STUDENT - bcu.ac.uk · Web viewthe concept of admission is retained here to emphasise the need to observe proper admission procedures and records. this definition excludes minor

STUDENT

DAY UNIT INFORMATION PACK

DAY SURGERY

CONTENTS

PAGE

Student Information 1

Day Unit Staff Members 2

Profile of the Unit 3

Orientation to the Unit 4

Day Unit Philosophy of nursing care 5

Day Unit Telephone Numbers 6-7

Concepts of Day Surgery 8-11

Student Objectives (ward based) 12-13

Meaning of ‘Orthopaedic’ 14

Menu of Learning 15-18

Day case procedures 19

Injection room procedures 20

Orthopaedic terminology 21-23

Further reading and reference list 24

Appendix 1 25Incident Evacuation Plan for Day Unit

Additions:-Venous Thromboembolism Guidelines Must Tool Slips/Trips/Falls Infection Control – Think Link

DAY UNIT STUDENT INFO PACK

STUDENT INFORMATIONThe Royal Orthopaedic Hospital NHS Trust supports the viewpoint of the NMC that all students be allocated a mentor, who has the relevant qualifications. This includes both pre and post registration students. To ensure continuity of mentor ship it is suggested that each student be allocated two mentors, e.g. a primary and associate mentor; however it is the responsibility of all the ward staff to help you.

Effective mentorship of nursing students at the Royal Orthopaedic Hospital is essential to maintain high standards of nursing practice, promote learning and to develop a culture of dynamic practice.Regulations state that the mentor must work with the student at least two shifts per week. If this is not possible due to annual leave or sickness, the ward manager must take responsibility for arranging an associate mentor to take over supervision and support of the student.It is extremely important that those nurses acting as mentors to students liaise with the relevant course/module lecturer to facilitate integration of theory into practice.

Your allocated mentors are responsible for discussing your placement objectives and helping you to achieve them. They are also responsible for completing your CPA document at the agreed date for midway and final assessment. It is the student’s responsibility to bring the document with them and for its safe keeping.

It is important that any student having difficulties whilst on placement bring these difficulties to the notice of their mentors as soon as possible, likewise it is your mentor’s responsibility to bring to the student’s attention any concerns she/he has as early as possible. In order to discuss, take action, to enable the student to complete his or her objectives.

It is hospital policy that you do not travel to work in your uniform. There are changing facilities on the ward.It is important that you contact the Unit and University if you are ill and unable to attend your placement.Day Unit: 0121 685 4080/4207 BCU: 0121 331 7010The staff on Day Unit wants you to find your placement enjoyable and interesting. We endeavor to provide an environment to facilitate your learning whether pre or post registration.

DAY UNIT STUDENT INFO PACK 1

WELCOME TO DAY UNITPROFILE OF UNIT STAFF

Senior Manager: Sr. Stacey Keagan

Unit Managers/ Sisters Sr. Suzanna Day Sr. Jill Barr

Staff Nurses: Sn. Arlene Carr Sn. Fiona Heames

Sn. Tina Lane Sn. Sharon Gardner

Sn. Rebecca Preece Sn.Vim Chakadini Sn. Lisa Marshall

Orthopaedic Support Angela Vigus Jane Jobbins Worker: B

Nursing Auxiliary: Jayne Carter Ann Ali

Ward Co-ordinators: Dawn Austin Anne Stephens Donna Mulholland

Ward Clerk: Amanda Hill


DAY UNIT

ATTENTIVE…...WELCOMING……APPROACHABLE

Day Unit is a busy area of 11 beds, 7 trolleys and 4 reclining chairs. We deal with a wide variety of orthopaedic cases. Please see your menu of learning experiences. We encourage your involvement and feedback.

Our method of nursing is ‘the named nurse’.The shift patterns are: - 7:15am --- 7:00pm 7:15am --- 3:15pm 11:00am – 7.00pmPatient hand over is between individual nurses

Coffee break ---15 minutes. Lunch break ---30minutes.

You will have the same shifts as your mentor except when you are visiting other wards. If you require different working times due to University or personal commitments, please let your mentor know. We will always try to accommodate your needs within reasonable requests.

We aim to assess, plan and implement and evaluate care based on ‘Ropers’ model of nursing. Involving patients/relatives and other disciplines as necessary.

