HAEMATOLOGY WARD E55 PROFILE OF LEARNING OPPORTUNITIES - (POLO) STUDENT NAME: MENTOR NAME: ASSOCIATE MENTOR: DATE: Updated February 2010 MS
INTRODUCTION WELCOME TO WARD E55 Ward E55 is primarily a haematology ward but also takes general medicine and oncology patients so there is opportunity to gain a variety of experience. Ward E55 is a mixed sex ward compromising two bays, one a six-bedded bay, the other a four-bedded bay. There are also six side rooms in total, four of which are ventilated side rooms for neutropenic patients. Most of the haematology patients are either planned admissions for treatments, selfreferrals or referrals for gp. The medical patients usually come from the admissions wards within the hospital. The ward adheres to the Trusts visiting times (2pm 5pm & 6pm 8pm) although exceptions are made as required under instruction from ward manager / coordinator. We hope that you enjoy your placement with us and have the opportunity to develop your knowledge and understanding of haematological diseases as well as the opportunity to develop your clinical skills. You will be allocated a mentor to guide you through your placement and they will provide you with support, knowledge and advice.
THE DIRECTORATE Haematology comes under the directorate of general internal medicine (GIM). MEDICAL STAFF CONSULTANTS: x6 Haematology consultants (Some based at South Tyneside Hospital) OTHER MEDICAL STAFF: x2 Registrars (SPR)(working between clinic & ward) x2 senior house officers (x1 F2 x1 CMT) x1 Junior HO (F1) NURSING STAFF: Ward Manager Junior Sister Staff nurses (RGN) Band 5 (x16) Auxiliary nurses (HCA) Band 2 (x7) OTHER STAFF; Matron Haematology specialist nurse (x2) Practice development nurse Business manager Research nurse (x2)
OFF DUTY Your mentor will be allocated to you prior to commencement of your placement. Your mentor will help to coordinate your experience during the placement ensuring you have to opportunities to fulfil your outcomes. All the mentors have been prepared for the role and are aware of your learning needs If you are unhappy at all with the placement or your mentor you can either speak with ward manager or practice placements facilitator. Off duty should be negotiated with your ward manager or mentor if manager is unavailable. It is your responsibility to be flexible to ensure that you have the opportunity to work with your mentor for at least 40 % of the time thus ensuring that your learning outcomes can be met and that you can gain the most out of your placement. To enable you to gain insight into different aspects of care, you should try to work a variety of shifts. Off duty requests can be written in the request book, which is situated in the ward mangers office. Off duty (wherever possible) is usually done 3-4 weeks in advance. Sickness or absence should be reported to the ward at the earliest opportunity and also to the university. SHIFT TIMES 0745 AM-2030 PM (12.25 HOUR SHIFT) 0730 AM 1630 PM (EARLY SHIFT) 1230 PM 2030 PM (LATE SHIFT) 2000PM 0745 PM (NIGHT SHIFT) (Although times may vary slightly).
ADMISSIONS AND TRANSFERS ADMISSIONS When haematology patients are admitted this can occur in a variety of ways; they may be referred from their GP or from clinic or day case unit. They may be a planned admission or a self-referral to the ward. Whenever possible we try to admit them to the ward especially if they are found to be neutropenic. When they are admitted a full assessment is carried out. TRANSFERS Although ward E55 is a haematology ward, we do at times have medical patients transferred to us for the admissions ward. When the patient is transferred we carry out a full assessment on them including ADLs, nutritional score, Braden and bartel score, falls risk assessment, manual-handling assessment and MRSA screening. If we have no available bed at the time of admission for Haematology patients, they are admitted to other areas and transferred to E55 as soon as possible. Our patients are discharged via the discharge lounge (unless neutropenic). SELF-REFERRALS The ward operates a 24 hour self-referral system for all haematology and oncology patients. When the chemotherapy day unit is open the patients are advised to ring there for advice. After 7 pm or on a weekend (after 2pm on Saturdays), the patients are advised to ring the ward for advice. If they are unwell, arrangements would be made to have them come to the hospital to be seen by a doctor and admitted to the hospital if necessary. Very often we have no available bed for self referrals to be brought to the ward to be examined / assessed by a doctor so they are often advised to attend A+E (staff in this department are informed by coordinator of the planed visit as a way to decrease their waiting time). Oncology patients are also offered this service and if the are neutropenic and unwell they will be admitted to the ward under the care of the haematology team. All of the self-referrals we receive must be seen by the SHO on call for medical specialties. If an oncology patient is not neutropenic they will be admitted under the medical team. WARD ROUNDS The main haematology ward round is held on Thursday afternoons and attended by all, including Microbiologist and pharmacy staff too. The consultant, who has been on call at the weekend, does a mini ward round with medical staff on Monday (usually after their clinic). The SHO is ward based but the registrar also has audit work, lab work and occasionally clinics to attend to. The consultants carry out clinics and lab work and work on an on call rotation during the week and at weekends along with the registrar.
