"Reducing the anxiety of carers when their loved one becomes an in patient"

About: Royal Bournemouth General Hospital / General surgery

(as a relative),

My mother's fear is that my father will die or become more permanently disabled not due to medical error but due to a lack of joined up care. As a retired social care professional herself she is well aware of the difficulties of public sector work and also the idiocyncracies of individual employees but it is systemic failings that unnerve her the most.

Fantastic surgical care and thorough intensive treatment brought my father back from the brink of death. His initial recover was partly due to his sheer determination to survive and partly due to the expertise of clinicians who know how important positive calm action is in critical care. Little personal touches like the daily diary providing the link between unconscious patient, relatives and hospital staff show that the patient is a person and not just a set of symptoms and help to create a bond of trust. This is then undermined when the patient is transferred into an ordinary ward where care is not so critical or intensive and the diary and relative contact information disappears.

In patients in ordinary wards have limited contact with their relatives ostensibly so they can rest and recuperate. This can cause anxiety for a carer who suddenly has to hand over care to strangers with whom they have little contact. When this leads to mistrust the anxiety of carer is transmitted to the patient which can have serious negative outcomes for both.

In a gastrointestinal case, confidence in the care of adequate nutrition seems obvious to most lay people. However my mother, together with two willing but ill informed healthcare assistants tried to navigate the menu choices on offer for my father today so that he could have the low residue diet instructed by the paperwork. One of the healthcare assistants suggested to my mother that the advice of a dietician would be useful! My father has been eating in the hospital for the past 6 days! Today the only obviously safe choice was macaroni chees which he does not like. Meals like "cottage pie" and "fruit salad" have no ingredient list with them and no indication if they are low residue or contain restricted items like onions, mushrooms or even apple peel.

My father cannot be the only patient that has been given a stoma whilst suffering from damaged kidneys. He cannot be the only patient on a low residue diet. He cannot be the only patient who is still in hospital in order to balance his digestive system and ensure adequate nutrition. So why is the system causing my mother so much anxiety and raising her blood pressure to such an extent that as a family we are all concerned (including my father) that she is at risk of an imminent stroke?

Surely if a hospital can get the signage right on all its toilets to aid people with a dementia diagnosis, it can provide inpatients and staff with more information on what ingredients the daily meal choices comprise and which would be the best for those on a low residue diet. Sweetcorn that highly indigestible vegetable that is often used to determine digestive transit has appeared in various disguises including "mixed vegetables" which could be difficult to easily pick out.

The healthcare assistant was great, trying to find options like scrambled egg and jelly but the anxiety caused was all so uneccessary and should not be part of the healthcare assistants responsibilities. Managing the nutrition of patients should have more importance as my mother commented "What is the point of all the critical care team spending so much effort and no doubt expense in keeping him alive only for lack of nutritional support to kill him off ".

If she could take him home and feed him according to the recommended list my mother would do so. My father is working so hard to get out of hospital to return balance and harmony to his life. My sister and I are just so frustrated by the lack of effective communication between departments that should be working together to facilitate this. Catering in hospitals should not be an added extra for in patients but a necessarily important part of the healing process. In patients cannot opt out and choose to eat elsewhere so what is the management issue?

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Responses

Response from Sue Mellor, Patient Experience Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust

Dear ‘Scotch daughter’

Thank you for your detailed feedback regarding concerns for your father’s low residue dietary requirements.

Due to the nature of your concerns and how seriously we regard them, I have passed them on to the Dietetics Manager and the Head of Catering Services. Please allow me a few days to receive their responses and reply to you in more detail.

If in the meantime you wish to provide any further detail or have more concerns please could I direct you to our PALS department who are always happy to assist.

They can be contacted on 01202 704886 or via PALS@rbch.nhs.uk

Regards

Sue Mellor

Head of Patient Engagement

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Response from Sue Mellor, Patient Experience Lead, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust We are preparing to make a change

Dear ‘Scotch daughter’

Thank you for your patience whilst we reviewed the details behind your comments, we note that the 1st post you made referred to a South Coast hospital which I am not sure if that is The Royal Bournemouth and Christchurch Hospitals Foundation Trust. We have now spoken with the catering manager, the dietitian Dietetic manager and the ward sister regarding this.

I am sorry that you feel that carer’s anxiety levels are increased due to the patients rest period and accept that the balance of managing the carer’s anxieties and maintaining confidence in both carers and patient is paramount. Supporting carers is an area I feel of particular importance and recognise your concerns.

Having been in contact with the dietitian Dietetic manager she has offer this response below

“If a patient is admitted to hospital and requires a low residue diet or is placed on one by the medical/surgical team the standard process is to refer them to the ward Dietitian who will advise them on the principles of a low residue diet and provide supportive written information in addition to advice on appropriate hospital menu choices.

If the patient is placed on a low residue diet at the weekend or evening there is information available on the Dietetic intranet site for ward host/hostess/healthcare support worker to advise the patient on suitable menu choices.

If there is confusion or queries about menu choices the healthcare support worker should discuss with their nurse in charge and/or ward Dietitian.

One of the catering team also visits the wards every day so advice can be sought by ward staff from them also regarding recipes and menu choices.

Wards such as the colorectal ward also have additional low residue menu choices available to them as this area has a large amount of patients requiring this advice.”

The catering manager has asked us to clarify the following

“On the Hospedia terminals for meal ordering there is an information button that patients can press that gives a description and picture of the menu item, which is a useful tool to help patients.

Catering is keen to meet the individual needs of patients and additional meals can be ordered by ward staff when necessary”.

Although there are items that can be chosen from the standard main menu, there is not a set menu for low residue. This is due to the very wide variation in patients bespoke needs and why we encourage staff and patients to speak with our expert Dietitians. The Dietitians hold a two hour session for all healthcare support workers and ward hostesses during their induction to the Trust and we will ensure the process of ordering special meals is highlighted. To ensure we also refresh those staff who have been with us for a longer period, we have agreed to provide additional training for healthcare support workers in their development package which is currently being designed.

We are aware that the process was not seamless and have made plans to improve the communication with the wards to ensure that in the future patients who need additional information can get it. We are developing an information sheet and will incorporate into training how staff can access information and support for any patient with more complex dietary needs. We will start the process during the next healthcare support workers starting this week.

I hope the action we are taking is an assurance of how earnestly we value the feedback we receive and I thank you for taking the time to express your father’s experience in such detail and clarity.

Regards

Sue Mellor

Head of Patient Engagement

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