You will be expected to adhere to the ROH& NMC guidelines for record keeping. We will obviously provide you with information and opportunity to achieve this.

We see all members of the multi-disciplinary team on the Day Unit. All Consultants involved in the Trust have patients on the Day U nit at some stage. Therefore, you will probably see patients that are not day cases as well.If you are unwell and unable to come on duty, contact the Unit and University.Day Unit: 0121 685 4080/4207UCE: 0121 331 7010The Day Unit is locked at night. Access is by contacting the on-call Sister or the porters. DAY UNIT STUDENT INFO PACK 3

ORIENTATION TO THE WARD

You will be introduced to your mentors who will:

1. Conduct a preliminary interview.2. Introduce you to the geography of the Unit and the staff working here.3. Ensure you are aware of the emergency procedures and can locate

fire equipment, bells and exits.cardiac arrest equipment.

4. Ensure you are aware of the location of policy and procedure files.5. Show you where and how the Unit keep the patient profiles.6. Give you a report of the patients on the Unit.7. Introduce you to other members of the multi-disciplinary team as required. 8. Explain to you the general running of the Unit and the admitting and discharging procedure.

Staff on the Unit are all experienced within the field of Day Surgery. Please ensure you use their knowledge and help. Make the most of this allocation as you can. You will only get out of it what you are willing to put in, and we will endeavour to help you as much as we can.

ENJOY YOUR ALLOCATION WITH US.

Please remember the following:

IF YOU DO NOT KNOW ASK! IF YOU WANT TO KNOW ASK!IF YOU ARE NOT SURE ASK!

DAY UNIT STUDENT INFO PACK4

5

DAY UNIT PHILOSOPHY

We as a team will provide holistic, quality care to all who use our services. We will provide a professional, approachable, friendly environment for care. We will treat each individual with dignity, sensitivity, fairness, respecting and recognising rights, cultural needs and wishes. We will carry out all care to the highest standards, implementing best practice and innovations to enhance and improve the experience of patients and relatives. We will provide every opportunity for patient/relatives to ask questions re care/procedures and recovery. Be professional and honest in providing answers.

All staff will act as role models.

We will work in partnership with other members of the multi-disciplinary team, ensuring good communication and acknowledgement of the roles of other professionals.

We will value our colleagues – offering support and friendship. We will provide a helpful, educative environment for all learners.

We will continue to be reliable members of staff, implementing all statutory

duties, hospital policies and protocols. APC/ROH/2010

PHONE

1

LOCATION

Nurse base1Bed area

EXT

55323

USE

Outside line

External No

685 4080

2 Nurse base1Bed area

55326 DAY UNITIntercom

NIL

3 ConsultationRoom

55237 Externaluse

NIL

4 Nurse base 2TROLLEY

55281DAY UNITIntercom NIL

5 Nurse base 2TROLLEY

55238 Outside line 685 4207FAX NO. ALSO

6 SISTER’S OFFICE

55904 Externaluse

7Injection

room 55234 DAY UNITIntercom

NIL

LIGHTONLYNO RING

8ADMIN OFFICE 55237

DAY UNITIntercom

NIL

9 ANNE’S DESK D.U.C

55236 Outside line 685 4081

10 DAWN’S DESK D.U.C

55283 Outside line 685 4283

6

D AY UNIT USEFUL TELEPHONE NUMBERS

Useful and emergency information

To use bleep system:-Dial 88 – listen for message follow instructions, you will be told to:Dial bleep numberDial the extension number you are ringing from

BLEEP NO’SDoctor on call 2621Sister on call 2627Porters/Security 2641

EXTENSION NO’S

RECOVERY UNIT 55618/55619HIGH DEPENDENCY UNIT (HDU) 55691PORTERS 55297

CARDIAC ARREST 2222FIRE/SECURITY 333

DAY UNIT STUDENT INFO PACK7

CONCEPTS OF DAY SURGERY.

DEFINITION.

"A SURGICAL DAY CASE IS A PATIENT ADMITTED FOR INVESTIGATION OR OPERATION ON A PLANNED NON-RESIDENT BASIS WHO NONETHELESS REQUIRES RECOVERY.

THE CONCEPT OF ADMISSION IS RETAINED HERE TO EMPHASISE THE NEED TO OBSERVE PROPER ADMISSION PROCEDURES AND RECORDS. THIS DEFINITION EXCLUDES MINOR OPERATIVE PROCEDURES UNDERTAKEN IN THE OUTPATIENT OR ACCIDENT AND EMERGENCY DEPARTMENT."