LEARNING OPPROTUNITIES ON THE HAEMATOLOGY WARD PRACTICAL NURSING SKILLS COMMUNICATION SKILLS ANATOMY, PHYSIOLOGY & PATHOLOGY MANAGERIAL & ORGANISATIONAL SKILLS STAFF DEVELOPMENT MANAGEMENT OF PATIENT CARE QUALITY ISSUES HEALTH EDUCATION & PROMOTION
PRACTICAL NURSING SKILLS LEARNING OPPORTUNITIES Recording physiological observations e.g. pulse Oxygen saturations, weight, fluid balance, blood glucose, BP Administering medications e.g. oral, intravenous, subcutaneous, (chemotherapy) Intra muscular, controlled drugs, infusions Care of venflons, Hickman lines and other medical devices Administration of blood and blood products Aseptic technique e.g. dressings, Hickman line care Nutritional intake e.g. assessment Moving and handling assessment e.g. use of hoist and other aids Hygiene needs of patient e.g. mouth, skin care, pressure area care Bathing Infection control Setting up equipment e.g. catheter insertion, lumbar puncture, bone Marrow biopsy, Hickman line insertion, wound dressings Patient safety/risk assessment Preparation for investigations e.g. echo scan, bone marrow biopsy, CT scan Endoscopy Consent /information for investigations Checking equipment e.g. crash trolley Nurses, doctors, research Nurses, doctors, pharmacy, administration policy Nurses Nurses, doctors, blood transfusion policy and blood transfusion practitioner Nurses, wound care nurse, research COI team Nurses, dietician Nurses, moving and handling facilitator Nurses, research Nurses, doctors, infection control team Nurses, doctors, specialist nurses, research nurses Nurses, doctors, MSW, OT, Physiotherapist Nurses, doctors, trust policy and procedure, radiology department, Endoscopy department Nurses, medical electronics department specialist nurses, research nurses Nurses Resuscitation team
COMMUNICATION SKILLS LEARNING OPPORTUNITY Telephone skills e.g. answering calls, ring back, transferring calls Bleep system Talking to relatives, patients, doctors, specialist nurses, Members of the multi disciplinary team Interacting with the clinical teame.g nurses, doctors, handovers, Ward rounds, team working Patient transfers in trust and outside of trust Facilitating investigations Computer skills e.g. evaluations, care plans, investigation results Booking transport The emergency system e.g. cardiac arrest, fire Ward staff, ward clerk Nurses, doctors, ot, msw, patients, relatives, specialist nurses, Physio, dietician Nurses, doctors, domestics, porters, secretaries Bed manager, nurses, doctors, patients, relatives, ambulance Liaison Nurses, doctors matron Nurses, doctors, IT staff Ward clerk, ambulance liaison, nurses, bed manager, matron Ward staff, doctors
ANATOMY, PHYSIOLOGY AND PATHOLOGY LEARNING OPPORTUNTITY Abnormal anatomy, physiology and pathology e.g. ONCOLOGY epidemiology, aetiology, pathology Treatments HAEMATOLOGY blood formation and destruction, red blood cells, White blood cells, platelets, cell cycle, anaemia, blood transfusion, Myeloma, lymphomas, leukaemia s, haemorrhage, thrombosis, Chemotherapy, transplants RESPIRATORY anatomy and physiology, investigations, Treatments, pleural effusions, chest infections, nebulisers, oxygen Therapy, inhalers CARDIOVASCULAR CCF, LVF, hypertension, angina, MI, Cardiac arrest, ECG, medication LIVER AND BILIARY SYSTEM anatomy and physiology, jaundice Tumours, clotting disorders, alcoholic liver disease, cirrhosis, Hepatic failure RENAL AND URINARY SYSTEM acute, chronic renal failure Urinary tract infections, testing urine, fluid balance NERVOUS SYSTEM epilepsy, tumours, CVA, infections, Headaches TISSUES, BONES AND JOINTS- lupus, arthritis, osteoarthritis, Osteoporosis Nurses, doctors, books, research, literature, Macmillan nurses, chemotherapy day unit, NCCT, Dr mallick, Dr Pedley, Dr Hughes pharmacy, hospice Nurses, doctors, pharmacy, chemotherapy day unit Lab staff, blood transfusion practitioner, literature, Haematology consultants Nurses, doctors, pharmacy, physio, lab staff Respiratory nurse specialist Nurses, cardiologists, ECG department, coronary care unit Literature, pharmacy Nurses, doctors, Macmillan nurses, pharmacy, lab staff GI nurses, endoscopy Nurses, doctors, renal units, literature, lab staff GI nurses, endoscopy Nurses, doctors, pharmacy, stroke unit, physio Dietician, SALT Nurses, doctors, pharmacy, physio
