An Uncertain Future by Ken Donaldson

Well, that’s been an interesting few months, hasn’t it!! We all watched with fascination as Covid spread across the Globe – China first then Italy and Spain – before it hit our shores and started creeping towards Dumfries and Galloway.  Everything changed. We were told to stay at home, avoid loved ones we didn’t live with, only go out if necessary and our work was transformed. Many people had to ‘Shield’ at home and could no longer work. Those still coming in found their working day turned on its head; perhaps completely new duties or sitting in front of a screen all day. But there was one thing I am pretty sure was felt by everyone; fear.

I was terrified. Terrified of how many people were going to get sick, terrified of how many may die, terrified for our frontline staff who were putting their lives at risk. I was also terrified for my own family and loved ones and, whilst this may sound selfish, I was terrified that I would fail in my job. This felt like a big test of leadership. Was I up to the task? Was D&G at risk because I was about to fail.  Many sleepless nights followed.

However it all looks different now. We have survived the first peak of Covid and, in general, we have gotten off fairly lightly. Our colleagues in the Critical Care Unit and Care Homes may disagree as those two areas have experienced a significant impact from the disease but, as a region, the numbers were nowhere near what we expected and whilst this may be down to our rurality it also reflects how all of us have adhered to social distancing and isolation and stopped the spread.

So what happens now? Lockdown restrictions will start to ease, people will be out an about and there is the strong possibility of a second wave. However there is no doubt that we are much more prepared for that and have systems in place to deal with it should it come. But social distancing is here for some time and we all need to think how we are going to deliver our services for the people of D&G in this uncertain future.

Things have changed and one message I would like to share today is that we cannot go back to what we had before. It quite simply wasn’t working and if we have demonstrated anything in the past 3 months it is that we can deliver healthcare in 2020 in a very different and more efficient way. We don’t need face to face consultations all the time, we don’t need to admit so many people to hospital, we don’t need lots of different steps before a patient interacts with the professional they need to.

There was one other noticeable change when all this kicked off; we all pulled together like never before. Many petty differences which had prevented progress vanished. People reached out to help each other (virtually or 2m apart, of course!) and it was obvious that we genuinely cared about our colleagues. There was really no need to use the phrase ‘We are all in this together’ because we all inherently knew that was the case.

So while the dust settles and we look around at the ‘New Normal’ let us not go back to what we did before. Let us embrace new ways of working and talk to our colleagues about how we do it together. Let us do the right thing for our population.

“A crisis can create an opportunity to learn and build a better way forward. The system that will emerge on the other side of the crisis is shaped by those leaders who are able to harness the potential in the moment and galvanise others to act.”

John Sturrock 2019

Ken Donaldson is Executive Board Medical Director for NHS Dumfries and Galloway

With thanks to Charles Mackesy for the image.

 

 

 

Patient Safety Group – PSG (not Paris Saint-Germain) by Emma McGauchie

Given that it is the year of the world cup we thought we would change our name to that of a football team.   For those of you (Eddie) who don’t follow football PSG stand for Paris Saint Germain and has a catchy ring to it!

Like some of these famous football players my job role as Adverse Events Co-ordinator is just as exciting!! I oversee the whole of NHS Dumfries and Galloway’s Adverse Events and risk.

I also co-ordinate the organisations Significant Adverse Event investigations and reviews and it was at one of the review meetings that I was put forward to write this blog – Cheers Ken!

I love to make the most of every opportunity therefore I thought I would use this blog to share with you some exciting changes you can expect to see over the coming year.

But firstly we would like to make a clear, public commitment to staff that our organisation supports an open and fair culture, by letting you all read a Key statement from our chair and  co-chair person, Eddie Docherty and Ken Donaldson (on behalf of Patient Safety Group (PSG))…….

“There is no doubt that over the years there has been a culture of blame in the NHS.

As chair and co-chair of the Patient Safety Group, we would like to see us move to a culture where we learn and improve from any failure.

It is our firm belief, that in a complex system like the NHS, it is often not the practitioner’s fault when things go wrong.

Staff will be treated fairly and supported to identify the failures in the system and improve service delivery.

