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Operational Policy: Ward 9
(This is how Ward 9 works)
Size: 30 beds
Used mainly by 3 clinical specialty teams:
Renal Team / Cardiology Team / Diabetes / Endocrinology TeamConsultants / Dr T. Muniraju / Dr A. Mackay / Dr F. Green
Dr N.Rathnamalala / Dr A. Husnat / Dr . Clark
Dr S. Esmail
Associate Specialists / Staff Grades/ Locum / Dr A Almond
Dr S. Robertson / Dr V. Matelyte / Dr M.Mohamed
Specialist Nurses / Contact Renal Unit / Joanna Toohey / Pam Young
Sue Bryant / Jill McIver
Karen McMeeken / Fiona Wilson
Linda Carmichael
The ward uses a colour coding system for Team case notes, patients name cards etc.:
Team / Consultant / Colour CodingRenal / Pink
Cardiology / Green
Diabetes / Endocrinology / White
Respiratory – / Blue
Respiratory – Dr S Little / Yellow
Infectious Diseases / Red
Gastroenterology – Dr Saha / Blue with Black Dot / To be seen by Dr Saha’s team
Haematology / Blue with Red Dot / To be seen by Haematology Team
Rheumatology – Dr McMahons team / Yellow with Black Dot / To be seen by Rheumatology Team
Nursing Staff:
Senior Charge Nurse: Sheila Grieve
Charge Nurse: Tracey Cairnie
The nurses usually work as 3 teams. Each team allocation is 2 x4 bedded rooms and 2 single rooms. The names of the nurses in each team will be written on the board outside the Doctors room each shift plus we have a “board” in each room which will also give staff names.
Clerkess: Cynthia Hart (Works mornings and is an invaluable font of knowledge)
The Ward Routine, Nursing Staff:
Approximate times
/ Activity / Notes6.30-08.00 / MEWS / IV antibiotics,nebulisers
7.00hrs / Blood Glucose Monitoring / As above
07.30hrs / Nursing handover/report
7.30hrs / Medicines round / Prescribed for 7-9am
8.20hrs / Patient breakfasts / Protected mealtime – please avoid interruptions
9.00hrs / Ward Huddle / Communication session for allocated nurse, physio, OT, SW, middle grade/junior Drs
9.00hrs onwards / Patients opportunity to wash / shower.Bed making. Ward rounds / Patients given opportunity every morning to wash/shower
Assisted as required
10.00-11.00hrs / MEWS
11.30hrs / Medicine round / Documented as 10am and 12md
12.00hrs / Blood Glucose Monitoring
1300hrs / Patient lunches / Protected mealtime – please avoid interruptions
14.00/15.00hrs / Nursing Handover report
14.00hrs / Some medications due
14.00 – 17.00,1900-20.00 / Visiting times / Visiting out with these times to be arranged by nurse in charge
16.00hrs / MEWS
17.00hrs / Blood Glucose Monitoring
17.00hrs / Medicine round / Documented as 4-6pm meds
17.30-19.00hrs / Patients evening meal / Protected mealtime – please avoid interruptions
1945-2000 hrs / Nursing handover/report
2030-2100 hrs / MEWS
2100- 2200 hrs / Blood Glucose Monitoring
22.00hrs / Medicine round / Documented as 10pm – 12mn meds
Care plans – updated continuously
Fluid Balance charts – update continuously
Audits – as required
The Daily Routine for Medical Staff:
Time / Renal Team / Cardiology Team / Diabetes / Endocrine TeamEach morning / Start prompt / Start Prompt / Start Prompt
Mon am. / 9am Morning Huddle / 9am Morning Huddle / 9am Morning Huddle / Short communication session in Nurses Room.