GASTROINTESTINAL SYSTEM nausea and vomiting, diarrhoea, Constipation, bleeding, dysphasia, cancer ENDOCRINE SYSTEM diabetes, thyroid problems, pituitary problems Pancreatitis Nurses, doctors, specialist nurses, dietician SALT Nurses, doctors, pharmacy, diabetes clinic, dietician HEALTH EDUCATION AND PROMOTION LEARNING OPPORTUNITIES Healthy lifestyle changes in relation to smoking, Alcoholic liver disease, obesity, cancer, heart disease, Bowel disorders, drug and alcohol abuse Counselling Health education and promotion literature Interface between hospital and community Nurses, doctors, pharmacy, smoking cessation nurses, dietician Specialist nurses, dietican, practice team, Macmillan nurses, hospice, Cardiac rehab nurses, drug and alcohol team, stroke team, SALT, Physio, ot Macmillan nurses, clinical psychologists, nurses, doctors Library, trust strategies, health promotion team, specialist nurses, Nurses, internet Health promotion unit, specialist nurses, government Targets, health of the nation document Community matrons Discharge team STAFF DEVELOPMENT LEARNING OPPORTUNITY STAFF DEVELOPMENT clinical supervision, Reflective practice, IPR, mandatory training, Courses, degrees Nurses, ward sister, practice development nurses
MANAGERIAL AND ORGANISATIONAL SKILLS LEARNING OPPORTUNITY Managing a team organisational skills, delegation skills Prioritising, time management, leadership, off duty, Managing patient workload, standards of care, implementing Change Giving information to - doctors, nurses, staff, patients, relatives Other departments, mulit disciplinary team Resource management stock control, drugs, non stock, stationery, Budget control, skill mix, materials management Risk management policies and procedures, equipment safety checks manual handling, quality control, Emergency situations cardiac arrest, fast bleep system, fire, bed Alerts, patient falls, violent incidents Nurses, ward manger/ sister, audit tools, practice development nurse, matron, business manager Ward manager / sister, nurses, doctors Nurses, pharmacist, ward manager / sister, stores department, business manager, matron Ward manger /sister, nurses, health and safety officer, practice development nurse, electronics, infection control team moving and handling facilitator, health & Safety officer Nurses, ward sister, cardiac arrest team, switch board, security officer, fire officer, bed coordinator, health and safety officer, doctors
QUALITY ISSUES LEARNING OPPORTUNITY Quality issues policies, procedures, standards of practice, Clinical audits, changing practices, handling complaints, Research Nurses, ward sister, practice development nurse Policy file, library, research and development department, research nurses MANAGEMENT OF PATIENT CARE LEARNING OPPORTUNITY Use of - nursing model, philosophy of care, Documentation used, policies, standards, protocols Assessment what is assessed, who is assessed, where Does it take place, how is assessment carried out. Planning care plans, risk assessment tools, care pathways, Discharge planning multi disciplinary team involvement Implementation /evaluation Self discharge Nurses, policy files, standards file, procedure file Nurses, patients, relative, district nurses, literature Specialist nurses Nurses, Macmillan nurses, specialist nurses, discharge liaison Team, Nurses, doctors, patients relatives, multidisciplinary Team Nurses, doctors, policy and procedure file
GENERAL LEARNING OPPORTUNITIES Religious needs arranging to see a priest, Communion Dealing with difficult situations Deceased patients Patients property and valuables Ward rounds Referrals to other agencies msw, ot, physio Macmillan Hiss system care plans, order entry, evaluation Document interventions Communication with patients and relatives Time management Drug administration policy Nurses, priests, chaplaincy Nurses, doctors, ward manager / sister, matron, Policy and procedure file, Lancaster Support team Nurses, ward manger / sister, doctors, chaplaincy, relatives, Policy and procedure file Nurses, ward manger / sister, matron, policy and procedure file Ward manger / sister, nurses, doctors Nurses, ward manger / sister, MSW team, Physiotherapist, McMillan nurses Nurses, HISS manual, IT and Hiss department Nurses, doctors, MDT, Discharge team Nurses, ward manger Nurses, doctors, pharmacy, policy file Research