We require ongoing honest reporting of concerns at the earliest possible stage to do what we can to ensure your working environment is safe. We would therefore ask all healthcare professionals to continue to raise all concerns in the appropriate manner predominantly by using Datix “.

 

During my first year as adverse event coordinator I found myself being asked two frequent questions, “Who are QPSLG?” and “What do they do?”

New name

Firstly the Quality and Patient Safety Leadership Group also known as QPSLG or “Quiggle Spiggle” have changed their name to Patient Safety Group (PSG for short).   We are confident this change of name will give a better understanding to everyone what we do.

 

Who are PSG?

Let me introduce you to a few of our members…..

Eddie Docherty

As Executive Director of nursing midwifery and allied health professions I chair PSG. I am passionate about pushing the organisation forward as a learning environment, with a key focus on patient and staff safety.

 

Ken Donaldson

For the past 8 years I have developed an interest in enhancing patients experience and ensuring staff experience is as good as it can be – which is difficult with current staffing issues and recruitment challenges. I believe my role in PSG is to ensure a balanced and fair approach to all serious adverse events and complaints. We need to focus on learning from error, improving systems and providing robust feedback – an area we are working on to improve. ‘To err is human…’

Andy Howat

My role as the Board’s Health & Safety Adviser involves identifying, helping manage, reduce and control exposure to workplace hazards. With the ultimate aim of reducing the number of incidents, accidents and ill health in the organisation.

I work with teams helping them assess risks, develop risk reduction strategies, instigate changes in working practice, develop and deliver coaching/training, and offer advice on all aspects of workplace safety and occupational wellbeing.

I have been part of the Patient Safety Group for about a year now and I am regularly involved in reviewing significant incidents, considering the staff, patient and organisational affect these have and trying to enable the development of practical and pragmatic ways of reducing the likelihood and consequence but, ultimately the prevention of these incidents.

Stevie Johnstone

“My name is Stevie Johnston and I provide administrative support to PSG by not only co-ordinating the meetings but by working with others throughout the organisation to gather updates on incidents and investigations.  My knowledge around adverse events and the investigation process was limited but the group has given me the confidence to ask questions from a different perspective during meetings and the review process.  I have recently undertaken Adverse Events Training and look forward to putting this into practice in order to understand why errors happen, how we can stop them from happening again and how we can share learning in order to support others within NHS Dumfries and Galloway”

Linda Mckechnie  

As Lead Nurse/Professional Manager, Community Mental Health Services, One of the most important things for me is to always look at what we can learn when things go wrong or don’t go as well as they should. This might be individual learning for staff, learning for teams or services, or learning across the organisation(s). Supporting staff when things go wrong is essential in order to encourage learning and reflection.

 

Emma Murphy

As Patient Feedback Manager, I regularly support Directorates with high level and complex complaints.  These complaints may be linked to adverse events or have other potential patient safety implications.  Sitting on the Patient Safety Group allows me to update members on relevant complaints as well as ensuring I have an overview of new and significant adverse events.   By building better links between patient safety and patient feedback, we can improve organisation learning and the patient experience.

Joan Pollard

As Associate Director of Allied Health Professions I am the professional lead for AHPs and manage the Patient Services Team and the corporate complaints team.

I am curious about processes and culture, passionate about quality and love developing people and teams.

 

Susan Roberts

I am passionate about supporting staff to learn from errors, near misses or complaints to improve care and therefore my role as professional lead on PSG is a priority for me.  It’s not always easy for us to reflect when things go wrong but this process, if supported well, not only benefits patients it helps the staff involved too.

Christiane Shrimpton

Associate Medical Director for Acute and Diagnostics, passionate about excellent patient care, keen to use any available opportunity to ensure we improve what we do and learn from situations that have gone well as well as those that have not gone so well.

 

Maureen Stevenson

As Patient Safety & Improvement Manager I am passionate about making every day an Improvement Day. I passionately believe that creating the conditions for staff and our communities to learn and share together will enable us to together find practical solutions that improve the quality, the experience and the safety of health and care.

