Nursing staff got together and made hospital better

When the Care Quality Commission (CQC) report was published on Thursday, May 26, I was swamped with calls from people lamenting basic standards of care not only at the Alexandra Hospital in Redditch, the focus of the report, but also the sister hospital Worcestershire Royal in Worcester.

The report focused on wards five and 11 at the Alex where “major”

concerns were raised about standards of nutrition.

The Alex was one of only two hospitals out of 100 nationwide which caused inspectors such concerns, according to the full CQC report published last week.

There were voices of dissent – one patient compared nurses to angels because of the superb treatment he received after his heart attack – but these voices were drowned out by the deafening tide of public outrage.

Harrowing descriptions emerged from the report itself, including patients prescribed water, food trays placed out of reach, patients eating with their hands because staff were not available to cut up their food and meals being served while they were asleep or not sitting in the right position to eat and no help with hand washing before or after meals.

Many I spoke to nursed deeply held grievances, their voices cracking with indignation.

Some sobbed as they recounted their experiences.

Among them were 71-year-old widow Patricia Hodges of Evesham who blamed poor care at the Alex for her husband’s death in January.

Laurence Hodges, who had suffered a stroke, was crying out for water before he died, the last thing he ever said to her.

Ron Grainger of Cherry Orchard, Holt Heath, was furious when his blind and bedridden mother, 90- year-old Lilian, was sent home from hospital in March with a letter telling her she should not be revived if she was dying.

The trust’s bullish and by now beleaguered chief executive, John Rostill, who earned about £162,000 a year in the post, stammered through toe-curling TV interviews.

He then promptly announced his retirement, claiming, predictably, that his departure had nothing to do with the report.

Trust chairman Harry Turner immediately issued a public apology. Staff, he said, were deeply hurt by the report.

As one of a series of reports to be published by the CQC, national media exposure was particularly brutal and unrelenting.

But in board meetings trust leaders wrongly blamed the media.

Journalists didn’t make up the lurid details and were simply quoting directly from the report which mentioned some examples of good practice as well as bad.

The trust has made key and sustained improvements following an independent trust-wide review.

CHANGING THE CULTURE OF NURSING

THE head of nursing said she would personally challenge examples of poor care on the wards.

Helen Blanchard, the trust’s director of nursing and midwifery, said there was a zero tolerance attitude to poor standards on the wards of Worcestershire’s hospitals.

“On every single occasion I would challenge and address the issues at the point that I saw it. I would never let something go, whether it is how staff carry out a task or how they speak to patients. Any poor practice or behaviour or poor attitude I will always address.

That’s what I expect of the most senior nursing staff, of all the nursing staff. We were devastated by what was reported but the nursing staff got together and galvanised their energies and did what they needed to do. I think they’re a much stronger workforce.

“I think the nurses have shown we have a great nursing workforce.

A lot of them are very proud of what they do and that’s why they were so upset. We know we have work to do to make sure the work is sustained but the evidence is that we have improved and that it is being sustained.”

IMPROVEMENTS SINCE THE CQC REPORT

(1) NURSING DASHBOARD: shows staff where patients have suffered falls, in which wards patients have developed pressure ulcers, where superbug infections such as MRSA and C.diff occurred, the location of medication errors and information about patient nutrition and care plans. The information is uploaded every month and can be viewed by clinical staff (nurses, doctors, consultants etc) and members of the Worcestershire Acute Hospitals NHS Trust board.

The aim is to spot trends but also examples of good practice which can be shared across the trust.

(2) INTENSIVE SUPPORT TEAM: Senior nurses and experts from across the trust will examine wards where performance has dipped. They will diagnose causes such as sickness levels or staff vacancies, allowing the trust to respond more quickly to situations as they develop. If there is a problem with higher than expected levels of hospital infection, infection control nurses will be deployed. Their role will be supportive rather than the team acting in a “punitive way”.

(3) FIRST DAY CARE: All the senior nursing team take part in a “back to the floor day” to identify any issues, speak to patients directly and identify areas of good practice.

(4) MEAL TIME VOLUNTEERS: Recruitment of people to help patients at meal times and talk to elderly patients. The trust is keen for people to contact them to volunteer.

(5) DIGNITY CHAMPIONS: 200 dignity champions recruited, mainly from clinical staff. Their job is to make sure patients are treated with dignity and respect. They have made a formal commitment to challenge other staff if standards are not met.

(6) PROTECTED MEAL TIMES: Nurses are to focus on meal times and not get distracted by their other duties.

Nurses are expected to help with cutting up patient’s food and with eating if they need it. If a patient cannot eat during conventional meal times because they are asleep or need a scan, for example, they must still be provided with a meal.

(7) MEAL CO-ORDINATORS APPOINTED: A person on each ward has been designated a meal co-ordinator who will look at whether patients have had an opportunity to wash their hands before and after eating and whether they are in a position where they can eat comfortably.