ENTER & VIEW FINAL REPORT

Transcription

1 ENTER & VIEW FINAL REPORT Date & Time of Visit 18 th March pm Name of Service Provider North Staffordshire Combined Healthcare NHS Trust (NSCHT) Provider of the Harplands Hospital; University Hospital of North Midlands (UHNM) Provider of the acute hospital Royal Stoke University Hospital. Premises Visited Ward 4, Harplands Hospital, Stoke-on-Trent Ward Managers Name Laura Jones We also spoke to Modern Matron Josey Povey (NSCHT) and Terry Bates Nurse Practitioner (UHNM) Authorized Representatives Hilda Johnson, Barbara Mawby. Reasons & Purpose for the Visit. This relatively new shared care initiative undertaken at Ward 4, Harplands Hospital is as yet an untried service in this area. Therefore, the objectives of the visit were to; -Learn more about the operation of shared care on this ward - To check the ward environment to ensure its suitability for the Shared Care Scheme. -To support Healthwatch Stoke-on-Trent s contribution towards the Step up and Step down New Model of Care Consultation currently being undertaken by Stoke-on-Trent Clinical Commissioning Group.

2 Overview of Ward In December 2014, it was decided by NSCHT that at that time beds on Ward 4, were surplus to requirements as the older peoples assessments are now carried out in the community by the Older Peoples Team, therefore, the ward was temporarily closed. In January 2015, UHNM experienced extremely high numbers of patients accessing services which resulted in difficulties with bed flow, discharge, and eventually UHNM declared a Major Incident. A joint decision was made by NSCHT and UHNM that Ward 4, Harplands Hospital would be re- opened from January 9 th 2015, to provide additional bed capacity for UHNM patients with both physical and mental health needs meeting specific criteria with the provision of shared care. It was anticipated that this Unit would remain open until the end of March The ward has 15 beds and on the day of our visit 11 beds were occupied. The age range of patients is years old. Criteria for admission The criteria for admission to this ward includes elderly, frail, patients with several comorbidities also suffering from mental health problems such as dementia /cognitive issues who were being treated at UHMN (Royal Stoke site) but considered as no longer requiring an acute bed. They would be medically stable for discharge but needing some additional help prior to discharge. Suitable patients are selected from all areas of the Royal Stoke site. Methodology We spoke to staff patients and visitors and had a look around one of the bedrooms, went into one of the quiet rooms and also went into the dayroom which is where we spoke to most of the patients. Staffing These were at the time of our visit. Staffing is provided both by NSCHT and UHNM, with a wide skill mix. It includes a Medical Geriatrician, an Advanced Nurse Practitioner, 2 RGNS and a Discharge Facilitator, Decision to support nurse from UHNM. Other staff included a Psychiatrist, Ward Manager, a dual qualified Nurse, RMNs,O/Ts and Physiotherapists from NSCHT.

3 The Ward also has visits from a Psychiatrist, a Geriatrician, Occupational Therapists, and Physiotherapists. Staff Training Staff are already experienced to nurse patients on the ward these include 1 band 6 and regular clinically trained staff and the Modern Matron told us that they were looking at the End of Life Care policy and Do Not Resuscitate (DNR) policies. Treatment The Advanced Nurse Practitioner informed members that MEWS (Modified Early Warning System) scores and blood tests are done daily so that patients could be monitored for any health deterioration. Occasionally some patients have to be returned to the UHNM for further treatment. Discharge The average length of stay is 12 days which, we were informed is now possibly longer than before as the clients have become more complex. Members were informed that patients actually want to stay on the ward. Some patients may be taken home for the weekend (with their beds kept open) to assess how they would be able to cope and so that an accurate care package could be sorted out. Discharge care packages were arranged from a week onwards. We were informed that in the past this would take longer for out of area patients, but recently a County Social Worker had been employed which would expedite discharge arrangements. Environment The ward appeared light, clean, well-decorated and with attractive floral paintings on the walls. Each patient has their own single bedroom (some en-suite) with male/ female bedrooms in two separate interlinking rows. Members were informed that bedroom doors were locked when the rooms were unoccupied to prevent other patients wandering in. HJ suggested that picture signs might be added to each bedroom door which is done on Ward 6 at Harplands for easier identification for patients. Each bedroom had a wash hand basin with special dementia friendly taps and toilet and shower doors were painted a very bright yellow for easy identification.

