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"Bone scan at Nuclear Medicine Department"

About: Queen Elizabeth Hospital Birmingham / Clinical oncology

(as the patient),

I was referred by my medical oncologist for a precautionary bone scan. 

I attended the department at the beginning of October for the injection. I had received a letter in the post along with a leaflet about the scan and the Covid precautions details, so I felt prepared. I had had a similar bone scan over 20 years ago at Guy's, London. 

A nurse / technician did my injection. They were very friendly and jokey, but missed a few opportunities to  explain things to me. The leaflet said: if you are claustrophobic to tell a member of staff when you arrive. I told the technician I was mildly claustrophobic but thought I'd be OK. I asked if music could be played (as the leaflet said) but I was told the fans drown out the noise. I asked if I could wear headphones and the technician said that wasn't possible because of the camera, and went on to say they keep meaning to get a picture of the camera machine on the wall in the consultation room to prepare patients. This would definitely be a good idea.

When I came back for my scan, it was late afternoon and I was the only patient around. The same technician was there again and showed me where I could change. 

Then the door the the xray room opened and another member of staff called me in. They introduced them self and then helped get me on to the machine. 

I hadn't been told that I would be strapped onto the machine with big cloth swaddling that was velcroed together tightly. The staff member was talking to me telling me this was to keep me in the same position and so I wouldn't move. I was wearing a mask. They went on to explain that the camera was going to come very close to my face but wouldn't touch me. The camera began to move into position and I felt increasingly panicked. I felt claustophobic, overheated and momentarily unable to cope.

I told the member of staff I didn't think I could cope. They asked me in what way do you think you can't cope? & they didnt want me to abandon the scan and I saw them look over their shoulder and wave a 'hang on a minute' wave to a colleague. I felt under pressure to get myself together. I took my time to breathe and asked for a bit of time. I said I suffered from menopausal anxiety. I asked if I could remove my t-shirt from under my gown, and the staff member said no because the scan had already started. I hadn't been told this. I then had to work out how to sort myself out, which I did.

I asked the staff member to remove my mask, and my socks to reduce my temperature, which they did. They told me that the camera was only going to come close to my face for a few minutes, then it would go away. I didn't realise they were going to be in the room with me, and they spoke to me and told me when  each section had finished. The staff member said the machine was a camera and was only taking pictures, which was a good reminder but didn't help with the claustrophobia.

At one point I began to shake for a few minutes, but it passed. I focused on my breathing and got through it. The staff member said repeatedly that I was doing really well. All the way through I felt stressed, and imprisoned as though I was in a strait jacked. But I got through it. Two thirds of the way through, another technician appeared and introduced themselves and said they were just going to do a quick CT scan. They seemed in a hurry. I asked how long that would be and they replied only 2 minutes max which was good to know. 

When the whole scan finished the staff member came back and told me I'd done really well. I got myself off the machine, got my stuff. The team all appeared and started hurriedly to clean the machine. I got a real sense of it being Friday afternoon and everyone was keen to leave. I was a bit shakey and upset but no one asked if I was OK. They weren't looking at me, so i said goodbye and opened the door myself but it was locked so the staff member let me out. 

I was proud of myself for getting through it but I felt I could have had more support from the team to help me get through a stressful experience. There seemed to be no idea how to help someone cope who was anxious and claustrophobic - no reassuring continual speaking to me as the patient, I felt like I had to do all the problem solving. No help with visualisation, or breathing. 

Responses

Response from Nicky Beecher, Patient Experience Manager, University Hospitals Birmingham NHS Foundation Trust 11 months ago
We are preparing to make a change
Nicky Beecher
Patient Experience Manager,
University Hospitals Birmingham NHS Foundation Trust
Submitted on 09/10/2020 at 13:15
Published on Care Opinion at 15:03


Thank you for taking the time to provide feedback about the Queen Elizabeth Hospital Birmingham. I am pleased that some aspects of your experience were positive but also sorry to hear the concerns you have regarding your recent attendance for a bone scan. Your feedback has been shared with senior colleagues who lead the department you attended and they are keen to use it make any necessary improvements to the service they deliver.

