RNOH Patients’ Group Visit: Re-visit to Alan Bray Ward
Date:
11th September 2008, 10.00am-11.30am
Forum members: Angela O’Halloran & Ruth Marcus
Staff interviewed:
Lynne Gunn Clinical Nurse Manager
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Background
Alan Bray is an intensive care (ITU) and high dependency unit (HDU). There are 12 beds (six
HDU and six ITU beds). This division of beds depends on patient care needs, thus it is
interchangeable.
The ward’s patient mix is; male, female and children, and two isolation rooms. The ward has 1:1
nursing for ITU patients and 1:2 patient for HDU. Many patients are on ventilation. Patients are
mostly post-operative, or have been transferred from other wards due to deterioration in their
condition. There are also a number patients transferred from other hospital HDU or ITU, who
require specialist medical input from RNOH.
Post-operative patients are usually on the ward for 24/48 hours, and then return to their original
ward. Some patients stay longer usually because they require ventilation. The ward has a
mixture of elective and emergency care. Most patients are catherized, or use a bedpan and
therefore there is no need for patient toilet facilities on the ward. Many patients are on a very
light diet, and do not eat much for the first 24hours; some patients are on a gastric feed.
Steamplicity meals are available to those who can manage a larger meal.
The Manager was satisfied with staffing levels, and uses bank staff to cover sickness / annual
leave. In the last report it was noted that there was a shortage of paediatric nurses, but Lynne
informed us that she had sufficient input, as there were only a small number of children admitted
to the ward. They have a regular rote of paediatric nurses from Coxen and the Adolescent Units
who undertake a months training on the ward. The Manager can always request further input
from Coxen and the Adolescent Units if needed.
The Manager was pleased that two of her nurses were attending university courses to increase
their paediatric training.
Infection levels on the ward are low and monitored closely. Each bed has its own gel, gloves and
aprons (different colour for each bed) and new sinks have been installed. All patients from other
hospitals are screened before admission to the main ward. The side rooms are used for patients
with an infection or awaiting the results of screening, and are deep cleaned before the next
patient’s admission.
The Manager was concerned that the security entry system was continually out of order despite
request to the maintenance department. The doors were open during our visit.
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Observations
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One small waiting room for relatives, which had a sofa and two reclining chairs (which
were provided by the Buttercup Fund.) There is a hot drinks machine (20p per drink). A
water dispenser is due to be installed.
The resource room décor had improved since our last visit. It is used for staff training and
team meetings as well a confidential area to discuss the patient’s condition with their
family.
One very small staff room
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Two staff changing rooms (one female, one male), which had lockers for staff
belongings.
Photos of staff on a wall on the corridor, very useful for patients/visitors to identify the
team.
One fridge for patients and microwaves allocated for Steamplicity meals.
Most equipment are in labelled trays in storage room and all linen in a locked cupboard
One sluice room, which had bedpans and bottles because they were unable to install a
macerator machine for disposable bedpans due to poor drains.
The ward was redecorated and had a deep clean at Easter (the ward was closed for 10
days) and appeared cleaner and more cheerful than at our last visit.
There are DVDs and DVD players available for patient use.
Storage space is limited, and an IT/ HDU store was cluttered with many pieces of
essential medical equipment as well as housing all the hospital’s emergency crash team
requirements. A porta-cabin just outside the ward would solve these problems
Patient interviews
Mrs C
This patient was admitted for an elbow operation the previous day, and was self-administering
her pain relief. She also had RA and osteoporosis, and had previous admissions for neck
surgery and broken femur. She expected to be in the HDU for the next few days then will be
transferred back to her ward. She was very pleased with her treatment by both medical and
nursing staff.
Mrs K
Mrs K had an operation the previous day for a replacement hip operation, and had been in
RNOH last year for a back operation.
She had an epidural as she had a heart attack last year. She was very satisfied with her care at
RNOH. She was not in any pain and was eating well. Mrs K was due to be transferred back to
her ward later that day. She was full of praise for the doctors, anaesthetist and nursing staff.
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Conclusion
The Manager and her staff appear to provide a very high standard of care in a ward that deals
with critical patient care. She seems a fair, but firm manager who seems to have the respect of
her staff. Infection control is a very high priority, and considering the limitations of space and the
age of the buildings they provide excellent care.
 Recommendations
1
The security doors require urgent attention.
2
Storage space is a high priority due to the large amount of specialised equipment required
by an IT/HDU. Could the feasibility of a porta-cabin be investigated by the Trust.
3
It is hoped that the rebuild plans have provided adequate ward space and storage facilities.
4 Poor drains are preventing the installation of a macerator bedpan machine. Some of the
other wards do not have this problem. Can the maintenance department investigate the drain
problem?
Ruth Marcus/ Angela O’ Halloran 11th September 2008
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