4 Amenities The Unit includes a Doctor s Examination Room, a Kitchen, a Dining Room, and both a Ladies (with reminiscence cards, a television and radio), and a Mens Quiet Lounge. Outside the Ward there is a reasonably sized garden with grassed areas, garden seats and a summerhouse, which, with a little work in summer could provide a wonderful recreational and activity area for the patients. Comment sheets are available on the lounge door, although no PALS/ Complaints leaflets were seen. Activities Members were informed that patients did not have to get out of bed at a set time (although it was limited to be by 10.00am) and then could either have a bath or shower, (Members were informed that one patient hadn t had a bath for months until he came to this Unit) and dress in their own clothes. Tea and medication were then available in the lounge followed by breakfast in the Dining Room. During the day there was Occupational Therapy and Physiotherapy if needed and various activities. A jigsaw was seen to be in progress, and we were informed that on the day prior to the visit some ladies had made cakes. Open visiting times occur. Meals/ Food Although patients do not choose their meals from a menu the day before, staff do order a variety of meals each day. Pictorial menus, which are changed daily, are displayed in the dining room. Staff can order other food if necessary depending on patients needs and whether they need a special diet, dietician input is provided by UHNM. Staff told us that diet and hydration are very important and they work with relatives to explain this. Relatives are involved in choosing meals provided as they know what food their relative likes. Drinks are readily available and at the time we visited patients had a drink and biscuits and cakes were available. Patients Privacy, Dignity and Respect The patients we spoke to were very positive about the ward and we saw no evidence to suggest that patients privacy and dignity was affected in any way in fact one patient

5 became upset while we were there and staff took them into the quiet room for some privacy. Medicines We didn t see any medicines dispensed while we were there but were assured by staff that any medication was given at the right time. Complaints We received no complaints during our visit. Feedback from Patients/Residents/Relatives/Carers/Staff We were able to speak to a number of staff, patients and visitors. All the staff spoken to were extremely enthusiastic about the Ward and enjoyed working there, one saying that she really loves it. One female patient said that she was very comfortable and that she was well looked after. She thought that she had been in for about 8 weeks and said that it felt a bit strange at first but that people are very kind, very good- can t fault them in anything. A relative said of a male patient: It s brilliant. Acted better since he s been in here they re trying him with different medication. One patient said the staff were really good and the food was lovely. We spoke to some of the visitors who said it was much better for their relative as the ward was much calmer and the fact that he was able to wear his own clothes and move around more was good for him. They also said that because visiting time was open it meant they could visit at a time suitable for them. Staff said that patients on this shared care ward were able to have home leave where staff could assess them better and had meant that some were able to return home rather than going into a care home or nursing home, this option wasn t possible at UHNM. Summary Ward 4 provides a quiet, calm, caring environment for patients; a step down for patients who no longer need an acute setting but may need some further help, towards physical and mental improvement including any medication reviews.

6 It provides shared care which works well with the appropriate skill mix to help patients with both physical and mental health needs. The time spent here also supplies the opportunity to ensure that an accurate, suitable care package is provided so that instead of moving directly to a Care Home patients may be given the opportunity to live more independently and happily at home. It was interesting to note that all staff, patients, and relatives spoken to were all very enthusiastic about the Ward, the only difficulty being that some patients wanted to remain there. Recommendations/Comments Not being able to find PALS or Complaints Leaflets. They may be there but not obvious. The possible use of pictures on bedroom doors to make it easier for patients to recognise their room. Although we are aware that this is a new service more information and leaflets could be made available for visitors. A garden update on improvements. Staff said that there was much more they could do to improve the ward environment and develop services more but at present this wasn t possible until it was known whether this model of shared care would continue, so it would be useful if any decisions on the Shared Care could be made quickly. Our thanks to all the staff and patients that gave up their time to speak to us and show us around on our visit.