am Consultant Ward Round
Start with very ill patients, then those likely to be discharged today / am. Consultant Ward Round
Start with very ill patients, then those likely to be discharged today
Daily clinical plans per patient including Expected Date of Discharge planning. Prepare discharge prescriptions
Draft IMDD for patients likely to be discharged the next day. Sign test results forms / Daily clinical plans per patient including Expected Date of Discharge planning. Prepare discharge prescriptions
Draft IMDD for patients likely to be discharged the next day. Sign test results forms / Daily clinical plans per patient including Expected Date of Discharge planning
Prepare discharge prescriptions Draft IMDD for patients likely to be discharged the next day. Sign test results forms
Mon pm / Out Patient Clinic / Out Patient Clinic
Tues am / 9am Huddle / 9am Huddle / 9am Huddle
9.15am Consultant Ward Round
Start with very ill patients then those likely to be discharged today
Tues pm
Wed am / 9am Huddle / 9am Huddle / 9am Huddle
Ed Centre Clinical meeting. Talks start 12.45pm / Ed Centre Clinical meeting. Talks start 12.45pm / Ed Centre Clinical meeting. Talks start 12.45pm
Wed pm
Thur am / 9am Huddle / 9am Huddle / 9am Huddle
Consultant Ward Round / Consultant Ward Round
Thur pm
Fri am / 9am Huddle / 9am Huddle / 9am Huddle
9.15am Consultant Ward Round
Fri pm / 12.45pm Journal Club / 12.45pm Journal Club / 12.45pm Journal Club
Weekend patient care planning / Weekend patient care planning / Weekend patient care planning / Patients may be discharged at the weekend if they meet appropriate criteria.
Other Useful Information
Phone Numbers:
· Really useful numbers: 2222 Adult Resuscitation Team
2222 Fire
100 Telephonist
0 Voice activated directory
A list of relevant numbers is kept at each telephone point in the ward
· To transfer calls: Press R and dial required number
· To dial an outside phone number, dial 9, then the number
Messages:
Be clear and brief, use the SBAR format i.e.
S – briefly describe the situation e.g. I am…… I would like to talk to you about ….. because….
B – give relevant background details
A – give your assessment of the situation e.g. I feel this patient’s condition is deteriorating rapidly
R – say what you want to happen e.g. I would like you to come to assess this patient now.
Discharge Planning:
Plan ahead and work towards an Expected Date of Discharge for each patient. Agree this date at the morning Huddle and on ward rounds. Please prompt discussion on ward rounds. Change the date if the patients’ condition dictates but ensure that everyone knows about the change – use the morning Huddles to inform and remember to keep the patient informed.
We are currently Testing a post ward round MDT Huddle in lieu of an MDT Meeting. This allows our AHP colleagues to carry out assessments
Estimated dischagre date should be on the patient board outside medical office.
We also use a Traffic Light system with coloured magnets:-
RED- acute or palliative treatments
AMBER-planning for discharge within next 24-48hrs
GREEN- ready for discharge that day
AMBER/GREEN-query home that day
BLUE- transfer to community/ other hospital awaited or delayed discharge
YELOW- these are to highlight Cardiology patients awaiting transfer to Golden Jubilee Hospital
This “at a glance” system informs all MDT members as well as the Capacity Managers
Input a draft immediate discharge document on the day before the expected discharge, make any last minute amendments on the day.
Write the discharge letter on the day of the patient’s discharge – it’s much quicker and easier than doing it a few days after the patient has gone!
Prescribe discharge medication prior to the day of discharge – this enables pharmacy to check it and prepare it. Do not prescribe medication if the patient already has ample supplies at home (it may be an idea to highlight “own supply” on kardex when meds rec done).
Shared Case Notes:
All members of the multidisciplinary team access and record in the same notes.
These notes are kept in orange folders (this is hospital wide). Stickers are provided for each discipline and please ensure your hand writing is legible and that ALL entries are SIGNED, DATED and TIMED.
Day Jobs:
It is vital that you are organised with regards to requests for bloods, CXRs, ultra sounds etc. This not only keeps you in good grace with your consultant but reduces delays in treatments and discharge dates. INR/Insulin/ I.V. fluid charts will be put in the basket in your office by 4pm. There should be no inappropriate work left for the Hospital at Night Team.
Evenings and Weekends:
We have a Dr’s “to do” folder which you will find on the ward desk. When you are phoned to review a patient or prescribe fluids, insulins etc we will also write it in the book. This should save you trying to remember “who/what/where/when”! It also serves as a communication mechanism to let us know that a job has been done.
We are currently Testing a “STRUCTURED RESPONSE TO THE DETERIORATING PATIENT” this is primarily on nights and is not for spread to other wards until we have trialled it fully.
