The Intensive Care Bed #Hospital


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Here in the UK last night the BBC aired a programmed called “Hospital”. It was a very moving programme showing how stretched the NHS is. It certainly opened my eyes to the daily nightmares that consultants, managers and nursing staff find themselves in on a daily basis. The shortage of Intensive Care beds the result in operations having to be cancelled and patients being turned away for life saving operations. The look of frustration and helplessness etched on the faces of many.

How I felt for the patient that had his operation cancelled for the second time, being sent home after waiting in the ward anxiously waiting to hear that an Intensive Care bed was available – it didn’t happen the bed was needed for another patient.

It brought be back to when my mum was “that patient”. Extremely poorly with bowel cancel, awaiting a life saving operation. She was prepared for the op by having nil by mouth for 24 hours the day before the scheduled operation. By 4.00 that afternoon she was still waiting, we her family were waiting with her trying to keep her spirits up. Finally, I went along to the nurse’s station to find out what was happening to be told that her operation was cancelled due to there being no Intensive Care bed that she needed after her operation. Her operation was delayed to the following week.

The following week arrives, my mum another week on, getting weaker by the day but we were all optimistic she was having her op that day. It got to lunchtime and we got the dreaded news her operation was cancelled again for the 2nd time. The Intensive Care bed was needed for a man who was involved in a road traffic accident. I remember feeling anger at this person who I didn’t know – because of him my mum was not able to have her operation again – and then the instant guilt of feeling like that. This faceless unknown person fighting for their life as my mum was doing got the bed first – WHY!! I often wonder how their family felt – they probably just took it for granted that the Intensive Bed was there – as I thought before this nightmare began. Her operation was delayed for yet another week.

The 3rd week arrived – just a few days before Christmas. We were told previously that mum would be first on the operating list. I sat with her – her fight all gone. All 4 and half stone of my beautiful mum wasting away in the bed before my eyes. They came around to get her prepped for the operation. Excitement building like this was something that we didn’t believe was ever going to happen. Somthing that before this we had just taken from granted. Patients starting going down to the theatre – the consultant came up and asked if he could have a word with the family. His dreaded words “I’m sorry but we are going to have to cancel mum’s operation again” Our grief at that moment was unbearable. My heat was torn in two – how on earth could she survive another week. Amongst all of the shouting and swearing the panic and the disbelieve I still remember the look of despair on the consultants face. He just didn’t know what to say. He apologised and said that he would have felt exactly the same if it had been his family. It was the same story – they didn’t have an Intensive Care bed for mum after the operation.

I would never in my wildest thoughts that it would have been a bed that would have prevented my mum from having a life saving operation. It just didn’t make sense. I actually believed at this stage that this was just a lie – that they didn’t feel that mum at the age of 70 years was worthy of this operation. I felt they were just waiting on her dying.

The consultant went and spoke to mum. She had lost the will and just nodded – perhaps like me she thought that she was never going to have this op.

I remember mum saying she was hungry – I sent my Dad to get her a sandwich from the canteen. This has been her 3rd week of starving for 24 hours before being told she wasn’t having the op. She then asked the nurse for the commode. The nurse went off to get one. The nurse took longer than mum could wait and she attempted to get out of bed to get to the toilet – as ill as she was she still had her pride. As she stood upright the tumour burst – all over the floor. Within 10 minutes she was being rushed to the operating theatre where she had the operation.

She finally had the Intensive Care bed that she was promised 3 weeks ago, albeit only for 2 nights instead of the 5-7 she was told she would be in there for. She was  then transferred to the high dependency unit. I often wonder if someone had to be moved out of intensive Care to make way for mum, or if someone who was waiting for it had been cancelled like my mum had.

Watching the programme last night brought it all back. It made me see the nightmares that the staff have on a daily basis trying to access Intensive Care beds for patients. As the programme showed last night we in the UK have the most wonderful consultants with the most amazing powers to carry out life changing operations, the dedicated staff who work around the clock to look after the patients before and after their operations and the most marvellous well equipped hospitals that we should be so proud of. But how shocking it is to think that it sometimes comes down to the “luck of the draw” when it comes to needing that much-needed Intensive Care bed.

Does your Receptionist recognise signs of Sepsis. A Patients Story #Bournemouth Hospital


There has been a lot of publicity recently regarding Sepsis. This is aimed at raising awareness and those that work in the GP surgeries and Hospitals will know on too well that this will create fear amongst some patients and therefore will be more than likely phoning the Surgery/Hospital for advice.

