Sunderland Royal Hospital Welcome to the Acute Medical Unit (AMU) Portfolio of Learning Opportunities (POLO) Student:... Mentor:. Date:. Produced: August 2012 Review Date: August 2013 1
Contents Page Page Introduction 3 Ward Philosophy 4 Ward Layout and Facilities 5 The Unit 6 Mentors 6 Shift Patterns 7 Visiting Policy 7 Admissions 8 Transferring Patients 10 Discharging Patients 10 Staff 11 Other Members of the Multi-professional Team 11 Nurse Practitioners 12 Named Nurse 12 Common Medical Conditions in AMU 13 Diagnostic/Treatment Procedures 13 Telephone Numbers 14 Learning Opportunities 15 Learning Zones 18 2
Introduction Welcome to the Acute Medical Unit (AMU). We hope that you enjoy your experience with us and gain valuable knowledge and skills which will help you successfully fulfil your learning outcomes. We hope you take advantage of the learning opportunities to help develop and enhance clinical skills. The Acute Medical Unit aims to facilitate the assessment of those who may require emergency admission to hospital. Patient s enter the emergency assessment unit via a range of sources such as Accident and Emergency, GP surgeries, Minor Injuries Unit, Urgent Care Team, 24/7 Team, Sunderland Eye Infirmary, Cherry Knowles Hospital and sometimes consultant clinics. Patients have rapid assessment by our medical staff, necessary investigations and treatment is initiated. It is a short stay unit and once patient s are reviewed by a consultant and a provisional diagnosis has been made they are then allocated a transfer destination and are moved when the bed is available. However if upon review they are medically fit, they can be discharged straight from the unit with follow up care. 3
Ward Philosophy The Acute Medical Unit aims to facilitate the best possible nursing care for patients admitted with acute medical conditions. We believe each patient is entitled to the highest standard of care delivered by an appropriately trained and competent practitioner. We work as part of a multi professional team and appreciate each member has valuable contributions and we encourage involvement and further education. As professionals we are committed to treating patients with care and take into consideration their physical, psychological, spiritual and social needs, essentially providing holistic care. We realise the importance of providing a safe environment for both patients, relatives and staff and follow procedures and protocols to ensure guidelines are adhered too. The medical team strive to deliver evidence based care for the assessment, diagnosis and treatment of patients. We regularly review and evaluate care by means of audit, appraisal and meetings to enhance and improve the care we deliver. 4
Ward Layout and Facilities The unit comprises of fifty beds of which there are seven six bedded male and female bays and eight side rooms. Each bay has piped oxygen, wall suction, hand-washing facilities and each bed has its own personal television. There are also sufficient washing and toilet facilities throughout the ward. The WRVS trolley visits the ward on a daily basis to offer snacks and newspapers. There are information racks on the entrance and exit to the unit which provide useful leaflets for patients staff and relatives. We have GP awaiting area which patients can wait until a bed is available on the main ward. This is ran by nurse practitioners and is available 8am until 10pm. Attached to AMU we have the Rapid Assessment Treatment Unit (RATU) and a Surgical Assessment Treatment Unit (SATU) which is ran by Nurse Practitioner s. These areas of care help the quick assessment of patients with a medical or surgical condition and aims for fast track treatment to enhance patient flow and reduced the amount of inappropriate admissions. We have a Deep Vein Thrombosis Clinic (DVT) that is attached to the unit which is nurse led. Patients can be fast tracked by GP, A&E, walk-in clinics and bloods can be taken and an ultrasound scan can be arranged according to clinical need. 5
The Unit A staff nurse is allocated a bay and two connecting side-room s per shift. In principle each shift has seven staff nurses and up to five health care assistances. The co-ordinator, usually the most senior nurse on duty will oversee the running of the ward and their responsibilities consist of range of duties. They are responsible for the skill mix and the staff ability. They are made aware of the acutely ill patients and help deal with them effectively. They allocate patients to beds available within the hospital and handover patients to appropriate wards. Generally they deal with any problems which arise on the unit. We have a bed bureau system which take referrals from departments that require admissions and then the allocations of these are made with the help of patient flow co-ordinators (formally known as bed managers.) They liaise with other wards to create beds and facilitate movement. Mentors Before starting placement on the unit you will be assigned a mentor whom will guide and support you through your placement. Your mentor will be a permanent member of staff and will have successfully completed the mentorship course. As they have been prepared for this role they will be familiar with the competency system. The assigned mentor will help the student develop their knowledge and skills under close supervision. They will help inspire and motivate the student and encourage participation to achieve learning opportunities. It is expected you work with you re a mentor for a minimum of 50% of the time and when your mentor is not available you will work with you co-mentor. Due to personal commitments shifts are negotiable within reason although required hours must be met each week. Practice Placement Facilitator: Sonia Malt 6
