page 4

ModernHousekeepers pilot

www.rdehospital.nhs.uk

Royal Devon and Exeter NHS Foundation Trust staff newsletter July/August 2011

RD&Enews

Emergency day casemedical care ambition

page 2

Why is matronMatt so proud?

page 6

Fit For The Future2

Ambulatory Emergency Care

allows patients to receive clinical

care as an outpatient or daycase,

when previously they would have

been admitted to hospital,

perhaps spending several days

occupying a hospital bed.

Over the next twelve months the

team of acute physicians, based on

the Acute Medical Unit, will be

looking at ways to introduce new

day case arrangements for up to

twelve clinical conditions ranging

from chest pain to falls.

The intention is to use the

facilities in the Medical Triage Unit

to be able to assess patients before

they are admitted to hospital and

then arrange for their diagnosis

and treatment to be provided

without admission to hospital.

Changes have already been made

for patients presenting with lower

risk cellulitis, pulmonary embolism

and upper GI bleeds, and so far the

improvements have been

impressive, with significant numbers

of admissions being avoided.

Tom Whitehead, Lead Clinician on

the Acute Medical Unit, pictured

left, said; “Close collaboration

with specialty teams and

diagnostic services is enabling us to

deliver urgent care in a more

planned fashion. The focus has

moved away from admission to a

hospital bed and onto pathways of

care delivered rapidly in an

outpatient setting.”

Over the next 12 months around

two pathways will be launched

every two months, and the

intention is to extend the

programme across the whole

hospital, as part of the Strategic

Redesign Programme’s Hospital

Utilisation project.

Matthew Bryant, Divisional

Manager for medicine and hospital

utilisation project manager said;

“This work will improve care for

patients by avoiding unnecessary

hospital admissions, meaning safer

care for people who don’t need to

come into hospital and ensuring

more beds are available for the

acutely ill and those who need

planned elective care. It builds on

good practice already in place

across the organisation where

some of these arrangements have

been developed by individual

clinical teams, but this project is

about looking at our whole system

of care and enabling clinicians

working across different

departments, including those

involved in diagnostics as well as

treatment, to provide this day case

care. I’m really impressed by the

extent of the clinical leadership

and the commitment of the teams

involved to see the changes put in

place.”

� For more information about

the programme contact

Nolwenn Luke on ext 6492

An ambitious projectis underway tointroduce day caseemergency medicalcare at the RD&E.

Fit For The Future 3

New FFTF pages on IaN

Staff have been invited to give constructive comment on a range of

options for change for the Administrative & Clerical Services at the

RD&E to achieve required financial savings in the current year.

Administrative staff are essential to the safe provision of services to our

patients and the effective professional running of this Trust. There are

many aspects of our administrative services which are highly effective

and valued within this Trust and by our patients. However, it is

recognised that growth over the past decade has not been approached

in a coherent or co-ordinated way.

The review has looked at Process, Technology and People.

No decisions have been made and comments through the options

feedback forms on IaN need to be in before 31 July 2011. There are

some recommendations regarding process and technology made by the

Administrative Services review steering group for consideration.

� If you have a concern or query about something which is specific to

you as an individual please discuss this in the first instance with your

line manager

� If you have a concern, enquiry or comment in relation to the review

complete and return the options feedback form/s or contact the Fit

For The Future project team: email is fitforthefuture@rdeft.nhs.uk

or 01392 40 6091

Stationery stock worth over

£15,500 has already been handed

in to RD&E Service Development

in the first phase of the amnesty

on the Wonford site.

All the collected stock – filling

about 25 cages - will now be logged

and priced; out of date or unusable

items will be recycled or shredded

as appropriate and procurement is

‘masking’ items on EROS so that

colleagues can consider the stock

we already have in before ordering

more. The amnesty has brought in

large quantities of unused printer

cartridges, Trust headed paper,

filing trays, suspension files, and

envelopes.

