Betsi Cadwaladr University Health Board Board Paper 28.11.13 Item: 13/183 Subject: Summary or Issues of Significance Patient Story : Mixed Sex Accommodation This story was recorded to gain an understanding of a relative s perspective of an elderly relation being nursed on mixed sexed accommodation. Mixed sexed accommodation also features as a problem in the results of the Picker Inpatient Survey 2012/2013. Therefore organisational wide information has been explored to gain a wider perspective of patient experience in relation to mixed sex accommodation. This information is also recorded as part of the story transcript attached and has influenced the five recommended actions for improvement. Strategic Theme / Priority / Values Francis Report recommendations addressed by this paper Relevant legislation or Standard for Health Services This section is mandatory due to legal requirements Equality Impact Assessment (EqIA) Making it safe / better / sound / work / happen Francis Report recommendations: 255 Using Patient Feedback Health Care Standard 5: Citizen Engagement and Feedback The Board and its Committees may reject papers/proposals that do not appear to satisfy the equality duty. See http://howis.wales.nhs.uk/sitesplus/861/page/47193 1.Has EqIA screening been undertaken? Yes the Patient s Story framework has undergon EqIA (If yes, please supply a copy) 2.Has a full EqIA been undertaken? (If yes, please supply a copy) No- 3.Please state how this paper supports the Strategic Equality Plan Objectives: http://howis.wales.nhs.uk/sitesplus/documents/861/sep_0412_e.pdf 4.Please include a justification if no EqIA has been carried out:
Recommendations: (e.g for Committee approval or for noting) Author(s) Presented by That the Board receives this story for information and the Quality and Safety Committee receives regular updates against improvement actions identified Diane Henderson Patient Satisfaction and Information Manager Mrs A Hopkins, Executive Director Nursing & Midwifery Date of report September 2013 Date of meeting 28.11.13 Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board
Betsi Cadwaladr University Health Board Patient s Stories Transcript Form Who took the patient s story: Name: Diane Henderson Patient Satisfaction and Information Manager Contact details: diane.henderson@wales.nhs.uk Tel: 01978 727125 Mobile: 07557197150 Reason for taking the story and areas covered: To enable a relative to share their feelings and perspective about an elderly relation being nursed on a mixed sexed bay (the relative approached the Patient Satisfaction and Information Manager asking to share their story). Brief summary of the story: An elderly male relative of mine was admitted to hospital (Wrexham Maelor) as an emergency patient he went via the Medical Assessment Unit (MAU) into a medical ward. The progression from MAU to the ward was really quick and impressive. He hadn t been in hospital for years so you can imagine that the urgency of his admission and the actual need for hospital care was a shock to his system. Fortunately we have a close family network and were able to support him. He was admitted to a 6 bedded bay and stayed in the same bed/bay for the five weeks he was in hospital. His overall care was faultless and his basic needs were met, so in relation to that aspect of his care I was not worried about leaving him after visiting times. As his family we all felt that we could approach the staff to talk to them. The staff were always helpful but at no time were we spoken to about why he was being nursed on a mixed sex bay and how long the bay would be kept as mixed sex. We were worried about raising our concerns about the mixed sex accommodation as another patient who had, had been moved to an isolated area of the ward. During the majority of his five week stay the bay was mixed sex. There were a lot of other emergency patients admitted into the ward for treatment all the time, approx 70% of these patients were female and on occasions there could be 4 female patients to 2 male patients.
One lady patient appeared to have complex needs and her condition meant she wandered around. There was intense input from the nurses to keep her calm. She could be very vocal and say inappropriate things to the other patients; she often talked in a provocative way. We felt that her behaviour was not her fault but a symptom of her condition. Her mannerisms frightened the other patients. She wore the hospital supplied gown which showed clearly that she wore no undergarments; this unfortunately meant that she was inadvertently exposing herself. She was unaware of what she was doing. Staff frequently asked her to return to her bed but she was soon out of it and wandering the bay again. She did not have many visitors and on occasion my relative s visitors including myself sat with her, to prevent her from wandering; we should have been spending that time with our relative. My relative felt really embarrassed about being on a mixed sex bay particularly when this poor lady was admitted. He is an old fashioned gentleman well mannered and considerate; he doesn t like to create a fuss. You could see he was struggling with the situation and his way of coping was to make a joke of things, he did not know what else to do. No matter how you cope with it, in reality the lady patient s dignity was being compromised. My relative who should have been recovering from his illness was also left to feel very compromised. I felt ashamed and embarrassed not only for myself and my relative but for this lady patient who could not help her situation. In relation to other females on the bay their dignity was also compromised, some had to use a commode and this was not a comfortable situation for my elderly relative. He often heard staff and patients discussions - not the sort of conversations he was used to. He would often tell me stories of what was said and what had been going on at night, this was another one of the ways he was able to cope with the situation. He was far more relaxed and comfortable when the bay was an all male bay. I was saddened by what I had witnessed and upset that in 2013 there is still mixed sex accommodation. I felt that the nurses were doing their best but wondered if the systems for admitting patients and the pressure for beds were working against them. Key themes emerging: Overall high satisfaction with nursing care Lack of Single Sex Accommodation Dignity and Respect Communication Systems and processes
