I walk and cycle to work because I’m lazy by Rhian Davies

It’s true, I’m lazy. If I didn’t travel on foot or by bike to work, the shops, the pub, I’d need to find the time, inclination and means to exercise. So I walk and cycle because it:

  • Gets me there

Walking is the oldest form of transport. In fact we’ve evolved to do it – having been walking around for about 1.9million years. Cycling has been a means of getting from A to B for nearly 200 years.

  • Gets me there quickly

No searching for car keys, waiting in traffic and finding parking spaces. A journey by bike in Dumfries takes about the same time as a journey by car. Walking or cycling on traffic free and quiet routes means I don’t get held up by queues and stay clear of road works.

Rhian 1

  • Saves time

No need to find time to get to the gym or go for a run as travel is my exercise. Most people say they would exercise more if they had the time. As I’m travelling anyway, that time is put to use as exercise time too.

  • Is enjoyable

Rhian 2The main thing for me is the fresh air, being outside and enjoying the wildflowers and wildlife that I see and hear, especially at this time of year. Winter has an upside too – no need to get up early to see a beautiful sunrise and the moonrises can be pretty spectacular too. I’ve also seen shooting stars on my way home from work. And despite what it feels like, it doesn’t rain that much! In fact, there’s a 95% chance of NOT getting rained on, on your way to work.

  • Is sociable

I often see people I know on the way and enjoy having a chat with them. Waving to the lollipop lady on the way to work or chatting with the nice man who walks his spaniel adds a little happiness to my day.

  • Is safe

The most recent figures from the Department of Transport show the fatality rate for pedestrians and cyclists is the same, with one death per 29 million miles walked or cycled. Looking at how many people were killed or seriously injured, it works out at one person for every 1 million miles cycled and one person for every 2 million miles walked.

  • Keeps me fit

The main difference compared to driving is that whenever you walk or cycle your health benefits, whereas remaining seated in a car does nothing to improve it. Typically I cycle to work, a 20 minute journey each way, which easily meets the guidelines for 150 minutes of moderate exercise a week.

  • Benefits people and planet

You only have to look at the news and you’ll see an almost daily report on worsening air pollution and the effect this is having on people and the environment. Walking and cycling isn’t the only way to tackle this problem but it is a difference we can make every day to the people and place we live.

  • Is easy to get parked

Rhian 3In my role as Active Travel Officer, I’m here to help anyone who is thinking of travelling by foot or by bike. I’m working with staff at DGRI, the new hospital, Crichton Hall and The Willows.

Over summer I’m running events including basic bike maintenance workshops, Essential Cycling Skills, information stalls on route finding and guidance on buying a tax free bike through Cyclescheme. Upcoming events are posted online and advertised in the core briefing and posters around DGRI, Crichton Hall and The Willows.

So if you’re feeling inspired come along to:

Bike Maintenance for beginners

Drop in session – not sure how to change an inner tube? Need to know how to check your bike is safe to ride? Find out how and have a go.
Monday 22 May and Friday 26 May: 12noon – 2pm and 4pm – 6pm

Venue: Garage 26, the hospital residences

Cyclescheme information stall

Come along to find information on applying for a tax free bike

Crichton Hall Canteen on Tuesday 23 May: 12 – 2pm

Essential Cycling Skills (Beginner)

Can’t remember the last time you’ve ridden, or feeling wobbly when you ride? This is the course for you. Please book here.
Part 1 Wednesday 24 May: 11.30am – 1pm, Part 2 Thursday 25 May: 11.30am – 1pm

Part 1 Monday 5 June: 5pm – 6:30 pm, Part 2 Tuesday 6 June: 5pm – 6:30pm

Meeting point: Garage 26, the hospital residences 

Essential Cycling Skills (Intermediate)

Are you happy cycling on quiet roads but not sure how to navigate roundabouts or junctions confidently? Then this is the course for you. Please book here.
Part 1 Wednesday 24 May: 5:30pm –7pm, Part 2 Thursday 25 May: 5:30pm –7pm

Part 1 Wednesday 7 June: 11am – 12:30pm, Part 2 Thursday 8 June: 11am – 12:30pm

Meeting point: Garage 26, the hospital residences 

Bike Security Marking

Thursday 1 June: 12 – 2pm and 4pm – 6pm

Meeting point: Garage 26, the hospital residences 

I also want to hear from you about what would help you get out and about on two feet or two wheels. Are there facilities or infrastructure improvements that would allow you to walk and cycle? Have you heard about electric bikes but never had a go on one? Just let me know!