THE ROYAL COLLEGE OF SURGEONS "GUIDELINES FOR DAY CASE SURGERY" (MARCH 1992)

When patients are referred for day surgery it is essential to ensure that:✦ the procedure is suitable✦ the risk of complications (from surgery and anaesthetic) are minimised✦ admission to an in-patient bed following day surgery is prevented✦ patients are adequately supported after discharge home.(rcn.org)

THE IDEAL UNIT

* PURPOSE BUILT AND INCORPORATING* FOR A UNIT OF 16 BEDS YOU NEED 2 THEATRES* RECEPTION AREA* MAIN WARD AREA* KITCHEN* OFFICE* COMPUTER LINK* EXTERNAL PHONE LINE* DAY R0OM

8

DAY UNIT STUDENT INFO PACK

NURSING STAFF: SHOULD BE

* DEDICATED STAFF* EXPERIENCED IN DAY SURGERY* SKILLED THEATRE AND ANAESTHETIC STAFF* EXCELLENT COMMUNICATION SKILLS* MANAGERIAL SKILLS* VARIED EXPERIENCE* FRIENDLY AND RELAXED NATURE* A SENSE OF HUMOUR

EXAMPLES OF DAY CASES FOR ORTHOPAEDICS

* MANIPULATIONS OF HIPS, KNEES, FEET& SHOULDERS etc.* ARTHROSCOPY OF KNEES, WRIST, SHOULDERS, ANKLES.* CARPAL TUNNEL DECOMPRESSION* RELEASE OF TRIGGER FINGER* EPIDURAL* NERVE ROOT BLOCKS* FACET JOINT INJECTIONS

TYPES OF ANAESTHETICS* LOCAL* LOCAL AND SEDATION* GENERAL* GENERAL AND LOCAL* REGIONAL BLOCKS : BIERS

-BRACHIAL PLEXUS* EPIDURAL

DAY UNIT STUDENT INFOPACK9

PATIENTS SUITABLE FOR DAY CASE SURGERY :

PHYSICALLY

* MALE OR FEMALE* NO UPPER AGE LIMIT* AMBULANT* A.S.A. LEVEL 1 & 2* STABLE BLOOD PRESSURE

SYSTOLIC BELOW 160DIASTOLIC BELOW 100

PATIENTS TAKING ANTI-HYPERTENSIVES ARE SUITABLE FOR DAY CASE SURGERY ON THE CONDITION THAT THEIR BLOOD PRESSURE IS WITHIN THE LIMITS AS ABOVE.

* DIABETIC PATIENTS MAY BE SUITABLE DEPENDANT ON THE MEDICATION BEING TAKEN AND PROCEDURE TO BE PERFORMED

* SEVERE ASTHMATICS ARE NOT SUITABLE FOR DAY CASE SURGERY.

SOCIAL CIRCUMSTANCES:

* ALL PATIENTS HAVING A GENERAL/ REGIONAL ANAESTHETIC OR SEDATION MUST HAVE A RESPONSIBLE ADULT TO COLLECT THEM FROM HOSPITAL.

* ALL PATIENTS SHOULD HAVE SOMEONE AT HOME WITH THEM

* FOR THE 24 HOURS FOLLOWING THEIR PROCEDURE.

* ALL PATIENTS SHOULD REFRAIN FROM DRIVING AND OPERATING MACHINERY FOR 24 HOURS FOLLOWING THEIR PROCEDURE.

* ALL PATIENTS SHOULD HAVE A REGISTERED G.P.

* ALL PATIENTS SHOULD HAVE ACCESS TO A TELEPHONE.

10DAY UNIT STUDENT INFO PACK

DAY SURGERY SHOULD BE :-* CONSULTANT LEAD BY BOTH SURGEON AND ANAESTHETIST

.* PATIENT SHOULD HAVE A LIMITED AMOUNT OF ANAESTHETIC

.* ONLY THOSE PATIENTS SUITABLE SHOULD BE TREATED BY

THOSE CAPABLE.