We are being told Sepis should be treated urgently as we would a heart attack.

For all Receptionists, Secretaries and Administrators who could be faced with a query regarding this are you fully competent to deal with it? Would you be confident in dealing with a call that could be Sepsis? I must confess I am not sure I would be able to identify this emergency a few weeks ago, but I feel a lot more confident now that I have read up on it.

You probably have procedures and policies in place for dealing with a heart attack. Have you a procedure or policies in place to deal with sepsis? Perhaps at your next team meeting you could put this on your agenda or speak to your Reception Manager or Practice Manager about having one written up.

The most important thing is that you know the facts about Sepis and what is expected from you as a Receptionist if you take such a call. Don’t be one of those surgeries/hospitals that could be highlighted as missing something that might be so obvious to someone who knows what Sepsis is.

Many doctors view Sepsis as a three-stage syndrome, starting with Sepsis and progressing through severe Sepsis to septic shock. The goal is to treat Sepis during its early stage, before it becomes more dangerous.

Sepsis usually comes with a probable or confirmed infection and includes several symptoms. These perhaps can be discussed with a Doctor and the Receptionists and a guide of what questions to ask the patient.

Septis has to be treated quickly as the patient can go downhill very quickly

A chart that I found very useful to help identify some of the symptoms:sepsisqa-2015-big

A very interesting clip from the Royal Bournemouth Hospital highlighted a patients experience and how his Sepsis was nearly missed. They are keen to spread awareness. Well done Bournemouth Hospital for sharing this short film.

Published on July 13 2016. 

Sepsis is a medical emergency, here at RBCH we are keen to spread  awarness and listen to patients experiences to improve care. 

 

Patient Access – Appointments


imagesCAUP3U1D“Improving patient access” is all something that we hear about on a daily basis. It constantly being discussed at all levels, Partner meetings, Reception Team Meetings and Multidisciplinary Meetings. There is no one working within the NHS who is not aware of this.

As Managers we all strive to make patient access the best we possibly can. Often systems are changed to try to accommodate patients, yet still we hear people complaining that they are unable to access appointments for days at a time.

Not having appointments can often cause frustration not only from the patients, but from the Receptionist Team too, they often feel that are unable to do their jobs and often having to deal with difficult situations because some patients can become aggressive.

I decided to be proactive and look at the amount of DNA’s we had at the surgeries I managed. We had over 30,000 patients and I was shocked when I realised just how many hours were being wasted on a daily / weekly / monthly basis by patients for whatever reason not attending their appointments.

Patients are often the cause of the lack of appointments. It is not acceptable to just “not turn up”.

But what can we do to improve DNA’s? What does your surgery do to try and keep on top the wasted appointments?

Some surgeries (and hospitals) display in the waiting room the number of DNA’s each month, and this can be pretty horrifying when you see just how many appointments are wasted in this way. But of course the people who did not turn up for their appointment do not see these statistics.

Some hospitals will send out a text message a few days before an appointment, thus giving the opportunity to cancel if the appointment is no longer needed (also a good reminder if the patient has forgotten) This system will only be helpful for those with mobile phones, perhaps not so good for some of the elderly that may not use mobiles.

Some hospitals are now sending out reminder letters a week before the appointment, again helpful when the initial appointment might have been made some months before.

Adding something to a Surgery website is another way to encourage patients to cancel unwanted appointments, you could also display the DNA’s for the previous month.

Practice Newsletters is also another way of encouraging people to cancel rather than just not turning up.

We did a trail at one of our surgeries. When a patient DNA their appointment a letter was sent to them pointing out that they missed their last appointment, and the practice would appreciate if they could not attend a future appointment could they please phoned and cancel the appointment. The letter would go on to explain the amount of DNA’s the surgery was experiencing and that patients were having problems booking appointments.

Another surgery I know of has a system in place, that they feel works extremely well and have been getting positive feedback from patients and the Receptionists. They have over 25,000 patients, and have their fair share of DNA’s. They found the amount of DNA’s they were experiencing each day was getting increasingly frustrating for the staff. The Reception Team Leader started getting the Reception Team on the late shift to phone the patients who had DNA that day to ask the reason why they had not attended their appointment. They make the call as friendly as possible; the call is not made with “all guns blazing” or “pointing a finger” at the patient for not attending. The Receptionist simply asks the patient did they realise they missed an appointment today, and would they require another appointment. They found that most patients were extremely sorry for missing their appointments, and some genuinely did forget, but more important it made the patients aware that the Surgery was monitoring the appointments. Since starting this system they have found that their DNA has fallen.