Contact me on:

rhian.davies@sustrans.org.uk

Mob: 07788336211

Tel:  01387 246246 EXT: 36821

 

Rhian Davies is an Active Travel Officer for NHS D&G

Lochar North

Crichton Hall

Bankend Road

Dumfries

DG1 4TG

 

 

 

 

 

Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

Preparation of a typhoid shot in the medical clinicThe advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

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In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

 
From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.

 

Why do we need OPAT?

 
In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

 
Main aims of OPAT.

 
Clinical
To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
Patient.
image3Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Organisational.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

 
We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.

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Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.

Be Prepared ….Have the Power by Graham Abrines

I think all of us would agree that making informed decisions for ourselves or others is one of the most responsible and indeed worthwhile things we do on a regular basis. It’s something we largely take for granted.

It’s only when matters begin to stray from the norm that we question our or others ability to make informed decisions. How many of us have parents, aunt’s uncle’s, partners even whose steady decline is becoming increasingly evident? Bring that same question into the professional arena; it will be more relevant for some than others, watching patients who you may have known for some time or perhaps only just met who are just struggling to make informed decisions.

Having conversations with people, whatever the context, about their wishes around how they want to be supported when they are not in a position to make informed decisions is important. It’s important for a whole raft of reason. The primary one for me; knowing how that person wants to be treated, cared for and supported  when they are unable to make informed decisions for themselves!

That’s why we all need to be better prepared

The message is quite simple if you have family members, patients or even yourself, who haven’t yet thought about how they would like to be supported if they lose the ability to make informed decisions for themselves then now is a good time to consider doing something about it.

Power of Attorney (POA) allows people, whilst they still have full decision making capacity, to state how they want to be treated and who and it can be more than one person, should be making decisions on their behalf when they are no longer able to do so. Quite simply it takes away many of the dilemmas that families and on occasion clinicians find themselves in when deciding what or what not to do in supporting the person.

There are some patients across our hospital settings, who with no POA  in place, require  an application by a family member or the local authority  for a Guardianship Order which is required to be heard in the Sheriff Court  to establish who should be making those informed decisions on their behalf. Take a moment; if that was you, or somebody you knew how does that make you feel? Particularly if you know there was an easier alternative where the person’s wishes were fully known?

POA is a legal process and the POA documents need to be very clear and detail the powers the adult proposes to grant to the prospective attorney/s.  As it’s a legal process involving a solicitor at an early point may be useful and most local solicitors should be able to assist in the drafting of a POA and can provide legal advice on this matter. A solicitor will charge a fee for this service.

Over the next number of weeks the Health & Social Care Partnership, via work within the Delayed Discharge Partnership, Local Authority Communications Unit & Local Authority legal services will be running a media campaign on local radio & TV supported via other methods, buses, bus shelters, flyers & local newspapers to encourage people to think about Power of Attorney.

Many of the local solicitors across our whole region, who are fully supportive of this approach will give a 10% discount to anyone wanting to progress with a POA until the end of June.

If you require further information, please contact Phyllis Wright, Regional  Statutory Mental Health Team Manager  on 03033333001 or Phyllis.wright@dumggal.gov.uk .  The Office of the Public Guardian in Scotland registers continuing and/or welfare powers of attorney under the terms of the Adults with Incapacity (Scotland) Act 2000, and their website offers full information on the POA process. www.publicguardian-scotland.gov.uk/power-of-attorney/power-of-attorney/the-power

So please, for everyone’s benefit   …. Be prepared and Have the Power of Attorney in place.

Graham Abrines is Interim General Manager Community Health and Social Care