THE PATIENTS FEARS: ARE

* ANXIETY DUE TO ADMISSION* FEAR OF PAIN AT HOME.* CAN I WALK?* WHAT CAN I EAT?* WHEN CAN I RETURN TO WORK?* DOES THE HOSPITAL WANT TO SEE ME AGAIN?* DOES MY GP KNOW THAT I HAVE BEEN TREATED IN HOSPITAL?* DO I NEED TO TAKE ANY TABLETS?* CAN I TAKE MY USUAL MEDICATION?

THE ADVANTAGES OF DAY SURGERY TO THE N.H.S * FASTER THROUGH PUT OF PATIENTS.* EASING PRESSURE ON ACUTE SPECIALITIES.* HELPS IN KEEPING WAITING LISTS DOWN.* MAKES EFFECTIVE USE OF OPERATING THEATRE.* SAVE ON HOSPITAL HOTEL COSTS.* EASE OF RECRUITMENT.* COST EFFECTIVE STAFF.

ADVANTAGES TO THE PATIENTS:* REDUCES WAITING TIME FOR OPERATION.* CONSULTANT LEAD SERVICE.* REDUCED ANXIETY CAUSED BY LONG HOSPITAL STAY.* REDUCED RISK OF HOSPITAL ACQUIRED INFECTION.* REDUCED INTERFERENCE WITH HOME LIFE.* OWN BED TO SLEEP IN.


DAY SURGERY OBJECTIVES

STUDENTSGENERAL OBJECTIVES

Within the first week the student should be able to:

1. Identify:(a) Fire exits and alarms(b) Emergency equipment(c) Relevant telephone numbers

2. Discuss the procedure in the event of a fire or an emergency e.g. cardiac arrest.

3. State where relevant files are kept for policies and procedures.

4. Discuss the action to be taken when dealing with telephone enquiries.

5. Describe the lifting and handling procedure to be used.

6. State the action to be taken in the event of an accident;(a) To a patient.(b) To a visitor.(c) To another member of staff.(d) To yourself.

SPECIFIC OBJECTIVES.

1. To explain the admission procedure, to include(a) Previous medical history(b) Contact numbers for next of kin.(c) Allergies(d) Drug treatment.

2. To identify parameters of pulse, blood pressure, temperature and respiration

3. To discuss the relevance of base line observations.

4. With trained staff supervision assess and plan the pre-operative care.

5. With trained nurse supervision discuss the information you need before taking a patient to theatre.

6. To discuss the relevance of the pre-operative period.

7. Observe hand over of a patient from recovery staff.8. Identify and discuss the relevance of post-operative observations.

9. Discuss the potential problems following surgery and the appropriate action that should be taken10. With trained staff supervision assess and plan the post-operative care.11. Explain the relevance of identifying and assessing size and site of a wound. 12

C r a n i u m

F a c e

M a n d i b l e

C l a vi c l e

S te r n u m

S c a p u l a

H u m e r u s

R a d i u s

U l n a

I l i u m

S a c r u m

P u b i s

I s c h i u m

V e r te b r aD i s k

C o c c yx

C a r p a l s

M e ta c a r p a l s

P h a l a n g e s

F e m u r

P a te l l a

F i b u l a

T i b i a

Ta r s a l sM e ta ta r s a l sP h a l a n g e s

C a l c a n e u s

C e r v i c a l v e r te b r a e

R i b

S k u ll

S h o u ld e r g i r d le

U p p e r l im b

Th o r a x

S p i n a l c o l u m n

P e l vis

L o w e r l im b

F o o t

H a n d

SKELETON, ANTERIOR VIEW

C r a n i u m

F a c e

M a n d i b l e

C l a v i c l e

S te r n u m

S c a p u l a

H u m e r u s

R a d i u s

U l n a

I l i u m

S a c r u m

P u b i s

I s c h i u m

V e r te b r aD i s k

C o c c y x

C a r p a l s

M e ta c a r p a l s

P h a l a n g e s

F e m u r

P a te l l a

F i b u l a

Ti b i a

Ta r s a l sM e ta ta r s a l sP h a l a n g e s

C a l c a n e u s

C e r v i c a l ve r te b r a e

R i b

S k u l l

S h o u l d e r g i r d l e

U p p e r l i m b

Th o r a x

S p i n a l c o l u m n

P e l vi s

L o w e r l i m b

F o o t

H a n d

SKELETON, ANTERIOR VIEW


ORTHOPAEDICS WHAT DOESIT MEAN?

