Enter & View Report
Arrowe Park Hospital: Surgical Assessment Unit
Service address: Arrowe Park Road, Upton Birkenhead.CH49 5PE
Service Provider: Wirral University Teaching Hospital Foundation Trust
Date and time: 29th October 2015, 2pm
Authorised representatives: Kate Gratwick, Tricia Harrison, Elaine
Evans
Table of Contents
Page
1.
Acknowledgements.
2.
What is Enter & View?
General profile of service and purpose of visit.
Type of E&V visit undertaken.
3.
Methodology.
4.
Findings and observations.
6.
Feedback from residents, relatives and staff
8.
Safeguarding, conclusions and recommendations
9.
Supplementary feedback from the provider post visit
Healthwatch follow up action.
10.
Glossary
Distribution of report
Acknowledgements
Healthwatch Wirral would like to thank the staff and patients at
Arrowe Park Hospital Emergency Surgical Assessment Unit who spent
time talking to us about their experiences working or being a patient
on the unit.
Please note that this report relates to findings observed on the specific
date and time of the visit. Our report is not a representative portrayal
of the experiences of all service users and staff, only an account of
what was observed and contributed at the time.
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What is Enter and View?
Part of the Healthwatch Wirral’s work programme is to carry out Enter
and View visits. Local Healthwatch representatives carry out these
visits to health and social care services to find out how they are being
run and make recommendations where there are areas for
improvement.
The Health and Social Care Act allows local Healthwatch Authorised
Representatives to observe service delivery and talk to service users,
their families and carers on premises such as hospitals, residential
homes, GP practices, dental surgeries, optometrists and pharmacies.
Enter and View visits can happen if people tell us there is a problem
with a service but, equally, they can occur when services have a good
reputation – so we can learn about and share examples of what they do
well from the perspective of people who use the service first hand.
1.0
General profile of the service that was entered and viewed.
The unit consists of 12 acute admission beds with a 4 bedded
ambulatory care triage area. It provides surgical assessment to
patients referred from A&E and General Practitioners (GPs).
2.0
Purpose of visit
To review any changes made by the Trust since our previous visit to
the Surgical Assessment Unit on 11th June 2014.
3.0
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Type of E&V visit undertake
Unannounced visit
4.0
Methodology
The visit is not designed to be an inspection, audit or an investigation,
rather it is an opportunity for Healthwatch Wirral to get a better
understanding of the service by seeing it in action and talking to staff,
service users and carers/relatives. Healthwatch Wirral seeks to identify
and disseminate good practice wherever possible. However, if during a
visit Healthwatch Wirral identifies any aspects of a service that it has
serious concerns about, then these concerns are to be referred to the
appropriate regulator or commissioners of the service for investigation
or rectification. Any safeguarding issues identified will be referred to
the Local Authority or Commissioner for investigation.
The rectification of less serious issues will be directed to the service
provider.
The Enter & View visits are a snapshot view of the service and
findings are reported based at the time of the visit.
Enter and View visits are conducted in a way that works in accordance
with Wirral Safeguarding Adults Partnership Board's principles and
procedures. Information will be shared accordingly in order to
safeguard adults at risk on Wirral and promote quality of local services.
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5.0
Discussions, findings and observations
Healthwatch reps were greeted by a member of staff at the reception
area situated in the waiting room.
The area was quiet with only 2 people waiting. It was clean,
comfortable and tidy.
Information was available for patients on arrival. A flow chart was
displayed giving details of the unit’s procedure and the patient
pathway. There was a television on the wall and drinks were available
for people waiting in this area. We noticed the End of Life Charter
displayed in the unit.
The deputy ward sister introduced herself to Healthwatch Authorised
Representatives (AR) before taking them to her office for a discussion
about any changes that had been made since the last visit. She
outlined the process for patients being admitted to the unit and
informed the AR that patients who require further inpatient care are
admitted onto a surgical ward.
We were informed that the unit had been relocated from its original
site. This was seen to be an improvement. The waiting area was less
congested due to the fact that, apart from the ambulatory clinic, other
clinics no longer run from the unit and have been moved to
outpatients. However, the Trust has plans to relocate SAU in the
future.
There are 3 bays housing 12 acute admission beds and a 4 bed
ambulatory care triage area.
