IFN Assignment 1 - Trust Report - King’s CollegeHospital NHS Trust
This essay will describe King’s College Hospital NHS Trust, the local community it serves, its areas of expertise and the particular area of cardiac care, in which the author has undertaken a placement as a student nurse. It will describe how patients access the Trust’s services, how patients’ information is stored and used, including the safeguards applied to such information. It will also describe how patients and service users can provide feedback to the Trust, and make complaints.
King’s College Hospital NHS Trust is one of London’s largest and busiest teaching hospitals. It provides a full range of hospital services for over 700,000 local people. Two thirds of patients are from Southwark and Lambeth, with the remainder coming from further afield for specialist services. The locality has a large proportion of ethnic minorities and has recently seen an influx of working people in the 20-39 years age group. Conversely, it also has a large number of long-term unemployed people. A high throughput of patients results from the Trust supporting deprived areas and accommodating many specialist units receiving transfers from other hospitals.
King’s has 936 beds and 18 operating theatres. In a year, there are 180 liver transplant patients, 112,000 A&E patients and 4,500 new babies. 5,000 people work within the Trust; 45% of whom are not doctors and nurses.
The Hospital moved to its present site at Denmark Hill in 1913. It was granted Teaching status in 1948 and further recognition in the NHS re-organisation of 1974. A refurbishment programme involves parts of the hospital dating from 1968 and the recent completion of the Golden Jubilee Wing, housing medical wards and outpatients departments.
King’s educates medical, nursing and dental students. It has academic links with Schools of Medicine, Dentistry and Psychiatry, and collaborates with local Primary Care Trusts and other acute Trusts. It enjoys national and international recognition for liver transplantation, neurosciences and cardiology. Medical breakthroughs in the past year have included the first successful UK islet cell transplantation in a diabetes patient, obviating the need for insulin injections. New treatments such as stem cell therapy, for heart disease, liver disease and brain disorders are also under development.
King’s was awarded only two stars in the July 2005 Healthcare Commission ratings, owing to its yearly financial losses, however, it met every key target, such as waiting times in A&E, outpatients appointments and cleanliness targets, including the reduction of MRSA rates. (KCH, 2005a).
King’s mission statement is “Achieving excellence in patient care.” The Trust’s Summary Report (2004-2005) states that King’s is “… proud of its history as a teaching hospital, working in partnership with other healthcare organisations to deliver first class services.”(KCH, 2005b). For its future aims, “King’s First Choice” Trust-wide, transformation programme, highlights the needs of the patient, best clinical practice and academic excellence, quality staff and a community whose diversity is valued. (KCH, 2005c).
The author’s clinical placement was in Victoria and Albert Ward. It is part of the Cardiac Unit at King’s, which provides comprehensive cardiology and cardiothoracic services (except transplantation). As well as serving the local population, it is a tertiary referral centre for south-east England. The Cardiac Unit comprises two operating theatres and 4-bed Cardiac Recovery Unit; the Cardiac Catheter Laboratory, for coronary angiography, angioplasty and pacemaker insertion; a cardiology ward with 23 beds, including 6 in the high dependency unit (HDU); and Victoria and Albert Ward, a cardiothoracic ward with 18 beds and 10 in the HDU. (KCH, 2005d).
Patients are admitted for cardiothoracic surgery, after attending a pre-assessment clinic, which explains the details of the procedure. This is usually a Coronary Artery Bypass Graft (CABG), or a replacement of one of the heart valves. Other surgery commonly carried out on patients from this ward, includes lobectomy (removal of part of the lung) and also repair of the sternum that has failed to heal properly after previous thoracic surgery. Most cardiac patients are middle-aged or elderly; the few younger patients usually requiring heart valve replacements.
Patients on the coronary care wards will usually have been referred to King’s by their GP or another hospital. In most cases, the patient will have consulted his GP with symptoms such as shortness of breath or chest pains and the GP will have referred the patient to his local hospital or directly to King’s. If a patient in a local hospital requires specialist surgery, a consultant will write to King’s, requesting that the patient be assessed. This may result in an admission to one of the coronary care wards for further investigation and surgery if required. More rarely, patients may be admitted from A&E, following a cardiac event such as a myocardial infarction. Patients who are not registered with a GP may be referred by walk-in centres.
In order to achieve a high standard of patient care, personal information must be obtained, stored and made available for use by clinicians, when required. This information must also be kept from members of the public who are visiting the ward. The records of nursing observations are an indicator of a patient’s health or otherwise, and confidentiality of these must be assured. With regard to diligence in respect of nurses’ record keeping, Dimond (2005a) writes: “Record keeping is the professional duty of care, owed by the nurse to the patient.”