If you require any stationery please

e-mail Debbie Ellis

(Debbie.ellis@rdeft.nhs.uk) before

placing an order and if the items

are in the amnesty we will pass

them on to your department at no

cost. Just over £1,000 worth of

stock has already been

redistributed in this way. It is not

feasible to publish a list of items

because the range is extensive and

changes daily.

Modern Housekeeper4

Dart, Okement, Knapp and Yeo

wards will be the areas where

this role will be developed. The

Modern Housekeeper is to be

‘service orientated’ to meet

patient needs so the team is wear

a distinctive new uniform (see

front cover picture).

Revised job profiles and

expectations were set for catering,

patient equipment and cleaning,

with added responsibilities for

weekly cleaning, catering and

environmental audits. Twenty-one

Key Performance Indicators (KPIs)

were developed and aligned with

the Care Quality Commission (CQC

– health and social care regulator)

and the Nursing Quality Assessment

Tool (NQAT – benchmarks from

patient surveys, audits and clinical

observations).

The key tasks of a Modern

Housekeeper are to:

� Oversee delivery of cleaning

and catering services

� Ensure the Ward is well

maintained and tidy

� Report directly to the Ward

Matron to discuss concerns,

issue and improvement ideas

� Monitor resource, productivity

and quality of service

� Meet and greet patients and

visitors where possible and brief

them on hospital facilities

In addition, the environmental and

patient equipment cleaning and

food service has been re-modelled

and will be piloted on the same

four wards. The Catering Assistant

role will:

� improve meal service delivery

and quality while focusing on

protected meal times

� emphasise good nutrition and

hydration

� improve quality and choice, and

enhance patients’ mealtime

experience

Another pilot has been introduced

to offer improvements in food

items. This was developed by the

Catering Sub-Group, which

includes dieticians and nutritional

nurses. There will also be changes

in the way Catering Assistants

order and prepare nutritional

supplements to be issued by

nursing staff to patients.

The pilot runs until mid-September

and there is also opportunity to

assess current waste management

and linen distribution and usage

systems.

An Outcome Report will be

presented to the Executive Board

for review and approval before the

service is expanded across other

wards.

Em Wilkinson-Brice, Director of

Nursing and Patient Care and

Executive Sponsor for the project

said “All members of the care

team at ward level are

contributing to the delivery of

safe, compassionate and effective

care. The early indications are

really encouraging and I am looking

forward to analysing the Key

Performance Indicators as the

project unfolds.”

A pilot has been launched at the RD&E of anew Modern Housekeeper role to explore waysto release more time for nurses to spend onclinical patient care on wards.

AMU transforms care 5

www.rdehospital.nhs.uk

A significant milestone was achieved

in a programme of changes designed

to transform the care of patients

coming into the RD&E as a medical

emergency.

The project ‘Right Patient, Right Care,

Right Place’ took a step forward with

the official opening of the new Acute

Medical Unit by the Trust Chief

Executive Angela Pedder with Director

of Nursing & Patient Care Em

Wilkinson-Brice.

The Acute Medical Unit (AMU) has

been operational since 1st April 2011

when the Emergency Medical Unit

(EMU) and Harbourne Ward were

merged to become the AMU East and

West.

The improvements to EMU &

Harbourne are as follows:

� Relocation of Medical Triage Unit

(MTU): The relocation has made room

for a rapid assessment bay, an

ambulatory care area, and a clinic

area, as well as allowing closer

working between the acute consultant

team and the acute GPs within the

community.

� Expansion of EMU: The new Acute

Medical Unit (AMU) now has a total of

48 beds, against the 31 beds

previously occupied by EMU. EMU

often had over 40 patients a day; the

new unit ensures that for the first

time this number can be catered for

within one area. This means that

patients can now be assessed,

reviewed and have their management

plan produced in the same place, as

well as ensuring smoother transfer to

speciality departments.

� Increased consultant cover:

Ensuring that an acute physician is

always on the unit between 8 am and

10pm will maximise efficiency and

decrease the time a patient waits for

consultant review.

� Allocation of patients to medical

specialties: Every patient will now be

allocated to a medical specialty for

ongoing management, with

consultants responsible for transfers

between the teams.