The word orthopaedic is derived from two Greek words orthos meaning straight, correct or right(e.g. orthodox) and arpaedia meaning childhood.

The English spelling is paedic the American is pedic.

The Greek word paideia is also used generally for discipline and training.

ORTHOPAEDIC = “straight child”

Nowadays the field of orthopaedics encompasses disorders of bone, joints, muscles, nerves and tendons in both children and adults.


Tina LaneMENU OF LEARNING EXPERIENCES FOR THE DAY UNIT

Listed are some of the learning experiences that are available on the day unit or in related areas i.e. theatres and the recovery unit. We hope they will help you to see how the competencies can be achieved during your placement. If you feel that you have no opportunity to achieve a particular competence then please speak to your mentor who will help you identify an area of work that will enable you to achieve it or, if necessary, arrange for you to spend some time in another area.

The list was drawn up by relating the course competencies to the day-to-day activities on the day unit. Items were then grouped into the following categories for ease of presentation; student’s orientation to the unit, nursing assessment, planning, implementation and evaluation of care, management of the unit and management of self. We welcome your ideas for amendments and improvements.

DURING YOUR PLACEMENT YOU SHOULD HAVE THE OPPORTUNITY TO:

Student's orientation to the unit.

Discuss the ‘Code of Professional Conduct’ with qualified staff and relate it to the working environment.

Reflect on your strengths, weaknesses, limitations and abilities and record this in your assessment document. Draw up an action plan based on this self- assessment.

Experience being in a professional role and reflect on how this affects relationships with the public.

Identify aspects of the physical environment that are governed by legislation, i.e. health and safety, control of substances hazardous to health, equal opportunities.

Encounter people from a wide range of racial, cultural and religious backgrounds and reflect on your personal experiences and feelings. Consider the overall mission of the N.H.S. with regard to equity and identify ways achieving this standard in the work place.


Encounter people with physical or mental disabilities and reflect on your personal experiences and feelings. Consider the overall mission of the N.H.S. with regard to equity and identify was of achieving this standard in the work place.

Identify aspects of the environment that support or detract from patient’s rights to privacy and dignity. Demonstrate attitudes and actions that help to achieve this standard.

Nursing assessment.

Identify the strategy used on the day unit for assessing patient’s nursing needs.

Use a systematic approach when assessing patient’s nursing needs.

Use a variety of assessment tools.

Practice listening skills, i.e. attending, paraphrasing, reflecting feelings.

Practice open and closed questioning.

Gather information from written sources.

Record vital signs as part of a physical assessment.

Carry out other physical assessments, i.e. skin integrity, weight and body mass index, urine analysis, blood glucose monitoring.

Examine blood test results, respiratory function tests and E.C.G. recordings and identify normal and abnormal results.

Identify ways of maintaining confidentiality of verbal, written and computer information and implement these.


Planning of care.

Discuss how the information gathered informs nursing care, i.e. identify actual or potential patient problems.

Consider how guidelines on obtaining patient’s consent apply to nursing.

Discuss nursing care with patients and relatives, (if patients allow).

Plan nursing care using the best available evidence.

Identify health education needs for patients and carers and plan how these can be met.

Identify the roles of other health care professionals and make necessary referrals.

Spend at least two shifts with AngelaVigus or Jane Jobbins (Orthopaedic Support Technicians)

Implementation of care.

Meet and work alongside other members of the health care team. Share information with other health care professionals with patient’s consent.

Practice clinical skills as outlined in the assessment document.

Discuss the purposes of making written records and principles of good practice and carry these out in the work pace.

Develop self-awareness with regard to customer care and continuing to maintain patient’s privacy, dignity and confidentiality.

Gain insight into the patients experience by visiting theatre and recovery departments and observing surgical procedures.


Evaluation of care.

Continually monitor the physical and mental condition of patients and report their progress to the relevant practitioners, i.e. surgeon, anaesthetist, physiotherapist etc.

Management of the unit.

Develop insight into the pressures that guide the overall management of care, i.e. national targets, allocation of resources etc. and where these pressures may be a source of conflict.

Identify actual or potential risks to patients, staff and others and learn how to take action to reduce these.

Understand the relevance and process, of incident reporting.

Practice decision-making in the allocation of staff and the use of recourses.

Management of self.

Share experiences with colleagues.

Actively seek supervision in the work place.

Use the trusts library facilities to find relevant research papers and share these with colleagues.