Shift Patterns Early 7.30am - 4.30pm Late Shift 12.30 8.30pm Night Shift: 8.15pm 7.45am Occasionally shift patterns are altered slightly to meet the needs of the unit. Visiting Policy Sunderland Hospital has a restricted visiting policy. The daily visiting hours are as follows: 2pm - 4pm 6pm 8pm The hospital promotes a protective mealtime initiative, which enables patient s to enjoy their meal free from interruptions and distractions. 7
Admissions AMU is a very busy admission unit and it is essential that an efficient and accurate assessment is carried out on each patient entering the unit. When a patient is admitted to the unit initial observations must be taken first. This is temperature, blood pressure, pulse, respiration rate, CNS, oxygen saturation, pain and sickness score. This will create an Early Warning Score (EWS) which must be recorded on admission documentation and the main white board. A blood sugar reading must also be taken and documented. If arriving from GP surgery an Electrocardiograph (ECG) must be taken and the patient must be screened for MRSA. The labels can be printed from the order entry section on the computer system and must be sent to the laboratory to be tested. The patient should be given an electronic name wristband and red allergy band if appropriate. All patients admitted to the unit must be placed on the HISS computer system. This is accessible through the Admission Module and once their details are added and confirmed, together with a printout their details can be placed with an admission booklet. The first 3 pages of this booklet must be completed. It requires a brief description of the reason the patient is admitted any past medical history the patient may have. Their communication needs, elimination needs, breathing needs, mobility requirements, sleeping needs, their social circumstances and also their smoking and alcohol habits is also required. In addition a property list must be taken i.e. jewellery, money and clothing. This documentation must be placed in the ducket to be seen by the doctor for clerking. Once the written documentation is completed the assessor can enter an appropriate evaluation on the HISS computer system using the emergency update template. 8
The following assessments are also required for each admission: Braden (Risk of pressure sores) Pilling (Moving and Handling) MUST (Malnutrition and BMI) IV Device (The insertion of a ventflon) 4 x daily Falls Trigger Tool (Factors contribution to the risk) Falls Risk Tool (If score 3 or above on trigger/over 65yr) IC Risk (Infection control- MRSA swobs) Catheter Insert Surveillance (If required) Pressure Ulcer (If required) It is important theses assessments are completed accurately for the health and safety of both staff and patients. Each patient entering the unit must be placed under the care of a consultant and this varies according to the day and time. This can change on a weekend according to the admitting on call consultant. Each admitting consultant has a pneumonic and there is a list available at the nurses station. 9
Transferring Patients The AMU co-ordinator works closely with the bed managers and once a bed has been identified and a handover has been given to the receiving ward a patient can be transferred. Their belongings must be checked using on the admission booklet and a Transfer Form must be filled in and sent with them. Their details must also be entered into the Transfer File located at the nurses station. Discharging Patients Once a consultant has reviewed a patient and they are medically fit they can be discharged straight from the unit. A discharge letter must be completed and a copy must be given to the patient to forward to the GP. Our ward clerk also faxes a copy to the GP surgery for confirmation. If they are prescribed medication or usual medications are altered then doctors and nurses must liaise with the pharmacist to convert medications and prepare them for the patient. A copy of their prescription is also sent to their GP to inform them of the changes. Transport for the patient should be arranged and ensure the care is in place for them at home should they need it. A print out of all documentation should completed and filed with their notes. Finally they must be discharged from the system and their name must be documented in the Transfer File located at the nurses station. There has been a recent drive to utilise the use of the discharge lounge. Therefore if patients are medically fit for discharge and are awaiting medications and transport this service is available as it makes ward beds more available. 10
Staff Matron Sister /Ward Manager Junior Sister Nurse Practitioner Staff Nurse Health Care Assistant House Keeper Ward Clerk Student Nurse Grey and Red Uniform Navy Uniform Navy Uniform Maroon Uniform Blue uniform (female) White with blue epaulets (male) Beige Uniform Grey with Maroon Uniform White Uniform White Uniform Other members of the Multi-professional Team Physiotherapists (chest) assess respiratory needs and provide chest physio The interface team comprises of physiotherapists and occupational therapists which work collaboratively to assess patients mobility and home circumstances to enhance their safety Porters transport patients to different departments within the hospital as required. From 4pm AMU has a porter assigned primarily to the unit. Dieticians asses the patients dietary requirements and offer advice and care plans to help improve their nutritional intake Pharmacists check medication and supply the required amount. They educate patients and provide advice and support to nurses and doctors regarding medication Ward Clerks carry out filling and ensure medical notes, are tracked to the ward, book scans, answer telephone calls Housekeepers - help to maintain the high standard of cleanliness on the ward and deliver meals and drinks to patients. They also help transfer patients to other wards and departments. 11
