"Generally good care but some flaws in overall practice"

About: Royal Cornwall Hospital (Treliske) / Trauma and orthopaedics St Michael's Hospital / General medicine

(as the patient),

I have to say, that I have been in two minds, about writing this review, of South Crofty Ward, at the Royal Cornwall Hospital, Truro.

On reflection, some of my observations, taken over a 3 day period in Feb, possibly warrant looking into and cast some serious doubts, especially in the area of hygiene control.

I will state from the start, that I found the greater majority of staff, at the Royal Cornwall Hospital and everyone at St Michaels, to be thoroughly professional and dedicated, but as with everything in life, a small percentage of individuals, can easily ruin the reputation, of any institution.

I was admitted to South Crofty Ward, at 07. 30 in late Feb 2014, for a replacement hip operation. My first impressions were not overly good. The ward appeared untidy with spillages of various items blocking the corridors and what appeared, from the untrained eye, to be a good deal of staff chaos. However this was at the height of a very busy changeover period between the night and day shift.

I was quickly shown to my bed. Obviously I was a little nervous.

At 11.00am I was informed that I would be going to theatre and within a short period, the anaesthetist was administering an epidural, which did not go entirely to plan, as the needle entering my spine, managed to come in contact, with the nerve, in my right leg. There was some concern, at the time, but luckily no damage was done.

I returned to the ward at approx 16.00 and was monitored hourly, for the rest of the day and through the night.

Although in a certain amount of pain, I remained in good spirits, managing to eat a light meal, but didn’t get much sleep.

It was during the night that I started to notice some marked differences, both in staffing and procedures, in relation to the day and night staff.

It's an unfortunate fact, that as a patient, you do feel vulnerable and you also have an awful lot of time, to just observe.

There were four night staff, as far as I could make out, one staff nurse and three nursing assistants, although it was difficult to tell, as some staff did not have name badges.

The first thing I noticed, was that hand washing seemed to be practically non existent. I had noticed that day staff, rigorously washed their hands, each time they moved from one patient, to the next.

During the course of the night an elderly gentleman in a nearby bed became clearly confused and unfortunately was doubly incontinent. As the bay I was in was being used as a post operative ward, I was perplexed, how someone, with clearly challenging hygiene issues, could have been placed, in amongst a highly vulnerable group of patients.

This obviously also perplexed the nurse, who was attending the bed, who stated in a loud voice that she was not sure what that patient was doing there and that she had absolutely no idea what was wrong with them.

This same nurse proceeded to change this gentleman a number of times throughout the night, seemingly getting more and more frustrated. Soiled bed linen was just dumped on the floor and the smell was quite sickening. Eventually the linen was bagged up, with no attempt to clean the floor. It was obviously very distressing for the gentleman in that bed and worrying for the rest of the patients in the Bay.

The same nurse seemed to have a rather bullish approach to patients and staff and was later heard to say, that she hated working in the womens ward.

Eventually after an interminable night, it was a relief to see the day shift arrive.

As I have stated previously, day staff worked faultlessly and although under pressure remained professional and compassionate at all times.

I would doubt however, the wisdom of using the same member of staff to dish up food at mealtimes and then revert to ward cleaner, surely introducing a high risk of cross contamination. (This same practice is carried out at St Michaels)

Unfortunately, the night shift eventually arrived and virtually a re run, of the previous nights poor hygiene practice, commenced.

A gentleman in a nearby bed became confused and it took the combined efforts of the remaining patients, to talk him into returning to bed, as he was in the early stage of recovery from a knee operation and we were extremely concerned, if he had fallen.

Ringing the emergency buttons, eventually raised the nursing staff, who seemed very slow to respond and quite dismissive.

Eventually the day staff arrived.

On my last night, before transferring to St Michaels, although under a different staff nurse, hygiene did not improve and I refused a replacement water jug which had been refilled, using the ward, hand washing sink by a male nurse. In the morning I reported this incident, but unfortunately was transferred before the ward co- coordinator, could speak to me.

As I stated at the beginning, just one or two staff not adhering to hygiene guidelines can ruin all of the highly professional work carried out by surgeons and the majority of nursing staff.

Having experienced my stay at Treliske, it appears that one of the routes that clostridium difficile and Norovirus may be entering the patient chain, is potentially through the night shift and in my opinion clearly action needs to be taken.

There was a serious issue concerning medication.

Before patients are admitted to Treliske, it is common practice in non emergency situations, for the individual to attend a pre-op assessment, normally a few weeks before admittance.

One of the features in this assessment is to ascertain the current medication that the individual patient is on.

When I was admitted onto South Crofty, the nurse attending locked my medication in a cabinet above my bedside cabinet and ignored it. I noticed that this happened throughout the ward. In my case I requested my medication at the correct time, only to be told that the ward had no record of my medication and that the nurse would not be allowed to administer it but that I could take it myself.

I questioned this practice and was told that the ward doctor would have to see me, so that my medication could be sanctioned. I explained that the pre op assessment had recorded my current medication, but to no avail, the doctor was called.

She eventually arrived some hours later and sanctioned the medication.

This happened again when I was admitted to St Michaels.

The problem with this arrangement, is that patients who are confused, or non communicative, are missing out on their normal medication, even though the pre op assessment has been carried out. It seems without prompting, the patients prescribed medication, is ignored by nursing staff.

I noted at St Michaels that a patient was delayed from leaving the hospital, by at least one day, because vital blood thinning medication, had been overlooked due to this flawed system, obviously causing an unnecessary bed block situation.

Surely these fundamental practices need an overhaul? Why bother to have pre op assessments, if the information is not forwarded, to the respective wards and nursing staff?

As I said at the beginning of this review, highly trained staff are carrying out complicated procedures, which require sound professional post-op nursing to guarantee successful outcomes. The majority of nursing staff, work tirelessly to achieve this goal.

To conclude, in my opinion:

A nurse that does not wash hands between patients is taking unnecessary risks.

A nurse that lets soiled linen, fall onto flooring, is risking faecal matter being transferred not only to the rest of the ward, but other wards.

A nurse that fills water jugs, from the ward hand washing facility, risks infection transfer, throughout the ward.

A nurse that shows a lack of respect to patients, should at the very least, attend retraining in Equality and Diversity.

None of these problems, have anything to do, with cut backs or efficiency.

Breaches of sound nursing practice, can cause Ward closures and unnecessary suffering and possibly worse. Management should be aware that they have a duty of care. Failure to adhere to these guidelines is in my opinion both costly and negligent.

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Responses

Response from St Michael's Hospital

Thank you for taking the time to give us your comments on your recent care. We have passed this onto the matron for South Crofty ward and if you would like us to respond to you personally, please contact our Patient Advice and Liaison Team at pals.service@rcht.cornwall.nhs.uk

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