� Nurse Practitioners: Introduction

of two nurse practitioners who have

recently received their BSc

qualification in emergency care. They

have been specifically trained to

notice and escalate deteriorating

patients, as well as having the

advanced knowledge that allows them

to communicate with patients and

relatives about their treatment.

Thanking staff for their hard work and

commitment, especially during an

unusually busy summer, Mrs Pedder

said: “This has been a huge journey

and the results, the Acute Medical Unit

and its provision of single sex

accommodation, are really impressive.

Patients have commented to me on

the high standard of treatment they

have received here and that is

testament to all your efforts.”

AMU matron Georgie Adams said: “We

are extremely proud of all that has

been achieved to improve our

services. We also want to continue

our development in the future,

including the implementation of

patient first as a tracking system to

monitor patients progress throughout

their treatment on the unit and

assessing the possibility of further

expansion to allow medical referrals

to be taken out of the Emergency

Department at the earlier, thereby

improving patient experience and

reducing the number of avoidable

admissions.”

Renal unit officially opened6

This unit, based in Torbay, provideshaemodialysis and acute dialysis services to upto 144 patients from the South Devon area with24 dialysis stations, side rooms and newoutpatient clinic rooms.

Lead clinician and renal consultant Richard

D’Souza said: “The new unit has been an

exceptional service development progression

from the old Newton Abbot site. The

investment has provided our patients with a

purpose built unit offering improved facilities

and treatment options to receive their life

saving care. From personal experience, it gives

me great satisfaction to see our patients

benefiting from the services provided in this

location. I would like to take this opportunity

to thank everyone involved for their hard work

and efforts in the successful delivery of this

unit.”

The £2.2 million South DevonKidney Unit has been declaredofficially open by the TrustChairman Angela Ballatti.

The artistic talent of Multiple Sclerosis patients and their carers is on

display in the level 2 corridor and courtyard gardens of the RD&E

Wonford hospital.

Symptoms of the neurological condition, including tremors and failing

eye sight, have been overcome by contributors to this exhibition which

runs until November.

MS Clinical Specialist Nurse Gail Hayes said: “This exhibition is a great

opportunity to celebrate the talents of these amazing artists whilst as

the same time raising awareness about MS. This condition can affect an individual’s self esteem and confidence. Art, for

some, can be a way of regaining an element of control over a part of their life. A creative outlet can also help sufferers

cope with the emotional stress of dealing with their condition. ”

On 30 September the Trust will be holding an event

entitled ‘An hour to remember’, aimed at raising

awareness of Dementia.

Due to the rising number of people who will be affected

by dementia – whether through work, friends and family

or as a carer – the Trust wants to encourage any

interested staff member to attend, not just those

employed in a clinical role.

The same session will be repeated throughout the day in

the hope that as many members of staff as possible will be

able to attend. Look out for posters and on IaN for further

details of times and locations in the coming weeks.

upcom

ing

eve

nt

healthy & wise 7

www.rdehospital.nhs.uk

The first RD&E staff weight loss groupprogramme – New Year New You – hasbeen popular and a success.

The Nutrition & Dietetic department was

approached by the Trust Staff Health & Wellbeing

group and the Staff Lottery Committee to run this

initiative. The 35 places on the programme were

quickly taken up and six sessions over a 12 week

period included talks on healthy eating, exercise,

motivation and eating out.

Overall the group membership lost 66kg in weight

between them and the colleague who had the highest

percentage body weight loss was senior matron Alison

Wootton (pictured right).

The current programme is

called ‘Shape up for summer’

and a third one will run from

September called ‘Christmas

Crackers.’ If anyone would

like information about the

third programme contact

Ruth Davies or Amy Bull (both

pictured) on ext 2524.

Patient experience and quality of carecould be improved by a newThinkGlucose toolkit being piloted bythe RD&E Diabetes SpecialistInpatient Team.

The pilot is part of a NHS Institute for Innovation and

Improvement national programme to improve patient

care and experience for diabetics. At the Royal Devon

& Exeter, Bolham and Mere wards are taking part with

the support and coaching of staff by the Trust Diabetes

Specialist Inpatient Team.