The most important thing when doing this is when a patient cancels an appointment that IT IS CANCELLED. Often for whatever reason if appointment stays on the screen, despite the patient cancelling the appointment it could result in a letter or a phones call going to the patient.

This unfortunately happened at our surgery, a patient was sent a letter when she had in fact cancelled her appointment, and understandably was quite upset when she received a letter. If this system was to work it is essential that every single Receptionist understand the importance of cancelling appointments on the screen – in not doing so could result in the surgery receiving a complaint.

By highlighting the amount of DNA’s in these ways it lets your patients know that you are monitoring your appointments system – especially for those patients that just have not “bothered” to cancel their appointment.

It could also flag up that patients are perhaps cancelling, but for whatever reason they are not being cancelled on the system – which could indicate a training need.

Are appointments being booked too far in advance (i.e 6 monthly BP checks, diabetics checks etc) if so how can you best deal with this? Could you use the texting system to remind patients a few days before their appointment?

I am always in favour of giving out appointment cards especially to the elderly. Always remember to put the day as well as the date on the card along with the time.

Monitoring DNA’s will flag up those that repeatedly fail to attend.

Always approach patients about DNA’s in a positive way. Explain that the Surgery is trying to look as the amount of DNA’s and at ways of decreasing these and feedback on why they DNA would help with the exercise.

Explain if patients cancel their unwanted appointments then this will free up more for other patients – which could be them.

And when a patient does take the time to call the surgery to cancel an appointment, the Receptionist should always thank them for taking the time to do so.

Patients have to be made aware that by not cancelling their appointments it just adds more pressure to the already busy system.

There is nothing more weird than folk


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I had to go into hospital for the day last week. I was sent a letter with instructions on what I needed to do and what I needed to bring, pyjamas, slippers and a book etc. All simply written out, easy to follow and to understand.

I arrived in plenty of time and was shown up to the ward. The ward was very quiet; there was just one other lady in the bed next to mine. I was shown my bed and asked to get into my pyjamas and told the nurse would be round shortly to take some details.

Then another lady came in. She took herself off to a bed opposite and sat there waiting on the nurse. She greeted the two of us and remarked on the weather, we all passed small talk that you have with complete strangers. Both ladies seemed really nice.

The nurse came in; she went to the lady opposite and drew the curtains.

There was no confidentiality whatsoever, we could hear the whole conversation, the nurse was taking her whole medial history.

When you are sitting there, nothing to do and everywhere is so quiet it is so hard not to hear what is being said.

I know I shouldn’t have but the lady did make me chuckle to myself at the same time feeling sorry for the nurse taking the details as I imagined there was a lot of crossing out on her notes.

Some of the conversation went

Nurse : Where is your bag?

Patient : What bag?

Nurse : A bag with your pyjamas and slippers

Patient : Oh was I supposed to bring something in to change into

Nurse : Yes it was in your information did you receive it?

Patient : Yes I did (and said no more)

The nurse went off to get the patient a gown 

The Nurse returned and continued asking the patient some more questions

Nurse : Do you smoke?

Patient : No

After a pause

Patient : well I do have 3 or 4

Nurse : is that a day or a week?

Patient : errrr well I probably have about 5 or 6 a week.

I imagined the nurse having to cross out what she has already written.

Nurse : Do you drink?

Patient : No

After another pause

Patient : Well………… I might have a couple now and then

Nurse : How much is now and again

Patient : A couple of time a week.

Another pause whilst the nurse crosses out what she has previously written.

Nurse : when did you last eat

Patient : Yesterday at 4.00 pm

Nurse : Did your leaflet not tell you to refrain from eating after 1.00

Patient : Oh I didn’t see that

Nurse : What medication are you taking?

Patient : ohhhh let me think? (this took a bit of time after several changes)

That entry also had a few crossed out too I should imagine!

And so the conversation went on with similar discrepancies to what was originally said.

I must say the nurse was brilliant; she never once got short tempered with the patient, took everything in her stride and was even able to have a laugh with the patient. She really was so professional.