THE FOLLOWING IS A LIST OF TYPICAL DAY-CASE

PROCEDURES:

Arthroscopy of the knee with or without menisectomy, lateral release and debridement.

Arthroscopy of the shoulder with or without sub-acromial decompression, rotator cuff repair and debridement.

Manipulation of various joints, mainly, shoulder and knee.

Less commonly, arthroscopy of hip, wrist, ankle and great toe.

Carpal tunnel decompression.

Ulna nerve decompression.

Release of trigger finger.

Release of Dupuytrens contracture.

Excision of ganglions from wrist, hands and feet.

Excision of swellings and lumps from hands and feet.

Correction of hallux valgus.

Tendon release of toes.

Fusion of toes.


THE FOLLOWING PROCEEDURES TAKE PLACE IN THE

DAY UNIT TREATMENT ROOM:

Epidural.

Facet joint injection.

Sacro-iliac joint injection.

Trans foraminal selective epidural.

Sclerosant injection of ligaments.

Intra articular injection.

Aspiration of joints, usually hip and knee.

Some of the procedures listed above used to be carried out in theatre, however are now carried out in the Treatment Room. We believe this has not only allowed for an improvement in the patients care with regard to less time waiting to get into main theatre but also is far less threatening to the patients. It allows us the nursing staff to provide patients with better quality and more efficient care.Please use the opportunity to go and observe procedures being carried out in the room and ask questions from the variety of medical staff that use the room. This will give you a clearer picture of the variety of work done on the Day Unit.


ORTHOPAEDIC TERMINOLOGY

WORK SHEETOrthopaedics is a specialised area. At first it may seem like a foreign language to you often Latin names are used. With the aid of a text book, dictionary, please find the meanings of the various words. To start with write in pencil any of the meanings you already know and see how you do without the aid of any books!!!

Abduction:

Adduction:

Anklosis

Arthodesis:

Arthogram:

Arthoplasty:

Benign;

Bivlave:

Callus:

Congenital:

Chondritis:

Chondroma:

Chondrosarcoma:

Contracture:

Colles fracture:

Dorsiflexion:.

Dislocation:

Eversion:

Equinus:


Excision:

Extension:

Fracture:

Flexion:

Fascia:

Fasciectomy:

Genu:

Hallux:

Hallux Valgus:

Heamarthrosis:

Idiopathic:

Inversion:

Inflammation:

Kyphosis:

Lordosis:

Mal-union:

Menisectomy:.

Myosarcoma:

Myositis ossificans:

Non-union:

Neurectomy:

Osteo:

Osteotomy:

Osteomylititis:


Plantigrade:

Planter flexion:

Palmar:

Potts fracture:

Rheumatoid disease:

Reduction:

Scoliosis:

Spond:

Subluxation:

Supination:

Synovitis:.Sciatica:

Laminectomy:

Talipes:

Trauma:

Valgus:

Varus:

All done I'm sure that there are several other terms that you would like to know about so see if you can do some more on your own and work them out for yourselves. For example:

Where is the Pubic Rami?Carpal Tunnel? Scaphoid?


FURTHER READING AND REFERENCE LIST.Footner. A.: Orthopaedic Nursing, Bailliere Tindall.

Apley. G. A: Concise system of Orthopaedics and fractures, Butterworth

Heinmann.1991.

Hughes' S. A New Short Textbook of Orthopaedics and Traumatology, Edward Arnold.1989.

Journal of One Day Surgery.

Guidelines for Day Surgery.

Ward Management in Practice. Mackenzie, Churchill and Livingstone.1998

Day Surgery A Nursing Approach, Hodge, Churchill and Livingstone.1999

Material for pack by:-

Evelyn O’Kane

Tina Lane

Arlene Carr


Appendix 1

Incident Evacuation Plan – Day Unit

All staff must be familiar with the Fire Action Plan situated near every alarm point.

All staff will be aware that in the event of an incident they must raise the alarm / dial 333 for assistance

Upon hearing a continuous sound in Day Unit, Day Unit staff should prepare to evacuate all patients and personnel if necessary.

One member of staff should report to the Fire Assembly Point immediately to ascertain type and location of incident.

In the event of fireFire Wardens must remain on the Unit to initiate and co-ordinate an evacuation if deemed necessary. You will be informed by a runner sent by the Bleep Holder if you need to evacuate.