This programme has been developed to:

� Provide a learning and support package to improve

awareness, staff knowledge & patient experience

� Remove obstacles to treating diabetic patients as a

secondary diagnosis

� Improve safety and effectiveness of insulin

administration

� Reduce cancellations and discharge delays

� Improve appropriate referrals to the diabetes

specialist inpatient team

RD&E senior clinical nurse specialist (diabetes) and

project lead Nicky Hinton said: “The ThinkGlucose

toolkit will introduce a clinical pathway to improve

patient experience and quality of care, as well as

reduce the length of stay in hospital which is on

average 2.6 days longer than patients without the

disease. On completion of the pilot it is hoped

ThinkGlucose will be rolled out in phases with ongoing

evaluation and monitoring.”

� For more information about this initiative contact

Nicky Hinton on ext 3836 and look on IaN

other news8

The RD&E News is now bi-monthly which gives colleagues more lead up time to contribute their

story and picture ideas by email to me. The deadline for the September/October edition of the

RD&E News is 18 September 2011.

Wendy Shaw, Communications Manager

Learning DisabilityWeek The safeguarding team at theRD&E supported Mencap’snational Learning DisabilityWeek which this year focussedon tackling hate crime.

The Trust supported the campaignby raising awareness of the issueamongst staff, patients andvisitors including a workshop onhow to identify this and othertypes of abuse, how to report itand what support is available forvictims.

RD&E Learning Disability LiaisonNurse Liz Jennings said:“Worryingly Hate Crime againstpeople with a learning disability isincreasing. At the RD&E we workhard to support our patients, andit is important that we raiseawareness of the issues that theymay face. The workshop helpedinform staff about the supportavailable to patients experiencingdiscrimination of this nature.”

Highlights of the week included: behind the scenes tours, shadowing staff, arecreation of a real life ward situation; and an ‘Apprentice’ style challengeto raise awareness of the RD&E amongst young people.

Library, What Library?Over twelve hundred nurses are registered users of Exeter Health Library butwe still meet colleagues who don’t know about us or, more often, think thatwe’re the medical school library or can be used only by doctors.

Perhaps the confusion is understandable. We are one of the libraries use bymedical students and the library is in the PMS building. But in fact we’re an NHSLibrary and many colleagues from all staff groups here at the RD+E as well asfrom NHS Devon, the Partnership Trust and WAST are library members, borrowingover 35000 books in the last financial year.

Literature searching is one of the library’s key services and one that DeputyDirector of Nursing Jane Viner made use of when planning a redesign project.Jane said: “I found being able to call for a literature search very valuable. Currentbest practice information is critical but it can be difficult to find the time tocarry out a thorough review yourself. Being able to enlist the help of the clinicallibrarian to undertake the search and provide the results quickly, ensured thatcurrent literature informed the project scope and direction.”

Physiotherapist Louise Watson said: "The Exeter Health Library staff haveprovided me with significant assistance, training and support with a diverse rangeof skills including literature searching, locating and obtaining journals andreference management. With their help I am able to apply the best availableevidence to my clinical decision making, ensuring patients at the RD&E receivethe best quality of care."

The library is accessible on IAN (under Key Shortcuts) and via the websitehttp://services.exeter.ac.uk/eml/.

On the website you’ll find an A-Z list of all the journals that you can access onlineand in print as well as a link to the book catalogue.

Joining the library is easy. There’s an online registration form that can be emailedto us or you can come in and register. You’ll get a swipe card with which to borrowbooks and get you into the library out of hours. If you want to use a computer justlogon to one of our 17 networked PCs.

To find out more contact us on x6800 or email us at medlib@exeter.ac.uk.

To arrange a visit to your team contact Library Manager Ginny Newton on ext 6729.

For information skills training David.Newman@rdeft.nhs.uk

Thirty students were given the chance to experienceworking hospital life as part of Work Observation Weekin July co-ordinated by the Trust Learning &Development Service.