There are many items of information kept on paper, in medical and nursing notes and electronically on the computer system, for each patient. This information includes personal details: name, address, telephone number, date of birth. Further information, obtained or collated by the hospital, may include a patient’s medical history, medication, correspondence between the patient’s GP and the hospital doctor or surgeon, blood test results, X-ray images, MRSA screening results, ECG printouts, observations sheets, drug charts, findings of investigations carried out, referrals and reports from physiotherapists and occupational therapists, concerning the patient’s fitness for discharge from hospital. Although some of these data may, on the surface, seem to be of little use to anyone but healthcare professionals, there are many reasons why patients’ health records should be kept confidential. Because of the sensitivity of this information, medical records on paper need to be stored securely. Dimond (2005b) states that “All personal health records, whether computer or manually held, come within the definition of sensitive personal data.”
Acquisition, storage and use of information is vital in modern healthcare. The electronic patient record (EPR) can be used to order tests and view results via networked computers. The new Patient Administration System (PiMs) allows staff to identify patients through an improved search facility, register new patients, add them to waiting lists, book appointments, admit, transfer and discharge inpatients and track notes around the Trust. (KCH, 2004a)
The Picture Archive and Communications System (PACS) is a near filmless imaging system which allows staff to view x-ray, ultrasound or any digitised image over the Trust network. It delivers “Any image, anywhere, anytime.” (KCH, 2004b) and is clearly advantageous compared with images on film, that have to be physically transported around the hospital and viewed by healthcare professionals gathered in the same place.
A person’s electronic health record (EHR) will be available at the time they are seen and will hold an up-to-date summary of their clinical history. The EHR is intended to be instantly available for clinical staff, to facilitate life-long healthcare for the patient. Naturally, it requires safeguards for confidentiality that are similar to those for paper records.
King’s obtains feedback on patients’ experiences in hospital from questionnaires, entitled “How are we doing?” which all patients are encouraged to complete. Opinions are also gathered from users of services, from anecdotal evidence, from over 5000 annual contacts with the Patient Advice and Liaison Service (PALS) and from complaints made by patients or their families. (KCH, 2005e). Information is available for patients who wish to make a complaint about the service they have received from King’s. (KCH, 2004c). Firstly they should speak to a senior member of staff, in an attempt to rectify their complaint immediately. If they are not satisfied, the Patient Advice and Liaison Service (PALS) will attempt to resolve the problem. (KCH, 2005f). They may also contact the Independent Complaints Advocacy Service (ICAS). (CA, 2004).
The patient can then commence a three-stage process of formal complaint in writing. (KCH, 2004d). A nominated officer will investigate and the Chief Executive will respond within 28 days. The complaint can be taken to the independent Healthcare Commission which “…is responsible for reviewing formal complaints about the NHS in England, that have not been resolved by the NHS organisation or practitioner about whom a complaint has been made.” (HC, 2004). The Healthcare Commission might seek an explanation and acknowledgement of what went wrong; action to put the matter right and an apology but they cannot provide legal advice or award compensation. Ultimately, the complaint may be referred to the Health Service Ombudsman, who may also investigate the case, request the NHS to take further action to resolve matters, or carry out a formal investigation by appointed external assessors. There is no appeal against the Ombudsman’s findings. (HSO, 2001).
Complaints about the professional conduct of nurses can be made directly to the Nursing and Midwifery Council (NMC) as detailed in the NMC publication Complaints about professional conduct. (NMC, 2004a).
One important aspect of patient information collection and storage is confidentiality. “All patients have a right to expect that information provided by them to staff working in the Trust will be treated as confidential.” (Patients Charter 1995). The NMC Code of Conduct says that nurses must “treat information as confidential and use it only for the purposes for which it was given.” (NMC, 2004b). This is echoed by the Data Protection Act (1998), which regulates the storage and protection of patient information held on computer. A basic principle of the Act is that: “…any personal information given or received in confidence may not be used for a different purpose or passed to anyone else without the patient’s prior consent.” (Data Protection Act 1998).
Trust guidelines are that “Patients have an absolute right to confidentiality.” (KCH, 2004e). However, personal information often needs to be shared among healthcare professionals. “The Caldicott Report contains principles of best practice [for sharing patient information.] ” (KCH, 2002). These principles include justification for using patient-identifiable information, keeping to a strict need-to-know basis and ensuring compliance with the law.
Confidentiality is important, not least because any failure to keep patient information confidential could lead to a loss of trust between the patient and the healthcare professional, which would be detrimental to a therapeutic relationship.
In conclusion, King’s College Hospital NHS Trust is nationally and internationally renowned and respected, forward-looking, innovative and supportive of its patients and staff and of the local community. It is committed to improvement of its high standards, particularly through consultation with the people it serves and those it employs. It aims to continue to provide a lead in its specialist areas of research and teaching and in the advancement of information technology that will benefit its patients and staff. It adheres to prescribed guidelines on safeguarding the confidentiality of patients’ personal information. The area of coronary care that I have described is typical of other areas of care in the Trust, with respect to the standard of its facilities, the degree of patient satisfaction and involvement and the dedication of the staff who work in it.
References
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