RNOH PATIENT GROUP REPORT JUBILEE REHABILITATION CENTRE Subject: Fact finding visit to the Rehabilitation Centre Date: 23 rd October 2012 10 am -12pm Patient Group members: Marion Cumbers and Ruth Marcus Staff interviewed: Amanda Denton, Senior Sister (Acting Ward Manager) Patients interviewed: 2 male, 3 female Background Since our last visit on October 13 th 2011, the Rehabilitation (Rehab) unit has undergone significant changes after a flood in February 2012. The Unit was closed in February in order for major refurbishment to take place (some Rehab patients were admitted to the Philip Newman ward during this period). The Unit was renamed the Jubilee Rehabilitation Centre and re-opened in the summer. The flood, though unfortunate, did, however, give the Hospital the opportunity to instigate major changes which were needed to improve the patient and staff facilities and be able to put in place some of the plans the Manager had discussed in our last report. There have been major improvements in all aspects of the Unit but there are still some areas that require attention which cannot yet be achieved due to limitations of the building and budget restrictions. These will be highlighted later in the report. Care Provision The Centre provides programmes for: 1) Pain Management 2) Rehabilitation 3) Complex Pain Syndrome which includes a combination of pain management and rehab programmes. The above three programmes are 3 week duration, with 12 patients at any one time with four admissions per week. All programmes are Mon-Fri and patients return home at weekends. 4) Peripheral nerve programmes for one week, Mon-Fri which are booked into the Rehab Unit 6 weeks after surgery. 5) Shoulder Rehab one or two week programmes 6) Rescue Rehabilitation. Patients under Mr Skinner/Professor Briggs who need more intensive rehab after knee surgery. 7) Hotel Inpatient option. For those patients with less complex needs, the Hospital use the Mercure Hotel, Watford for patients who do not need nursing input. The Village Hotel is used for the Active Back programme. The hotel programmes are usually of 3 weeks duration, 8 people per session, Mon-Fri. These programmes are run by therapists and 1
managed by Gill Thurlow, Nurse Consultant. This facility allows more complex patients to benefit from inpatient care on the Rehab Unit. 8) In October bookings are being allocated for January on the ward and February at the hotels. No figures were available broken down by gender. 9) Patients having intravenous treatment who are under the Metabolic Unit for infusions for osteoporosis will now be accommodated in the Rehab Unit. A new IV room has been set up in the Unit for new metabolic patients and, hopefully, in January 2013 will be used for all patients rather than the Metabolic Unit. The Unit also provide day beds (and chairs if preferred) for Dr Keene/Dr Cohen s patients who require infusion of Rituximab (for rheumatoid arthritis). Nurses attend a day s course and are signed off before they can administer an infusion. Only one nurse has been signed off out of 5 nurses trained. The infusion patients make good use of the nursing in the Rehab Unit during quieter periods in the day when the inpatients are at their therapy sessions away from the ward. Preassessment is vital to ensure the patient is fit and suited to the programmes. It also highlights patients who may have special needs. Paperwork is completed and the patients are provided with a comprehensive range of booklets and leaflets including Code of Conduct and programme information. The aim of these programmes is to improve fitness, independence, confidence and quality of life. Patients attend group sessions, goal-setting and therapy within the Unit or at Aspire and the main Hospital. If the dedicated stretching sessions that take place three mornings a week at 9am could take place in the Conservatory, it would save nursing staff and porters a lot of rushing around trying to fit in drug rounds and getting patients ready and transported to the gym on time. The DIY stretching session takes place on the Unit on a Friday, so it could be done. Staffing Amanda is acting Ward Manager while Lewis Kendall is on secondment to the Spinal Unit. There are 2 vacancies of Band 5 nurses which Amanda has now filled, but they have not yet started. Staff need to be experienced in nursing patients with complex psychological needs or difficult behaviour patterns. There is a multi-disciplinary team supporting the programmes including physios, OTs, medical staff, including clinical health psychologists and nurses. There are monthly staff meetings to discuss areas of concern, training and patient feedback. Good communication is very important, and as it is a small team, the Sisters manage to discuss issues with staff on a weekly basis. The Productive Ward initiative stalled during the refurbishment but is now in operation again. Configuration of Wards The recent refurbishment has allowed some reconfiguration of the Unit and has increased the number of female beds. There are now 13 female beds (an 11-bedded ward and one with 2 beds which could be increased to 3 or 4 beds for less complex patients who do not need a wheelchair). There is an 9-bedded male ward which is usually not fully occupied. The Unit is always looking to increase the occupancy of the Unit and reduce the female waiting list. This can also include better use of the Hotel facility for less complex patients. Catering The Unit has now introduced an alternative menu for lunch alongside the standard Hospital meal and is proving popular with the patients who would like this option for supper as well. 2
The alternative menu includes paninis, jacket potatoes and sandwiches. Patients can request extra helpings (the Rehab Unit patients are often younger and more active and therefore may require larger portions). Tea and coffee, fruit and biscuits are available for patients and visitors in the conservatories. There is a voluntary donation box for visitors. The money raised is to be used for purchasing art, crafts, games and DVDs for inpatient use. Observation Staff toilets and training/staff rooms have all been refurbished Linen room clean and tidy Kitchen clean and tidy Male and female toilets and shower rooms have been refurbished There is no sluice on the ward. It is urgently required because there are patients with more complex needs on the Rehab Unit now. It needs to be sited where the noise will not disturb patients. However we are aware that space is at a premium and hard choices may have to be made. The Reception area has been refurbished and is now a light, airy place with new vinyl flooring. The electric doors are now working well. The Key Performance Indicators were displayed by the ward, showing no infections, minimal falls, 18 compliments and no complaints. Appraisals are now at 100%. The new IV room is sited where the manager s room used to be. The staff would like to provide drinks or a