Lucy Hodgkiss Chief Technologist has provided a response below:

'We take the feedback very seriously and if there is an area that we can improve the patient experience then we are glad to have this highlighted.

Cleaning during the COVID pandemic is especially important and we have an intense cleaning programme in place. Social distancing and safety of patients and staff is also paramount at present to keep an active service. Staff, patients and visitors should all be wearing PPE as per Trust policy and government guidelines. It is not expected to encourage removal however in this circumstance removing the mask to ensure a diagnostic image was acquired was a sensible option.

It is unfortunate that the scanning team were unaware of the mild claustrophobia prior to positioning, had this been discussed sooner an alternative positioning technique could have been implemented, but it is appreciated that you initially felt you would be ok during the scan. It is not usual for a team member to remain with the patient throughout the scan as the staff member receives a radiation dose from this, however I understand that in this instance, in order for the patient to feel more comfortable, they did stay and talked through the process.

There is a DVD player attached to the system but we have no access to music DVD’s. However, there would have been no issue for you to wear your own earphones (small plugs but not large head set) attached to a personal media player and this could have been set up prior to the start of the scan.

If you still have any concerns I am happy for a face to face meeting as a process to enhance our services and improve patient experience'

Additional Response from Nicky Beecher - Patient Experience Manager

I hope that information is helpful; I also wanted to let you know that I am meeting with senior colleagues from this department to go through your feedback and helpful suggestions in more detail. I will also be walking through the department to have a look at the patient journey to see if there is anything that can be improved. If you would like me to feedback to you directly following this please get in touch and provide your contact details. My email address is Nicky.Beecher@uhb.nhs.uk

Thank you again for taking the time to share your experience with us, we do value it very much and hope that we can use it to benefit future patients.

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Response from Nicky Beecher, Patient Experience Manager, University Hospitals Birmingham NHS Foundation Trust 7 months ago
We have made a change
Nicky Beecher
Patient Experience Manager,
University Hospitals Birmingham NHS Foundation Trust
Submitted on 11/02/2021 at 11:07
Published on Care Opinion at 11:16


Dear Fresh Air Fan,

I thought you might be interested to hear about some of the changes that have happened in the Nuclear Medicine Department as a direct result of your valuable feedback.

I had a walk through the department with one of the senior managers who was very keen to help identify any improvements that could be made to the patient journey.

We looked at the waiting room and felt it could benefit from a couple of things: camomile teabags have been added to the drinks provision as we know some people find this helpful when feeling anxious. We have also added a patient activity box; this contains puzzle books and mindfulness colouring books/coloured pencils, this may help with the long wait some patients have in between their dye injection scan. Everything in the box is for single patient use and can be taken home.

We also looked at the information patients receive prior to their appointment; specifically the advice given to patients who feel anxious or claustrophobic. This information is being updated with clearer guidance about what the patient can do to themselves, as well as how to let staff know they may need to do something different to be supportive during the scan. The changes to the leaflet are delayed slightly due to new scanning machines being installed. We are going to include a photograph of the scanning machine on the leaflet so that patients know what to expect, therefore we need to wait for the installation to take place so that the photos are accurate.

Staff have also been reminded that if a patient feels anxious they may need more support before, during and after their scan. This may be just taking a little more time to explain things, or it might be something else. The important reminder for staff is to have those conversations with the patient at the time.

If you would like to discuss these changes further please get in touch directly with me. You can contact me via email: nicky.beecher@uhb.nhs.uk

Kind Regards

Nicky

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Update posted by Fresh Air Fan (the patient)

Really good to see that positive changes have been made in the department. I do think they will benefit people having scans.

Needing to have scans can produce anxiety anyway, aside from claustrophobia, so having relaxation materials / drinks as well as more detailed information leaflets available is really important. Most importantly staff being able to take more time to listen and talk to patients throughout the appointment will ensure a calm and positive experience.

Thank you for helping make these changes happen.

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