I posted a story previously about the poor care of my step-father who died of stroke related problems in Rotherham General Hospital. This led to an offer being made by the hospital of a meeting, which I attended yesterday (15.5.08). The staff took the complaint very seriously and were not at all defensive; they accepted, in principle, all of the reports from my family of the incidents that reflected poor nursing standards. I was very impressed by the attitude of the staff I met, and their openness to learning from complaints. From my notes in the meeting, I can confirm that we agreed on the following points: 1 There is a need to review the training needs of nursing staff about communication with patients and relatives. This seemed to implicate both competence (how to speak and listen) and confidence (the willingness and ease in speaking and listening). Sensitive and attentive communication with patients and their relatives has to be at the top of the training agenda for nursing (and medical) staff. As a relevant aside here, it seems unfair at present that medical staff have protected learning time but nursing staff do not in the NHS. 2 In the past, the hospital has experimented with the use of diaries by carers but it has not always been taken up when offered. It might be useful to re-launch this initiative and target those relatives, where it is evident on admission that they are already experienced informal carers and so know the nuances of a particular patient's needs. 3 I was very pleased to hear about overlapping initiatives about food and hydration. The hospital has now implemented a policy of protected meal times when all clinical routines and meetings are stopped (unless there is a medical emergency). Everyone on the ward then helps with feeding. Also the wards for older people have a newly trained housekeeper, who will pay particular attention, in close cooperation with the nursing staff, to patients receiving drinks with the appropriate level of assistance. A chart system over each bed will enable this to work. 4 Negotiations are taking place to increase the number of qualified staff on the ward. This is a necessary but not necessarily sufficient condition to ensure improved nursing standards. 5 The staff explained to me that the ward my step-father died on is a general medical ward for 'the elderly' (a term by the way I do not like, as it turns people who are a collection of distinct individuals into a depersonalised herd- but this is a wider problem of terminology still in the NHS and reflects traditional professional specialisation- 'geriatric medicine'). The existence of such generic wards means they include patients with a mixture of illnesses and disabilities. A proportion of them are dying and so require sensitive palliative care. Some are passing through to a rehabilitation facility and require accurate and efficient assessment. Some have acute illnesses, which are treated and then the patient returns home fairly quickly. The ratio on the ward of these three broad groups means that it is very challenging for the nursing staff, as their time and skills are being pushed and pulled in a number of directions at once. Moreover, the ratio fluctuates over time and so from week to week the patient mix keeps changing (in relation to types of illness and degrees of impairment to be managed). Although the staff assured me that they have learned to cope with this fluctuating demand, I was not convinced that patient-centred care could then be delivered consistently, especially in relation to dying patients and their relatives. How does a ward like this develop a consistent philosophy of care with such a fluctuating and diverse patient population? Returning to my point about 'the elderly' the only consistent factor is the age of patients on the ward- but what has that got to do with individual need? Are we still organising wards according to pre-existing medical categories ('geriatric medicine') rather than in a patient-centred way? Yes older people are more likely to have multiple illnesses ('co-morbidity') but this can be the case with some younger people. Some older people have been healthy and independent but then suddenly have a first stroke or heart attack and would be admitted to the same ward as a person with complex long term health problems or multiple previous admissions who is now dying. I was left perplexed about this point about the sense of this patient mix and not convinced that it allowed for optimal nursing care of all patients. Some clarity about this might come out of the next point. 6 I was told that the hospital now intends to implement the Liverpool Care Pathway (LCP). The National Stroke Strategy issued by the Department of Health (6th December 2007) explains that LCP '..is used to care for people in the last days or hours of life. It enables clinical staff to deliver high-quality care as death approaches, providing guidance on comfort measures, anticipatory prescribing, psychological and spiritual care and family support....' It is very encouraging that Rotherham intends to implement this type of care protocol. My doubt is whether it can work in practice in the mixed setting I describe in the previous point. Overall this was a really constructive meeting. I was offered a follow-up meeting in October to discuss progress in the relation to the above six points. I will report back to this site about the outcome of that follow up meeting. Thanks again for the openness of the staff at Rotherham and thanks again to Patient Opinion for facilitating this type of public reporting of care in the NHS.
"Positive response to complaint at Rotherham General Hospital"
Posted by Duffy (as ),
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