Staffing levels have increased with the recruitment of a band 7 nurse,
a flow manager and a deputy ward sister in post. Two advanced nurse
practitioners are working with the F1 doctors to review admissions and
initiate treatment plans. The Trust will recruit a prescribing
pharmacist for the unit soon.
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Three emergency consultants have been recruited since Healthwatch
last visited and a further weekend consultant will be recruited in the
near future. A duty rota will be introduced to cover 7 days when the
fourth consultant is in post.
Better communication between primary care and secondary care
clinicians has been established and GPs can contact the consultant
directly by phone.
The Trust has worked with the CCG to improve how GP’s can inform
patients what they can expect when they are admitted to SAU.
After our discussions with the deputy ward sister we were invited to
look around the unit and to talk to patients and staff.
The unit was clean and tidy and staff appeared to be organised and
attentive to patient needs. The care delivered appeared to be person
centred and staff interacted well with patients in their care.
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Feedback
Healthwatch Representatives spoke to three members of staff –
Staff told us that they keep patients informed about waiting to see a
clinician. They conduct comfort checks every 2 hours. One member of
staff was unaware of the unit’s hydration policy.
Staff spoken to were unaware of when the consultant would arrive to
see patients but said that if a patient had been waiting a considerable
amount of time they would inform senior staff as part of their
escalation procedure.
Staff said that they were supported by management. Two felt that the
unit was adequately staffed but another felt that at certain times the
unit is understaffed.
All staff spoken to said that they would recommend the unit to family
and friends.
When asked if they could suggest any improvements on the unit the
following responses were received;
“No, no improvements needed”
“I enjoy working on the unit and find that the changes made have
improved staff morale”
“I do not like the ward being used for medical outliers, as this
interferes with the routine on the ward.”
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Patients –
Three of the four patients spoken to were referred by their GP and one
came in by ambulance.
None of the patients referred to the unit by their GP received any
information about SAU from their GP.
Three of the patients said that they felt supported and had received
comfort checks from staff.
Three patients agreed that they would recommend the unit to family
and friends.
Other comments received included;
“I have been waiting over 4 hours but have not been offered any food,
only tea and coffee”
“I was discharged from the hospital 6 weeks ago although I did not feel
fit to go home. I had to call an ambulance today and have been
admitted to SAU. I informed the staff that I am allergic to dairy
products but was offered butter and mayonnaise with my lunch. I have
also requested medication but have not been given any. I feel that the
service is better when you are an inpatient on a ward. SAU is not as
good”
Relatives –
“My wife has received very good care while she has been on the unit.
The staff have been very kind”
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6.0 Safeguarding observations on day of visit.
No Safeguarding issues were identified at the time of our visit.
Healthwatch Enter and Views are not intended to specifically identify
safeguarding issues. However, if safeguarding concerns arise during a
visit they are reported in accordance with Healthwatch safeguarding
policies.
If any safeguarding issues are identified during a Healthwatch Enter
and View the Local Authority will be notified on the same day as the
Enter and View visit
It is seen as good practice for all Health and Social Care Services to
report potential Safeguarding alerts to Wirral Council Central Advice
and Duty Team.
7.0 Conclusions
The ward appeared to be well organised.
There appeared to be inconsistencies on how patient’s dietary
requirements are assessed.
We would appreciate some clarification on how the Hydration Policy is
implemented and whether this forms part of the 'patient rounding'
process.
Clarification on questions asked at the admissions process would be
helpful.
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8.0 Recommendations
Although HW are not making any formal recommendations we would
welcome additional assurances on the areas we have highlighted in
the conclusions and the report.
Healthwatch Wirral would also like assurances that the
recommendations from our previous visit to SAU have been
achieved.
8.1 Supplementary feedback from the provider post visit
SAU would like to thank Healthwatch for visiting us and speaking
to our staff and patients and for making recommendations in how
we can improve our services. SAU is pleased that Healthwatch
found SAU clean, comfortable and tidy. We are also pleased to
know that Healthwatch noticed overall improvement in patient
experience due to various measures been taken in most recent
times.