The nurse then came to me.

We whipped through the questions, and when she came to medical history and medication I handed her a typed sheet with all the information on – she smiled and whispered, “if only everyone was as well organised as you.”

 

Eye Contact and a Smile


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A friend of mine had to go for an X-Ray yesterday at his local hospital. The hospital is in the process of going through some building work and many of the departments have been moved around – so finding the X-Ray department was somewhat of a challenge.

He followed the temporary signs to the X-Ray department and upon arrival asked the Receptionist if he was in the right place.

He was quite surprised by her attitude, he was made to feel as if he was a nuisance, and an inconvenience for being there. She replied quite abruptly that he was, took his referral letter and told him to take a seat.

At no time did the Receptionist give him eye contact, smile or show any signs of any customer care.

He sat and waited. There were another 4 people in the waiting room.

A nurse came out and called his name, the receptionist rudely snapped at the nurse and asked what she was doing and asked if she had taken from the bottom of the pile. My friend said that you could feel the nurse’s embarrassment at being spoken to in such a way, her red face for all to see.

The nurse explained to the Receptionist that the other people in the waiting room in fact were waiting to be accessed by her colleague before being seen.

My friend got up and followed the nurse, who was absolutely lovely. She welcomed him with a smile. She asked him how he was, and spoke about the weather and held a general conversation. He found her extremely friendly and this put him at ease.

I asked my friend how he felt about the two completely different approaches when be dealt with and he said that going into a Department people can be often worried and concerned as they could be going for tests that could have such a big impact of their life. Many people that are having tests at a hospital are feeling anxious and do not need to be met with rude staff.

He found the Receptionist unhelpful, uncaring and actually felt uneasy when being dealt with by her. He also found it embarrassing when she spoke in such an abrupt way to the Nurse, and he felt that she should not have done that.

As for the nurse, he found her lovely, helpful and put him at ease within the first couple of minutes. He felt able to ask questions about his test something he wouldn’t felt he was able to do with the Receptionists.

Staff have such a big impact on patients in the way that they deal with them, from the moment they walk into your organisation whether it be a hospital, or a Surgery every single member of your staff should treat every single patient with respect.

Eye contact and a smile speaks volumes.

Staff that gossip about patients and break patient confidentiality


imagesWorking in a surgery or hospital you get to see and hear all sorts of situations that occur everyday. Patients come in all shapes and sizes and all have a different story to tell – but just how confident are you that their “story” is kept within the surgery/hospital walls.

Figures show that in the past 12 months (figures taken at October 2011) doctors, nurses and admin workers breached patients’ confidentiality some 802 times and that is probably a small amount of what is being breached. ***

There were at least 23 incidents where staff had openly discussed patients with colleagues, friends and family on websites such as Facebook.

There were also 91 incidents where NHS staff admitted to snooping through the medical files of their own colleagues.

I actually had the unfortunate task of speaking to, and going through the correct procedures and dismissing a member of staff due to her looking at a neighbours records, (to what she admitted doing) and then commenting on them to another member of staff. Sadly it wasn’t the first time she had been seen to have done this – staff grew concerned about the amount of time she was taking to doing the scanning – it later came out that she was reading most of the letters to gain information on people she knew in the local area then discussing this with other reception staff.

This receptionist had no excuse as she had gone through several training sessions one of them being patient confidentiality where she was clearly told that situations like this would be a breach of patient confidentiality. Unfortunately she didn’t feel that she had actually done anything wrong and it involved a tribunal case – to which she didn’t win.

We produced documents that she had signed a patient confidentiality statement, and also produced proof that she had been given appropriate training in patient confidentiality. There was no way she could have said that she “didn’t know”

This wasn’t nice for me as a Manager to have to deal with, for the Receptionist that lost her job (albeit it she was in the wrong). It also caused a lot of upheaval for her fellow team members as they had been witness to her doing this and of course having to make written statements accordingly.

It caused the practice lot of expense and extra workload for the staff doctor and myself. But most of all a patient at our practice had information about him discussed within staff members – which just isn’t good enough.

It is also not just admin staff that I am talking about, I have also overheard Doctors and other healthcare professionals discussing patients in a way other than in the manner they should have been – and most of these time I don’t think for one moment that they realised that they had broken patient confidentiality.

How can you ensure that your staff are not discussing patient details at work, at home and perhaps sharing information on social networking sites?