Deliberate Self Harm Team (DSH) - assess patients psychological state of mind once medically fit and can arrange support for discharge Nurse Practitioners AMU has a hugely valuable and experienced group of Nurse Practitioners based on the ward which have undertaken further training and completed the clinical skills course. Their role consists of: Clerking patients and undertaking treatment and investigations Attending consultant ward rounds Ordering and investigating diagnostic procedures Taking referrals for admissions from A&E, GP Surgeries, Urgent Care Team and Minor Injuries Unit The organising and running of the nurse led DVT Clinic, RATU, SATU and the GP assessment area. Named Nurse AMU operates a named nurse policy as it is a valuable method of managing and caring for patients. Their responsibilities consist of: Co-ordinating the plan of nursing care, including assessments Identifying and ordering initial investigations To have in-depth knowledge if the patients condition Communicate with relatives ensuring information is provided and options are discussed Ensure the Essence of Care Standard is adhered too Liaise with other health care professionals and members of the multiprofessional team Evaluating the effectiveness of care delivered 12
Common medical conditions in AMU AMU takes acute medical admissions 24 hours a day, 365 days a year and it is a very busy unit. It caters for patients with a variety of medical conditions offering a unique experience to students. In preparation for arriving on AMU it would be helpful to familiarise yourself with medical conditions which are common in acutely ill patients. Headache Deep Vein Thrombosis Collapse Pneumothorax Diarrhoea Myocardial Infarction Vomiting Angina Seizures Left Ventricular Failure Renal Failure Unstable Diabetes Self Harm Meningitis Pulmonary Embolism Pleural Effusion Overdose Exacerbation of Gastro-Intestinal Bleed COPD/asthma Diagnostic/Treatment Procedures To enhance your learning opportunities it would be beneficial for you to understand and if possible observe and assist the following procedures:- Urinary catheterisation CTPA X Ray Electrocardiograph (ECG) CT Scan Echocardiogram (ECHO) MRI SCAN Venpuncture Lumber Puncture Cannulation 13
Telephone Numbers Internal External Main Hospital Switchboard 0 (0191) 5656256 Acute Medical Unit 49734/49735 (0191) 5699734 Fire 333 N/A Cardiac Arrest 2222 N/A Security 777 N/A All other frequently used numbers can be found on a list behind the nurses station and in the hospital telephone directory. All internal ward extension numbers in the hospital start with the prefix 497 followed by the ward number. All external telephone numbers begin 56997 followed by the ward number. All bleep numbers begin with 5. When using the bleep system the number should be dialled and then wait for two rings and replace the handset and wait patiently for a reply. 14
Learning Opportunities Learning Opportunity Interpersonal Skills Use of the telephone:- Making calls Receiving calls Transferring calls Use of the bleep system Use of the fax machine Computer Skills Admit a patient Complete assessments Complete nursing documentation Transfer a patient Discharge a patient Communication Skills Talking to:- Patients Relatives Staff Clinical Skills Patient Hygiene:- Mouth care Hair care Nail care Pressure area care Continence care Showering/bed-bathing Resource Ward Staff/Ward Clerk Registered Nurse Ward Staff Registered Nurse/Health care Assistant 15
Record Vital Observations:- Blood Pressure Temperature Pulse Respiration 02 Saturations Early Warning Score (EWS) Registered Nurse/Health Care Assistant/Critical Care Outreach Record Physiological Observation:- Blood Glucose Fluid Balance Weight Urinalyses Peak Flow Use of medical device:- Baxter Pump Syringe Driver ECG Machine BP Machine Peak Flow Meter Cardiac Monitor Moving and Handling Use of:- Hoist Slide Sheet Pat Slide Registered Nurse/Health Care Assistant Registered Nurse Registered Nurse/Health Care Assistant Registered Nurse/Health Care Assistant/Back Care Facilitator Administration of Medication:- Oral Intramuscular Subcutaneous Registered Nurse/BNF/CHS Policy 16
Intravenous Rectal Sublingual Inhaled Topical Procedures:- Catheterisation Venapuncture Cannulation Control of Infection Hand Washing Aseptic Non Touch Technique Barrier/Isolation Nursing Safe disposal of waste/linen Registered Nurse/BNF/CHS Policy Registered Nurse All ward staff/infection Control/Link nurse/surveillance nurse 17
Learning Zones Deliberate Self Harm Team A/E AMU Nurse Practitioners Deep Vein Thrombosis Clinic SATU Intensive Care Unit Critical Care Outreach RATU Bed Manager AMU Specialists Nurse: Alcohol Liaison Diabetic Stroke Speech and Language Team (SALT) Dietician Occupational Therapist Chest Pain Assessment Unit Pharmacist Control of Infection Physiotherapist Interface Team 18