If evacuation is necessary all staff must be familiar with the following;

If an incident occurs in the treatment room all persons will exit via the fire doors in the treatment room corridor and follow path under the covered walkway to Ward One As treatment room is separated from the main department you must ensure the main area staff are aware of incident.

If you are in the Nurse Base II area you can exit via the treatment room doors then exit via the treatment room corridor, taking the path under the covered walkway to Ward OneAlternatively if you cannot safely reach the treatment room doors you can evacuate via the doors at the end of Day Unit adjacent to the chair bay. You must ensure all patients and visitors are escorted through the garden towards Ward One.

If you are in the Nurse Base I area you will evacuate via the doors at the end of Day Unit adjacent to the chair bay. You must ensure all patients and visitors are escorted through the garden towards Ward One. Alternatively you can exit via the treatment room doors then exit via the treatment room corridor, taking the path under the covered walkway to Ward One.

How you evacuate will depend on the type and location of the incident.

In the event of fire or potential injury the main objective must be to reach relative safety by ensuring there are fire doors between you

and the incident.

Fire doors are clearly marked and in the event of fire will offer 30 – 60 minutes of protection.

If you have to evacuate, ensure the nurse in charge takes the off duty and patient allocation books from NB 1 & NB 2. Ensure all staff and patients are accounted

for.The nurse in charge (or delegated person) should complete a final search

Make sure no one enters the incident area.

Important Safety Points to Remember

Ensure you have read the Fire Safety Policy & Procedures document

Ensure you are familiar with the fire action plan.

Ensure you know where the fire assembly point is.

Ensure you know where the alarm points and fire extinguishers are.

Ensure all new staff are shown around the unit and know the location of fire points and extinguishers.

Ensure all new staff / students and temporary staff have been orientated to all areas of the unit and have signed the orientation document located in the clean utility room.

Jayne Carter and Ann Ali are the trained Fire Wardens for Day Unit and are available for advice and information.

You must ensure the kitchen door is kept shut at all times.

In the event of fire, all doors must be closed.

If you see smoke coming under a door – do not attempt to open it – raise the alarm

It is the responsibility of EVERY member of staff to ensure exits are kept clear.

Good housekeeping buys valuable time!

Venous Thromboembolism (VTE) Guidelines (Adults)

1. Background

These guidelines for VTE prophylaxis have been developed for use within The Royal Orthopaedic Hospital NHS Foundation Trust (ROHFT) and are based on the NICE clinical guideline 92, Venous Thromboembolism : Reducing the Risk

All patients admitted to the Trust for surgery must have a documented ROHFT risk assessment, and from this, a decision to prescribe thromboprophylaxis for the patient or not will be taken.

It is expected that these guidelines will be followed in the majority of cases.

Ultimate responsibility for the prescribing of VTE prophylaxis for all patients remains with the consultant responsible for the care of each individual patient.

If a consultant decides not to follow the guidelines, they must prescribe the alternative medicine themselves on the in-patient chart and then on the discharge prescription if required. They must also state in the patient’s notes the reasons for not following the guidelines and document clear instructions of the plans regarding thromboprophylaxis treatment for the patient while they are an in-patient and also the plan for discharge.

2. Risk assessment

ALL patients having surgical treatment, i.e. excluding injections and manipulations, will be assessed for both increased risk of VTE and increased risk of bleeding. This will be done using the ROHFT risk assessment form (This is based on the Department of Health’s Recommendations)

The initial risk assessment will be done in POAC, the day unit or in ward areas for patients not seen in POAC . This ultimately may be part of the POAC computer interview.

On Admission, the Dr or Advanced Nurse Practitioner (ANP) will check the assessment form if it has been completed by a nurse.

The Dr or ANP will also make a decision as to whether patients who are not going for surgery in the next 24 hours require thromboprophylaxis or not.

Patients that are identified with a thrombosis risk and a bleeding risk must have their treatment plan re thromboprophylaxis discussed with the operating

surgeon. The outcome of these discussions must be documented in the patient’s notes.

The risk factors identified are not exhaustive. Clinicians may consider additional risks in individual patients and offer thromboprophylaxis as appropriate.

It is up to individual clinicians to weigh up the relative importance of identified risk factors as decisions in this area cannot always be based upon hard scientific data.