You cant!

But what you can do is ensure that you staff are fully trained on patient confidentiality, ensure they understand what actually is patient confidentiality and that they understand the implications of what happens if they do this and update training on a regular basis.

Ensure that staff are fully aware of  What is Patient Identifiable Information? http://wp.me/p1zPRQ-7b

Does your staff sign a confidentiality statement when then start working for you? Do you include cleaners and porters in this? Are your cleaners and porters contracted by an outside agency? If so ensure that the agency are getting these forms signed before they start working for you.

Do you have a confidentiality clause in your visitor’s book?  Local trades people might often have access to your surgery to carry out work – they too could be privileged to patient information (notes on desk, computer screen left on, patients in the room) they should also be signing a confidentiality statement – and the best way for this is when then sign the visitors book at reception – have a confidentiality clause in the book for them to read before signing the book.

A lot of the time people do not realise they are breaching patient confidentiality – but if someone can identify a patient through a name, date of birth, address or whatever then the confidentiality is broken – and the patient would have ever right to complain.

Are you confident that ALL your staff are fully aware of the meaning “patient confidentiality.”

***Here is the link to the article that I speak about above

http://www.dailymail.co.uk/news/article-2054436/The-nurses-gossip-patients-Facebook-spying-loved-ones.html

3. DNA and the Patient’s Experience


I have had several people contacting me regarding my posts on DNA’s.

The first blog I did was the impact DNA appointments have on Hospitals and Surgeries.

The second blog was in response to a comment made by a Reception Team Leader and how her surgery is proactive in dealing with this problem, which I might add I think is a great system.

This the 3rd blog on DNA’s is from a patients point of view.

Someone contacted my regarding DNA’s and how this impacts on the health service resulting in people having longer waiting times for appointments.

This lady had a hospital appointment a couple of weeks ago, she realised the week before that due to unforeseen circumstances she was unable to keep the appointment the following Monday afternoon, and working in the healthcare sector knew how important it was to cancel the appointment and give someone else the chance of the appointment.

On the Wednesday the week before her appointment she tried to call the consultants secretary to cancel the appointment.

She was greeted with a recorded message saying that the secretary was on holiday and the secretary actually said in the recorded message there was no facility to leave a message. She asked that people call back on her return in 10 days time.

Obviously this would be too late to cancel the appointment. So this lady phoned the hospital and asked for outpatients department, the switchboard put her through and it rang and rang and no one answered. So she had to phone the main switchboard back again. She explained that no one was answering in outpatients, but she was put through again anyway – and again no one answered. So, she had to phone back yet again, she explained about wanting to cancel her appointment, before she could say much more she found she was put through to the “secretary” again, and heard the message she originally heard – and the fact she couldn’t leave a message!

She gave up at this point and left it until the next day when she tried again. She said that she was put through to several different departments, no one wanting to take responsibility for the call she was even told to phone the secretary on her return in 10 days time. She explained that the appointment was in fact in 4 days time and wanted to cancel it and not have a DNA against her name.

She got nowhere – so tried again on the Friday – the same run around.

Monday morning the day of the appointment she phoned the hospital and finally got put through to someone – she explained that she was unable to attend her appointment that afternoon and could they cancel it and ask the secretary to send her out a new appointment.  After taking the woman’s name said she would.

Two weeks went by and this lady had heard nothing so she telephoned the consultants secretary who was not back from her holidays – and to no surprise she found that they appointment had NOT been cancelled, she in fact had a DNA against her name, and the secretary did not get the message about her wanting another appointment made.

To say she was fuming was an understatement.

So, in order to get the DNA rates reduced it takes time and effort from all involved.

Patients have to be more responsible for cancelling appointments and this needs to be dealt with in a delicate manner.

Surgeries and Hospitals need to ensure that if a patient does cancel their appointment that it is recorded and cancelled and the patients does not received a DNA against their name.

Hospitals and Surgeries cannot moan about the amount of DNA’s they have unless they have a policy in order that will actually deal with this when the patients requests to.

And systems have to be in place that these messages are getting through to the right people.

The lady involved felt that no one wanted to listen to her – the operator just didn’t listen to what she was saying which resulted in her being put through to departments that if she had been listened to could have been avoided.

I would suspect that most patients after the first 2 or 3 phone calls would have simply given up trying to cancel the appointment.