"Basic Care of Toenails whilst in Queens Medical Centre Nottingham"

About: Queen's Medical Centre / Trauma and orthopaedics

(as a relative),

My elderly Diabetic (on Insulin) relative is a patient. She has been an in patient in this same hospital for a couple of months, although was sent home for a very brief period under a temporary red cross care arrangement) but had to be readmitted.

I am concerned and astonished that it seems that long term elderly patients in this hospital(especially diabetic elderly patients who cannot bend to attend to cutting their toenails are unable to have their request to Nursing Staff for their toe nails to be cut, to be actioned.

When we as relatives have requested this we have been told that we needed to contact her Gp to arrange for someone to come to do this for her. However when we did so, her Gp told us that he cannot send someone while she is an In patient in the QMC.

Obviously due to the length of time that she has been an in patient, her toenails are now extremely long and beginning to curl, and she has now been told by nursing staff on her ward that she will have to wait until she returns home to have her toenails attended to. We do not know how long it will be before she returns home. Our complaint is that surely on a ward for the elderley especially, care of patents toenails, especially elderley diabetic patients toenails, should be an essential aspect of patient care, aswell as infection control. Care of the nails is important to prevent the occurrence of pain and infection. Nails harbour debris and are potential sources of infection. Care of a patients toenails by Nursing staff should be as routine an assessment as any personal hygene care and I cannot comprehend why Nurses at the QMC say that they are unable to carry out this task. I draw your attention to an article from the nursing standard Art and Science section by RCN publishing-

Malkin B, Berridge P (2009) Guidance on maintaining personal hygiene in nail care. Nursing Standard.

23, 41, 35-38. Date of acceptance: April 16 2009.

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Response from Jessica Haggett, Patient Experience Officer, Communications, Nottingham University Hospitals Trust

picture of Jessica Haggett

Thank you for getting in touch. I have spoken with the Podiatry Service and understand from them that they are now working with you directly to resolve this issue. The Podiatry Service is currently exploring various options to replicate the service currently provided at City Hospital, at QMC to ensure that situations such as this are avoided in the future. Should you wish to discuss your concerns further, please do contact the Podiatry Service directly on 0115 969 1169 ext 57946.

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Update posted by Disgruntled Relative (a relative)

I have spoken with Podiatry Service who contacted the ward to offer advice to the Ward.

We quoted the Nottingham University Hospital Clinical Guidelines re Toe Nail Care,but apparently these are not obligatory for nursing staff to follow, some wards follow these guidelines some do not.

The Nurse in charge has stated that the Nursing Staff on the ward are not happy to cut my relatives Toe Nails as she is diabetic and do not wish to risk causing any Injury which may lead to risk of infection and will refer to Podiatry Service on discharge. But that they would be willing to try to file Nails if we brought in Nail files or alternatively suggested that we contacted a private Podiatrist to visit the Ward if required Toe Nails Cutting rather than filing.

However as discharge may not be be for some time yet as surgery is being discussed the only solution may be to pay for a private podiatrist to visit the hospital ward.

There is no NHS Podiatry Service at QMC and it is not deemed urgent for a NHS podiatrist to attend an elderly diabetic in patient with Back problems in the QMC unless they also had foot ulcers, and Nursing Staff Not willing to do this -So No the issue has not been resolved.

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