONS UNIT& INFUSION BAY
STAFF VALUES
High quality of care at all times.
Ensure confidentiality.
Open and honest with each other, no bitching/talking behind each others back.
Be punctual.
Respect each other and other disciplines
Supportive environment
Feel safe.
Have fun
Challenge each other
First tea break 09-30
Second tea break 10-00
First lunch 12-30
Second lunch break 12-30 to13-00
First afternoon break 14-15
All input valued
Work as team
Be non-judgemental
Flexibility in crisis
Staff not to moan or be too serious.
Bank/pool staff to be made welcome at all times.
Ensure day cases have choice of meal.
Tidy up after yourself.
Liaise with secretaries re notes and x-rays.
Time to vent feelings and thoughts.
PHILOSPOHY OF EDUCATION WITHIN CIU
We are committed to provide and maintain a quality learning environment for registered, unregistered and student nurses. Students are encouraged to develop the knowledge, skills and attitude to competently deliver care under the supervision of a registered practitioner.
We encourage students to ask questions and will always try to answer them. However, we expect the students to assist with their own learning by developing a questioning approach and setting goals. We look forward to hearing their views and suggestions about how we can improve the learning experience for our students. Questionnaires are to be completed at end of every placement.
We will treat students as individuals acknowledging their needs and encouraging them to feel part of the care team by involving them in assisting and directing healthcare professionals in providing nursing care.
We will treat students with respect and recognise and value the contribution of all students in the process of planning and carrying out patient care and assist them to achieve/maintain knowledge and skills in order to provide safe and effective care.
We aim to work in partnership with the university in order to maximise the provision of an enjoyable and effective learning environment for nursing students, in order to advance knowledge and skills, which will benefit our patients – current and future.
ORIENTATION CHECKLIST
- Introduction to other members of Ward Team and identify other members of the team.
- Tour of the Unit to locate:
- Emergency buzzers
- Cardiac arrest trolley
- Fire extinguishers
- Fire alarm
- Fire blanket
- Location of
a) Policy Manuals
b) Ward Protocols
- Allocation of valves oxygen/air
- Discuss Ward Philosophy
- Set date for discussion of objective
Signature of Mentor……………………………………………
Signature of Nurse ……………………………………...
Date………………………
LIST OF COMMONLY USED TESTS/INVESTIGATIONS
RENAL
Renal biopsy A tissue sample of the kidney is taken under local anaesthetic and sent for analysis.
GFR “Glomerular filtration rate”, calculated following an injection of radiopaque dye and the collection of blood samples at set times.
Renal angiogram A catheter is inserted through an incision in the groin and fed
through the main artery to the kidney where dye is injected,
the blood supply to the kidney then becomes apparent under x-ray
conditions.
RESPIRATORY
Bronchoscopy a bronchoscope is passed via the nose or the throat into the lungs
and into the bronchi for examination. Biopsies, brushings and
lavages can be performed during this procedure.
PDT “Photo dynamic Therapy”, a laser treatment used via the
Bronchoscope to reduce the size of a tumour. Patients must not be
exposed to sunlight during treatment.
Lung Biopsy a small part of lung removed under ultra sound scan.
Thoracosopy a small endoscopic camera is inserted through incision made in
side to allow samples to be taken
CARDIOLOGY
Cardiac Cath “Cardiac Catheterisation”, also called coronary angiogram. A
catheter is inserted through an incision in the groin and fed
through the main artery to the heart. A radiopaque dye is then
injected into the blood supply which makes the blood supply to the
heart muscle apparent under x-ray conditions.
Percutaneous Coronary As above for coronary angiogram. Plus the narrowing's are Intervention(PCI) stretched with a balloon, and a metal mesh scaffold(stent)
is embedded in the vessel wall.
Cardioversion an electrical countershock to restore a normal “sinus” rhythm.
Carried out under general anaesthetic.
TOE “Trans-oesophageal echocardiogram”. A camera is passed down
through the oesophagus to behind the heart where an echo probe
picks up sound waves to produce a picture of the heart and valves
Pacemaker Insertion Performed under local anaesthetic. One or two wires are inserted into the chambers of the heart through the sub clavian vein. The
wires are attached to the pacemaker box, which lies under the skin
On the front of the chest, just below the collar bone
ENDOCRINE
On Tuesday mornings we often carry out various endocrine blood tests. These tests take from 1-4 hours and include
SST Short synacthen test
TRH thyrotropin releasing hormone
LHRH leutinising hormone releasing hormone
ITT insulin tolerance test
GTT glucose tolerance test
CPFT’s complete pituitary function tests – which include: TRH, LHRH,
ITT
GASTRO-INTESTINAL
OGD “Oesophageal gastroduodenoscopy”. Also called gastroscopy.
This is an endoscopic examination of the upper alimentary tract.
Colonoscopy This is the use of a fibreoptic colonoscope to view the colon
Flexible Sigmoidoscopy This is the use of an instrument to view the rectum and sigmoid
flexure of the colon
ERCP “Endoscopic retrograde cholangiopancreatography”. The
introduction of a contrast medium via an endoscope into the
pancreatic and bile ducts – During the procedure stones can
be removed, sphincterotomies can be done, or stents can be
inserted.
PEG “Percutaneous endoscopic gastrostomy”. A surgically established
opening between the stomach and abdominal wall for artificial
feeding.
Liver Biopsy a small part liver removed under ultrasonic scan.
Barium Enema X Ray examination of the large bowel. Barium is passed through a
tube in the rectum then films will be taken.
Oesophageal Dilitation same as OGD, then small balloon within endoscope is inflated to
stretch oesophagus. (Bougie may be used)
Oesophageal Banding same as OGD, then bands attached to varicies if required.
Oesophageal Stent same as OGD, then stent inserted via endoscope at identified
stricture
F Kennedy Senior Charge Nurse and work colleagues
CIU UPDATED Sept 16
SBAR
For good communication about patients between all health professional use the SBAR tool.
Before call:
1) Assess the patient
2) Know the admitting diagnosis
3) Read the most recent progress notes and the assessment from the prior shift
4) Have appropriate documents available, eg nursing and medical records, SEWS chart, drug Kardex, allergies, iv fluids and resusication status.
Situation State your name and unit
I am calling about Patients name
The reason I am calling is:
Background State the admission diagnosis and date of admission
Relevant medical history
A brief summary of the treatment to date
Assessment State your assessment of the patient
eg vital signs, SEWS score, mental score etc
Recommendation I would like (state what you would like to see done)
Determine timescales
Is there anything else I could do?
Record name and contact number of person you are speaking to.
DON’T FORGET TO DOCUMENT THE CALL IN THE NURSING NOTES
This is a working example
You are calling parent ward.
Situation Hi this is nurse brown from CIU
I am calling about Mrs Patient, give DOB and CHI
The lady has a temperature of 39 degrees
Background This lady came in yesterday for an ERCP which she had today
with sphincterotomy
Assessment She has a News of 4 due to temp and pulse of 113.
Recommendation I would like you to review this lady, within the next hour. I have administered paracetamol and taken bloods including
amylase.
Is there anything else you would like me to do for this lady?
F Kennedy and work colleagues
CIU
Updated Sept 16