CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Paper prepared by: Angela Smith Safeguarding Adults Matron Date of paper: October 215 Subject: Therapeutic open visiting time pilot. Ward 1 Trafford General Purpose of paper: To brief Trafford Divisional Team on the findings and recommendations from the month therapeutic open visiting pilot on ward 1. Stroke ward 1. Introduction 1.1 The purpose of the pilot was to see if therapeutic open visiting improved the patient and carer experience and to see what the benefits and disadvantages were for the patient, visitor, staff and the organisation. The therapeutic open visiting pilot took place on ward 1 during the period 15th February 215 for 12 weeks in response to feedback from a family about their experiences on the ward. This paper provides an overview of the pilot, the data collected and recommendations regarding visiting times within the division for the future. 2. Background 2.1 Historically restrictions have been in place regarding visiting times since the 15 s which have intended to aid patient recovery by providing adequate rest and quiet and allow staff to undertake clinical work done without interruption. In later years hospitals have used visiting restrictions as part of a drive to reduce infection. There is no national policy or guidance with regard to visiting restrictions within the NHS and each organisation, department or ward can adopt their own visiting times and restrictions. 2.1 The Francis Inquiry report 21 discussed the need to review unnecessary restrictions on hospital visiting and added that they should be as open to visitors as would be a patients home. 2.2 In the summary of the forward in the NHS England Business Plan, Grant and Nicholson (21) highlighted the key measures of success as being satisfied patients and staff who feel positive about what they are doing, and to do this we must strive to design and deliver care based on the needs and choices of each patient. 2. There has been little research into general ward visiting undertaken in recent years and much of the work is either anecdotal or focuses on the specialist area such as ICU s or coronary care. Most of the studies reviewed looked at visiting times from a nurse s perspective and not from the patient or visitor. The only literature review that considered both patient and visitor perspective was undertaken in 21 (Taylor A).. Process.1 Prior to the pilot taking place a pre pilot questionnaire was undertaken with the patients, their visitors and each member of the ward team with the current visiting times 15.hrs 16.hrs and 1.hrs to 2.hrs. The questions asked are recorded below and the responses given by each group. 1
.1.1 Patient and carer responses Do the current visiting times enable you to 27 12 72 spend enough time with your family, friends and 7% 17% 46% Do you currently get enough time to rest and 1 12 27 7 recover from your current illness with the 44% 17% % Are staff readily available to talk to you and your relatives regarding your treatment and progress during the 47 67% 1 27% 4 6% 7 5 75% 15.5% 1.5% 71.1.2 Staff responses. Do you think that open 6 17 1 6 visiting will improve the patient experience? 17% 47% 6% Do you think that open visiting will interfere with the delivery of patient care? 27 75% 22% 1 % 6 Do you think open 17 4 visiting will improve communication between 2.5% 5% 26.5% staff and patients, relatives, family and % 1 6% 2 56% 6 2
.1. Patients, visitors and staff were also asked for additional comments and the following themes emerged..1.4. Patients and visitors Open visiting would be more convenient and would suite work and family commitments. Open visiting would allow more time with family and this would aid recovery..1.5 Staff Open visiting would greatly compromise patient care and prevent work form taking place and may disrupt the therapeutic environment and prevent recovery Open visiting would compromise patient dignity and privacy especially around protective meal times. Open visiting would compromise the patient s ability to rest which would increase fatigue and prevent rehabilitation and recovery..2 Following the pre pilot questionnaire the following were put in place to ensure concerns raised by staff were addressed before the pilot started. Weekly therapy time tables for patients put at the end of the bed for easy access for all visitors so that they could schedule their visiting around the therapy sessions if desired. Posters displayed above every bed with guidelines for visitors regarding the open visiting pilot in order to support the patient with their rehabilitation, therapy, recovery and rest Engagement sessions with all staff at ward meetings and by email so that they were fully appraised of, involved with the pilot and encouraged to discuss any concerns. Leaflets for all visitors to the ward outlining the aims of the pilot and guidelines regarding patient dignity and privacy. Anonymous comment sheets and a box on the ward for patients, staff and visitors which were collected daily and acted on as appropriate. 4. Results The following results were obtained at the end of the 12 week therapeutic open visiting time pilot 4.1. Patient and carer responses. patients and 26 visitors Do the current visiting times enable you to 5 5 spend enough time with your family, friends and 1% % % Do you currently get enough time to rest and 4 4 recover from your current illness with the 1% % % Are staff readily available to talk to you and your relatives regarding your treatment and progress during the 5 1% % % 5
4 1% % % 4 4.1.2 Staff responses. Do you think that open 7 2 visiting has improved the patient experience? % % 24% Do you think that open 1 visiting has interfered with the delivery of 6% 27% 1% patient care? Do you think open 17 2 visiting has improved communication between 5% 1% 1% staff and patients, relatives, family and 2% 4% 1% 2 5. Findings While a significant number of staff after completing the pilot still felt that therapeutic open visiting interfered with care delivery this had reduced by 12% since commencement of the pilot and there had been an increase of 7% of staff that felt it had not affected service delivery at all in an adverse way. Much of this from the additional comments made was around staff finding it difficult to initiate requests for relatives to leave bays when personal care needs of patients needed to take place. This was a common theme amongst a number of staff members including nursing staff, domestic and ward clerk and staff need to be supported in this area to develop these skills. A significant finding was that 5% of staff felt that the pilot had improved communication between staff, patients and their relatives. This is mirrored in the results from the patients and relatives, where prior to the pilot only 2.5% felt that staff were available to discuss care and treatment and this has risen to 1% at the end of the pilot. There had also been changes to practice during the pilot where the Ward Consultant actively encouraged engagement with relatives during the ward round. The use of the therapy schedule and plan at the patient s bedside for relatives and visitors also enhanced communication. Evidence of improved communication with relatives and carers is also supported as there were no formal complaints during the period of the pilot compared to 4 during the same period in 214. There was a reduced number of falls during the period of the pilot compared to the same period in 214. The Ward Manager felt the open visiting pilot contributed to this sustained reduction in falls. At the beginning of February prior to the start of the pilot the weekly average incidence of falls were 6. During the pilot incidents of falls reduced, ranging between 2 and 6 per week. 4
All patients and their visitors felt that opening visiting met their needs and they preferred this to the restrictive visiting times. The ward have continued to facilitate therapeutic open visiting. One of the comments from both the staff and visitors was that there was a delay in answering the buzzer to the ward on trying to enter as the ward was often locked due to the vulnerable client group. This was due to the buzzer not being in an accessible place for the ward clerk from her desk and she could not access the buzzer when on the phone and that nursing staff were delivering care. 6. Recommendations For open visiting to be rolled out across the division due to the following benefits: Preferred visiting option for patients and their visitors. Improved communication and engagement for patients, and relatives with ward staff of all levels regarding their care and treatment Reduced number of falls Reduced number of complaints It supports other pieces of work within the division such as Johns Campaign and the carers passport. Divisional Management Board are requested to note the content of the paper and support the recommendations. 7. Outcome At the Divisional Management Board meeting there was unanimous support for the adoption of open visiting in all ward areas and a commitment to become a visitor friendly hospital during 216. 5