If there are any concerns about the best choice of pharmacological prophylaxis in a patient, please contact haematology for advice

3. Care Pathway

a. For All Patients

Do not allow patients to become dehydrated unless clinically indicated

Encourage patients to mobilise as soon as possible after the procedure

Do not regard aspirin or other antiplatelet agents as adequate prophylaxis for VTE

Consider offering temporary inferior caval filters to patients who at very high risk of VTE (such as patients with a previous VTE event or active malignancy) if mechanical and pharmacological VTE prophylaxis is contraindicated

Before VTE prophylaxis is started, patients, carers and or their families must receive information on risks and consequences of VTE, importance of VTE prophylaxis and the possible side effects, correct use of VTE and how to reduce the risk of VTE.

On discharge, patients, carers or their families must receive information on signs of PE and DVT and who to contact if these are suspected, duration of VTE prophylaxis treatment if to use at home, importance and correct use of treatment, possible side effects (if discharged with prophylaxis) and who to contact if they experience any problems with any issue related to the prophylaxis.

If any patient develops a DVT or PE, a Trust incident form must be completed. This will be treated as a Serious Untoward Incident (SUI)

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INTRODUCTION

1.1. Slips, trips and falls are the most common cause of major injuries in the workplace in Great Britain. Slips, trips and falls are not an inevitable part of the healthcare industry – they can and should be prevented.

1.2. This policy covers staff, volunteers, contractors, patients and all other visitors to the Trust. Falls are amongst the most reported incidents in this Trust.

1.3. Patient and Staff safety is a key priority within this Trust. Falls can affect individuals of all ages with older people being especially vulnerable. Falls are a particular clinical concern because of the frequency at which they can occur and also because of the physical, psychological and social consequences.

1.4. Falls are a key focus within the National Service Framework for Older People with Standard 6 aiming to reduce the number of falls which result in serious injury as well as ensuring effective treatment and rehabilitation for those who have fallen, (DOH 2001)

1.5. Falls are a major cause of disability and nationally a leading cause of mortality. A fall can precipitate the need for long-term care; fear of falling can provide a significant limitation on daily activities and long-term psychological difficulties for the older person.

1.6. More falls are reported to the National Patient Safety Agency than any other type of patient safety incident, (NPSA 2007)

1.7. Slips, trips and falls can be minimised through planning and positive management during re-furbishment and new build. Good housekeeping, is an essential part of the prevention of slips, trips and falls.

1.8. The National Audit Office, in their report of 2003 highlighted slips and trips as a main type of accidents to staff and patients.

2. DEFINITIONS

There are many definitions of falls within the healthcare setting. However, it is important to identify a practical definition that is workable in the clinical setting, as the current lack of conformity has led to vast differences in auditing and researching the numbers of falls (Cochrane 2001). We feel that these definitions, can also apply to Staff, Visitors, Voluntary workers and contractors.

FALL – A fall is an event which results in the person or a body part of the person coming to rest inadvertently on the ground or other surface lower than the person, whether or not an injury is sustained.

SLIP – A slip is to slide accidentally causing the person to lose their balance, this is either corrected or causes a person to fall.

TRIP - A trip is to stumble accidentally often over an obstacle causing the person to lose their balance, this is either corrected or causes a person to fall

3. KEY ROLES & RESPONSIBILITIES

3.1. The Trust Board must ensure that mechanisms are in place to:

Ensure that staff, patients, volunteers and contractors are made aware of the policy.

4.3 Ward Managers/Department Heads; must

Ensure that slips, trips and falls risk assessments are carried out (as per the Trusts Patient Manual Handling Assessment/Generic risk Assessment procedure), which cover their areas of responsibility and that appropriate actions are taken to reduce these risks so far as is reasonably practicable.

Maintain safe staffing levels and adequate cover in wards/departments at all times.

Ensure that the Risk Assessment Tools are used appropriately and staff are supported in the facilitation of the process.

Ensure that all accidents, incidents and near misses are reported and Incident Report forms completed as per Trust policy.

Ensure that during staff appraisal, health and safety compliance is discussed as per the requirements of the Knowledge and Skills framework.

Training to be provided in-house for carrying out risk assessments

Ensure that this policy is adhered to by staff and that resources are available to ensure effective implementation.

Documents

STUDENT - bcu.ac.uk · Web viewthe concept of admission is retained here to emphasise the need to observe proper admission procedures and records. this definition excludes minor