We would like to assure Healthwatch that we have invested in
nurse recruitment to provide better staffing levels across all
shifts. SAU now have 3 full time Advanced Nurse practitioners who
work closely alongside junior doctors and emergency consultants
to reduce patient waiting times to be seen by a senior doctor,
moreover to reduce length of stay as an in- patient.
SAU have recruited 4th emergency consultant who is starting in
April which will enable 7 day emergency cover to enhance our
patient experience further. The introduction of emergency
surgeons has improved our friends & family test scores. In month of
November 96% of our patients told us they would recommend our
unit to their friends and family.
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All our patients admitted to SAU get assessed for all their needs
such as social and dietary needs. Moreover all our in patients get
assessed for their dietary requirements through Malnutrition
Universal Screening Tool (MUST) and referred to dietician as
indicated by MUST. SAU have a displayed nutritional status board
where all the dietary requirements highlighted to ensure that the
care staff are aware of all the patient’s individual needs.
It is most disappointing to learn that not all patients who were
present on the SAU had a satisfactory experience in regards to
their nutritional aspects of care. In response to this we have
ensured that the mealtime experience role has been relaunched on
the unit. This places a focus on particular needs of our individual
patients. A member of staff has protected time to ensure that each
patient has that nutritional requirements addressed.
We have worked closely with our catering colleagues to ensure an
appropriate range of snacks are also available for our patients
outside of normal ‘meal time hours’, recognising that many of our
patients may not be able to eat and drink during normal mealtime
service due to the nature of their presentation and the need to
remain nil by mouth for a period of time.
SAU also has patient focused rounding in place which enables staff
to interact with patients regularly to ensure that their individual
dietary needs are met. During the ‘round’ patients who are able,
will be assessed to ensure they have access to fresh drinking water
and also provided with additional warm drinks if required. The
‘round’ also addresses other aspects of comfort such as position
and perhaps the need for assistance to the bathroom. The
underlying concept of Patient Rounding is that patients’ needs are
anticipated and therefore addressed much more proactively,
rather than met reactively.
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Due to the very nature of the SAU we recognise that many of our
patients are unable to take diet or fluids for a proportion of their
stay. To ensure they remain adequately hydrated the SAU have a
number of actions in place.
This includes a standard agreed maximum amount of oral fluids for
all patients, increased doctor and advanced nurse practitioner
presence on the unit ensuring the timely prescription of
intravenous fluids if required and the provision of mouth care
assistance to ensure that patients remain as comfortable as
possible during their stay.
The admission process is standardised throughout the hospital and
includes a series of assessments, which is recorded on Cerner
(electronic system) that allows us to gain a full insight into the
patient’s individual needs to ensure that each patient is treated as
an individual to provide safe and effective care.
SAU endeavours to provide good quality care to our patients at all
times. We are also planning to relocate SAU to provide our
patients with better and improved facilities. We would appreciate
Healthwatch’s feedback in future to improve our patient
experience further.
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9.0 Healthwatch follow up action.
Healthwatch are pleased with the additional responses received
from the Trust. We look forward to visiting the relocated unit in the
near future to check that nutritional and hydration assessments are
being consistently implemented in line with the Trust’s policies.
10.0 Glossary
CCG
Clinical Commissioning Group
Flow Manager
Controls the flow of patients through the
unit.
F1
Foundation year 1 doctor(This is a two-year planned
programme of training where doctors learn about working in the
teams that deliver care in the NHS as well as the clinical aspects of
caring for sick patients. It is a transition period of practice between
being a student and undertaking more specialised training for a
future career in a specialist branch of medicine such as general
practice or hospital medicine)
GP
General Practitioner
SAU
Surgical Assessment Unit
Ambulatory Care
Medical care provided on an outpatient basis,
including diagnosis, observation, consultation,
treatment, Intervention.
Medical Outlier
Patients with a medical diagnosis who are
placed on other wards, usually surgical wards
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11.0 Distribution of report
Healthwatch Wirral will submit the report to the Provider, to CQC,
and Health & Wellbeing Board.
Healthwatch Wirral will publish the report on its website and submit to
Healthwatch England in the public interest
Healthwatch Wirral
Pacific Road Business Hub
1 Pacific Road
Birkenhead
Wirral
CH41 1LJ
Telephone: 0151 230 8957
Email: [email protected]
Website: www.healthwatchwirral.co.uk
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