FoNs Developing Practice Programme: Enhancing the Patient Care Environment in Partnership with the Department of Health

Transcription

1 FoNs Developing Practice Programme: Enhancing the Patient Care Environment in Partnership with the Department of Health Introduction The Emergency Department The Adult Emergency Department at the Bristol Royal Infirmary treats 62,000 new patients per annum, this equates to between patients a day. The department comprises of a minor end (6 cubicles, major end, (11 cubicles), observation unit (8 trolleys) and resuscitation room (6 bays) The nursing team comprises of 66WTE nurses and is led by a matron and nurse consultant. In line with the Department of Health emergency access targets, the staff work hard to deliver quality healthcare within the 4 hr emergency access target for all patients. Why we applied for the programme The department cares for distressed relatives every day of the year. An audit of dependency demonstrated that on average 14 patients are treated in the resuscitation room every day. The allocated relatives room is situated a short distance away from the resuscitation room and relatives of patients who are being treated in the resuscitation room are asked to wait in this room. While there is an enormous amount of evidence and literature available to inform our practice when caring for distressed or bereaved relatives, there has been little work undertaken to inform staff in emergency care how a relative s room should be furnished. Relatives may feel as though they are waiting for a very long time to hear worrying and potentially life changing news about their sick or injured relative and we are keen to provide a room which is as calm as possible and makes the environment in which they are waiting for potentially bad news more bearable. The RCN & BAEEM (1995) developed guidelines for bereavement care in emergency departments based on a review of the available evidence around death, dying and bereavement in A&E departments in England & Wales. They found that while there were examples of good policy and practice, considerable shortfalls were found for

2 example in the environment in which relatives had to wait for news of their relative. They found that facilities were often not private and were variable in providing essential fixtures and fittings. Aim of the project To redevelop the exiting relatives room with staff and patient/public involvement The existing project plan and progress made to date A project group was formed comprising of a nurse consultant in Emergency Care, 2 x band 7 nurses, a band 6 and 2 x band 5 nurses. Project group formed Literature review Meetings with JW Consult staff in ED Values & beliefs exercise with staff Collate themes and feedback from staff Patient & public questionnaire sent out Collate replies Interior design ideas/plans Quote from works department FoNS & DH meeting London Collate themes and revisit original ideas Develop task list & project plan for room decoration Develop education programme for staff breaking bad news Develop departmental philosophy for care of relatives Benchmark room plans against essence of care care environment Write paper/conferenc e poster/oral presentation submissions Devis ed, passe d by gover nanc e Them es collat ed Pt gover nor invite d

3 May 2008 June July Aug Sept Oct Nov Dec Jan 2009 Key: Blue shading = achieved be achieved Plans for the relatives room Feb Green shading = in progress, to Mar ch Methods, tools and processes used within the project Jane Wright introduced the group to a values and belief framework in order to clarify our professional practice in relation to the care of relatives in the Emergency Department. This has been a big learning curve for us all but has produced some really interesting and helpful results. These issues such as developing a departmental vision/philosophy for caring for relatives and the need for bereavement education around breaking bad news have expanded the remit of the original project but are a valuable and necessary part of the project and clinical practice. What has gone well Public and patient involvement has been really positive. We were quite anxious about how we were going to approach relatives and members of the public in order to ask their opinion about a potentially very emotive subject. We are pleased to have a member of the patient governors joining us at our next project meeting in October. Involvement of staff in the values and beliefs exercise went better than expected and we have learned useful information about staff s educational and professional needs.

4 It has been helpful to have the input and thoughts of a patient governor on the project group. Challenges faced. Specific challenges have been in the cost of the works proposed we are going back to the drawing board about our original plans and are looking at ways of increasing funds for the renovation. Funds for a new carpet for the room have been gained by applying to the trust environmental fund. The project team will redecorate the room The company who are providing the preferred furniture have agreed to waive the VAT for the project. Current work Ideas identified were a 2 part programme with a reflective tool to allow staff to reflect on their experience to date, as well as discussion, good practice points and a DVD with examples of good and poor practice (to be delivered in lunchtime teaching sessions facilitated by RH/CF or CT) Part 2 would involve role play, Jayne(FoNS practice development facilitator) suggested the role of the relative could be played by someone the staff do not know to make it more realistic. This would be undertaken on a 1:1 or 1:2 basis for staff. Alongside this the group felt it would be helpful to develop best practice guidelines for staff in the department (nursing and medical) staff could then have a laminated card with reminders. NR to be approached to be involved The name of the room was also not resolved. Colin came up with an idea for asking staff in the department about their ideas and then we could ballot staff. Furniture being order, then redecoration and purchasing of lamps, crockery etc and distraction box for children.

5 Appendix 1 Examples of furniture