Ordercomms;
This is an electronic sample requesting system. No paper request forms are used in this ward. Colleagues and IT Facilitators are happy to assist/train.
HEPMA
This is the new online medication prescription and administration charts. There are no paper kardex’s any more. All meds are given via this system. Pharmacy and IT will assist. A copy of patient’s MAC and MAP must be printed if
a) patient boarding to a ward that does not yet have HEPMA
b) patient transferring to any other hospital ( local and national)
Cortix
This is the electronic clinical communication tool we update this every shift and it produces our SBAR for handovers.
Patient Safety:
Current activity includes:
· Infection Control. This underpins all we do.
· YOU WOULDN’T TAKE INFECTION RISKS HOME TO YOUR FAMILY- SO DON’T TAKE TO YOUR NEXT PATIENT!
· Hand hygiene. Please ensure the 5 Key Moments of opportunity and techniques are adhered to – you will be audited and challenged ( Audits are National as well as local thus available for public access). Hand Gel should be at every bed, all staff are accountable for checking- if you haven’t noticed there’s none you haven’t made the effort to clean your hands.
· Remember to wash your hands if patient has a Gastrointestinal infection
· PPE (gloves and aprons) MUST be worn as per Infection Control.
· APRONS- are now colour coded-
White for general duties and aseptic procedures, Yellow for isolated patients/infection risks, Green for food service
· Toiletries. There must be NO communal toiletries used. Patients should primarily be asked if they have and wish to use their own.
· Weekly auditing of hand hygiene compliance (including technique) as well as our ‘Bare Below the Elbows’ compliance. We have successfully reduced HAIs. We WILL politely challenge you.
· Regular auditing of completion of the MEWS observation charts, the recognition of the deteriorating patient and the resultant actions. Reduction of > 70% in confirmed cardiac arrest calls. This does not include calls for our Adult Resus Team.
· Checking PVCs – only inserted when required and removed ASAP. Medical Staff – you MUST initiate PVC Bundle Sheet as well as putting date and time on dressing – SABs kill!. PVC charts are to be kept inside MEWS charts-as visual prompt to nurses to document daily checks.
· SBAR communication including the patient sheets (you’ll find these patient notes sheets really helpful. They’re available at handovers and at the 9am Huddle). This sheet contains confidential patient information YOU MUST KEEP IT SAFELY and IT MUST BE PUT IN WHITE SHREDDER BAG at the end of your shift.
· Attendance at the morning Huddles. This 10-15 minute meeting will let you prioritise ie. ill patients and discharges. Huddles are attended by OT/Physio/Social Work/medics/nurses. This optimises communications between all of us.
· Medicines Reconciliation (for Consultant and Senior Grade ward rounds).
· Ward Round Stickers- these are entered into casenotes to prompt discussions and decisions re. DNAR, ceiling of treatment, frequency of MEWS, fluid balance/restrictions, IV to oral antibiotic switch (IVOST), Meds Rec and Estimated Discharge Dates. These stickers give invaluable guidance especially to “out of hours” medical staff not attached to ward. Please feel free to remind consultants to complete them.
Releasing Time to Care ( RTC );
These are modules and techniques which help to release staff to provide care. Examples are
POD keys – the main bunch of keys for drug cupboards are kept in a locked cabinet within the prep room. Each team lead has a POD key and a key to the cabinet. This saves a huge amount of time “playing hunt the keys”! Other systems include RTC Trolleys at each end of the ward corridor, keeping equipments in designated places, huddles. Medical staff are requested to PLEASE put patient folders back at bedsides – we spend time looking for them when we could be providing direct care.
May we also ask that equipments are looked after, reported if not working and kept where they should be. Monitoring equipments are vital in the prevention of the deteriorating patient.
Clinical Quality Indicators ( CQIs );
Each SCN is responsible and accountable for auditing and compliance.
These ensure the optimisation of;
Food, Fluid and Nutrition
Pressure Area Care Prevention
Falls Prevention
Active Patient Care (APC);
APC ensures regular checks of the safety and dignity of our patients. Times are discussed and agreed with each patient. Times of checks are prescribed by RGNs. New sheets are now used and a new sheet is to be completed each day.
MEWS- the recording of MANUAL PULSE is now MANDATORY.