Lessons learnt: Eliminating Single Sex-Accommodation the background: 2008, Free to Lead, Free to Care placed the onus on Ward Sisters/Charge Nurses to take responsibility for the ward environment including the placement of patients and the use of gender specific bays. 2009, all Health Boards submitted the results of a review of hospital accommodation to Welsh Government detailing the compliance in relation to single sex accommodation. 2010, all Health Boards required to further review their baseline position in compliance to the guidance issued. For ease of reference the Welsh Government Single Sex Hospital Accommodation guidance states: Other than circumstances where immediate intensive medical care is the priority (such as intensive care, coronary care, high dependency, theatre recovery and paediatric units) hospitals are required to ensure that patients are cared for in single-sex accommodation. However, in these immediate intensive medical areas there is a requirement to provide an environment in which patient dignity and modesty is protected and for the area to be managed to allow the mixing of genders to be for a limited period only. Practice in BCUHB In BCUHB the following areas will mix genders: Medical Assessment Unit Surgical Assessment Unit Acute Cardiac wards Trolley Bay Accident and Emergency Stroke Assessment Unit Wrexham (but not Bangor or Glan Clwyd) CCU, ITU, HDU Children s wards Endoscopy Theatres, Recovery wards Bays in all other wards are single-sex only and if this rule is breached permission must be gained from a senior manager. Any breaches of this rule should be reported on an Incident Reporting Form. However, an enquiry with the Risk Team has revealed that the Datix reporting system does not have a
category for breaches of mixed-sex accommodation or dignity. Therefore there is no facility to interrogate the Datix system to observe trends in these areas. Mixed-sex accommodation does not feature as a trend in BCUHB s formal concerns data. Patient s perception of Mixed-Sex accommodation The results of the BCUHB s Picker Inpatient Survey 2012 indicated that BCUHB was significantly worse that the 69 English Trusts 1 who undertook the survey in relation to Question B2: When you were first admitted to a bed on a ward, did you share a sleeping area, for example a room or a bay, with patients of the opposite sex. (BCUHB score 27% average for England 8%) Questions B4: After you moved ward to another ward (or wards), did you ever share a sleeping area, for example a room or bay, with patients of the opposite sex. (BCUHB score 32% average for England 12%) Further analysis of the Picker data demonstrates that patients answering yes to Question B2 have been admitted to the following areas: Grand Yes No (blank) Total Acute Medical Unit 37 30 1 68 Tryfan 33 32 4 69 Medical Assess Unit - Dept 12 30 15 3 48 Surg. Assess Unit - Dept U2 15 25 1 41 Acute Cardiac Unit - Dept 12 13 7 20 All these areas are assessment areas which are routinely mixed-sex within BCUHB. Question B4 asks if patients shared a sleeping area with a member of the opposite sex after moving ward, this showed that during September 2012 there were 41patients reporting that they had shared mixed-sex accommodation across a range of acute wards. To gain a comparison the Mixed Sex Accommodation statistics for England were used (there is no comparative Welsh data). English NHS Trusts routinely report 1 There is no comparative data available from other Welsh Health Boards.
breaches to the mixed sex accommodation rule and in June 2013, 25 English NHS Trusts reported a total of 198 breaches with one Trust reporting having resorted to using mixed sexaccommodation on 27 occasions. BCUHB s Picker Inpatient survey results detail comparisons by BCUHB acute site this information indicates that patients in Wrexham Maelor Hospital are more likely to share accommodation with the opposite sex when first admitted and after being moved to another ward. A Health Inspectorate Wales report into Care at Glan Clwyd Hospital in December 2012, noted that an area of particular concern was the use of mixed sex accommodation in AMU. It was acknowledged that attempts were being made to segregate male and female patients on AMU but that this was not always possible. Evidence suggests that in order to tackle mixed-sex accommodation, you need to know the scale of the problem and why it happens; that you should record and investigate each mixed-sex accommodation occurrence to identify and address its causes. Initial findings indicate that within BCUHB there is no formal process in place to systematically record the incidence of mixed sex accommodation and to identify and eliminate the causes. In some parts of the country there has been extensive investment and work undertaken to reduce the number of mixed-sex incidents. The 4 key success messages from organisations that have achieved this are: Track progress to know the scale of the problem and why it happens. Investigate each occurrence and address the causes. Improve patient flow: work across teams to assess patient journey and where delays occur Communicate with patients: give patients written and verbal information about ward or bays they are staying in and where they can find toilets and bathrooms. Design for dignity: more effective signage to say they are in single sex accommodation, full-length partitions to separate a mixed sex ward, dignity curtains that overlap. This patient s story also details an account of a female patient being nursed in a hospital gown which exposed her and compromised her dignity. Dignity Champions and ward sister are reporting that the lack of supply of nightwear on ward trolleys is a constant problem and is leading to dignity issues.
Proposed action: 1. Form a task and finish group to evaluate BCUHB against the 4 key success messages and to identify improvements for BCUHB in relation Mixed Sex Accommodation. The work of this group should be monitored by the Improving Service User Experience Committee. Progress against the lessons learnt in this story and the findings of the group to be reported to the Quality & Safety Committee and Board updated regarding progress. 2. CPG to explore the reasons why the Stroke Assessment Unit Wrexham (but not Bangor or Glan Clwyd) uses mixed sex accommodation and seek solutions. 3. Introduce a process in BCUHB for the reporting of mixed sex accommodation 4. When patients need to share mixed-sex accommodation, the clinical reasons for doing so should be explained to them and their carers. Written patient information should also be available to support the verbal advice given. 5. Laundry Manager has been notified of problems with supply of nightwear and new supplies ordered. However, this does seem to be a recurring problem. Sensitive issues to be aware of: Story teller wishes to remain totally anonymous and does not wish to name the ward their relative was nursed on.