vending machine, but there is no money for this as yet. The female 11-bedded ward is now where the male ward was. It has been refurbished and there are new rails and bed curtains (these do not now touch the floor) There is a 2-bedded female ward. The male 9-bedded ward is well furnished but under-occupied The male conservatory is well furnished and has new blinds, air conditioning and a computer. Both male and female conservatories have flat-screen TVs. Drinks, fruit and tea are available. Night lights are now installed, but unfortunately, patients complain they are too bright. Lower voltage has been requested. The female conservatory is now refurbished with new blinds and air conditioning It was noted that there is a trip hazard where the flooring between female ward and conservatory was not fixed under the metal threshold strip. There is an urgent need for a computer in the female conservatory for staff use during group sessions We were pleased to note that there is now signage directing people requiring Pathology or the Pain Clinic to access them through the back door and not use Rehab as a short cut, and this appears to be working. Interviews with patients Patient A A male with Chronic Regional Pain syndrome for 14 years, had attended other pain courses, but this 3-week one has been the most helpful. It is tailored, and being in a group of people with the same problems has helped him considerably. He now feels less isolated, and tips from others have been helpful. Staff are very aware of individual conditions, know their patients well and 3
give them space to come to terms with the fact that this may be as good as it gets. When he can t sleep for the pain, they talk to him or make him a drink. They communicate well and explain what is happening. Patients are taught coping strategies rather than being cured. Patient B Female arrived the day before. Staff were very helpful and communication was good. Food was OK. Had no complaints. She was to stay for 3 weeks, but so far had only done stretching. Patient C Female in 2 nd of a 3 week stay. Has EDS and hypermobility in many joints. Was learning to pace herself and finding a new approach is useful. Some food was OK particularly lunches eg jacket potatoes, but evening meals were atrocious unrecognisable, soggy fish and chips, potato wedges too highly spiced, soggy pizza. Staff tell patients what is going on and are happy to explain. Patients D Female group Waiting for their lunch. Staff fantastic, go above and beyond what they need to do, porter Mick always on the go, nothing too much trouble, whatever you ask is done, always helpful. Staff always explain and remove any confusion just ask! Ethnic food is good, and a good range, would like lunch menu in evening as well. Can order double if hungry. Would like menu changed more often as it gets monotonous after 3 weeks. Patient E Male, had a shoulder injury 6 years ago, has been a regular Rehab patient for last 3 years. He is on a two week programme to work on his arm ligaments and tendons. Very satisfied with the care and couldn t ask for more. Prefers the new alternative lunch menu, as they all do, and would like it to be available in the evenings too. Patient F Female in a wheelchair who is paraplegic. Was attending a one-week shoulder therapy course. The staff were very kind. She had only arrived the day before, but already had a problem transferring on to the toilet. We inspected the toilet concerned with her so she could explain the problems. Although the toilet appears to be designed for disabled patients, it was unsuited for her use. It was too low and the portable raised seat was too unstable for her to transfer on to without assistance. The rails were in the wrong place and the toilet roll was too far back. The mirror by the washbasin was too high. The Sister did know about her concerns and was trying to see what could be done to rectify this. The patient would also prefer only a female member of staff to assist with her toileting. The Sister said there would be no problem providing this. Comments/Areas of Concern 1. A sluice is urgently required 2. A computer needs to be available in the female conservatory for staff use during the group sessions. 3. There is still a need for more female beds, but this situation has improved since our last visit in Oct 2011. 4. There could be one or two more beds in the female small ward for less complex cases. 5. The nightlights need to be of a lower wattage. 6. The design of the disabled toilet needs reassessment in view of the concerns of a wheelchair bound patient. 7. There is a trip hazard between female ward and conservatory 4
8. The majority of the patients we spoke to thought that the food is still not at an acceptable standard. The alternative lunch menu is more popular than the regular menu. Could this option be available for the evening meal? 9. Could the 9am stretch classes be transferred to the Rehab Unit to assist nursing and save on portering. 10. Could drinks be made available for day patients in the IV suite? Conclusion We were very pleased to see that, due to the refurbishment, many of the concerns noted on our last report have now been addressed. The Rehab team provides enthusiastic and highly professional care to patients who have complex and challenging needs, and the multi-disciplinary approach provides this in a warm and friendly environment. We wish to thank Amanda and the team for their time and for a very informative visit. Response from Amanda Denton, Ward Sister Amanda Denton provided a few adjustments to the report which have now been included above by the RNOH Patient Group. These are: Care Provision point nine: Nurses attend a one days course and competencies are to be signed off before they can administer the infusion. Only one nurse has been signed off so far from 5 nurses trained. Configuration of wards: There is a nine bedded male ward ( not 11) Observation: There is a two bedded female ward which could accommodate 4 beds if necessary- Comment- This is not possible as the area between each bed is too narrow and does not meet minimum requirements, health & safety, infection control, manual handling in line with Mid Staff enquiry. Observation: The male 9 bedded ward... In response to the issue with the bedpans, bottles etc we empty contents down the toilet and dispose of receptacles into yellow bin and double bag. This is not ideal as it exposes a risk of spillage, skin contact and infection control risk therefore I have entered onto risk register. Wheelable commodes have now been purchased and have arrived in purchasing today, so this may help our issue by wheeling our patients over the toilet. No formal audit has been done however the use of these products are infrequent and as our patients dependency is increasing due to the hotel programme so might the demand of bedpans, bottles etc. I would propose that I carry out an audit to highlight this issue to provide further evidence. 5