 

Alice Wilson

Deputy Nurse Director; I am enthusiastic about what I do and motivated by seeing things improve. I really want people to be open with service users/patients and to talk with colleagues about lessons they have learned from good and bad experiences so others can reap the reward, do more of what works well and reduce the risk of repeating the same errors.

 

And me 🙂

What can you expect…….

 

Learning from Significant Adverse Events (SAEs)

We are producing Learning Summaries from all our SAEs and we plan to share these with each Directorate but we need these to be meaningful, therefore we would love to hear from you about what learning you have taken from SAEs you have been involved with and how you would uses such a summary.   Our first one is ready to distribute and should reach you all very soon so watch this space!!!

 

 

 

Patient Safety Alerts

 

We have tested a process of distributing a couple of patient safety alerts one about patients being discharged home with cannulas left in situ and one about poor communication around the location of patients with telemetry in situ.  The patient safety alerts will come from the patient safety group, are produced as a result of urgent issues arising from SAEs or themes and are designed to make you aware of a potential risk to harm. So far they have been well received; therefore we will continue to produce these. The next one is on route ………

 

 

Monthly News Letters

We plan to produce a monthly news letter on a “theme of the month“. The newsletters are informed from adverse events reported on DATIX.  Our first edition is ready to go and we have a plan for future ones therefore again watch this space……

Plan for the future

We recognise all the hard work from each directorate in relation to managing their significant adverse events therefore we have put together a timetable for each directorate to provide us with their updates to enable us to support adverse event management in a timely and effective manner.

Communication

The Patient Safety Group is contactable via

dumf-uhb.Adverse-Incidents@nhs.net 

Emma McGauchie is the Adverse Events Co-ordinator for NHS Dumfries and Galloway

The Paper Boat by Patricia Cantley

I’ve been reading a lot recently about the word Frailty and its importance within Medicine for Older People. We see a lot of frail people and as geriatricians they are our core business both inside and outside the hospital.

Healthcare professionals have debated over the last few years how to define Frailty, and even how we might begin to measure it. It is no longer adequate simply to shrug and say “we know it when we see it”.

From a patient or relative’s point of view however, the word Frailty seems to be at best somewhat vague and at worst, derogatory and demotivating. When we ask patients how they feel about the word, whether in large surveys or on a one to one basis, they do not like it.

One strategy that I have found useful over the years, especially when talking to relatives of the patients under my care, is to paint a picture that they can relate to by using a simple analogy. I’m sure others have used similar techniques – indeed I learnt this one from a consultant colleague many years ago.

So when I am talking to a family member about their older relative, I sometimes liken their clinical situation to a fragile yet beautiful paper boat sailing round a pond of their choice.

A while back I used this particular strategy for a very elderly man under our care who was going through a very complex and unstable time. At one point, there seemed to be a lull in the medical winds that were buffeting his fragile frame and I sat down with his daughter to chat things through. She was desperately seeking reassurance, but also wanting honest facts about what to expect over the months to come.

She smiled as I described my image of a beautiful paper boat, brightly painted and currently sailing proudly in the sunshine on the still pond, giving pleasure to all around. I explained that the difficulty was in not knowing what weather was ahead, and the problems forecasting accurately. If the weather were to remain fair with barely a trace of wind, then there was no reason to think that the boat would go down and indeed it might sail on for quite a while. If, on the other hand, the wind got up, or worse, if it started to rain, that frail wee boat would go over quite quickly with little we could do to save it.

As younger and healthier individuals, we react more like little tug boats of wood and steel… we would simply bob up and down until the storm had passed. Though a big enough hurricane could be too much for us too…

The chat developed a bit more as we translated some of this into more medical language and formulated a plan over what would and wouldn’t be reasonable things to try, should that wee boat capsize over in a high wind. We agreed that we’d want to try as much as we could, maybe including intravenous therapy but that at the end, a call to the family rather than futile attempts at CPR would be the right strategy. I noted it all down, and his daughter undertook to update the rest of the family.

As is the way in modern medicine, our paths diverged and he was discharged from our service. I didn’t keep in touch, though I knew his daughter had my mobile that she could call if she wished.

Many months later, a text came through…

“Dearest Trisha, I am sending this sad message to you to let you know that last night the paper boat went down in a storm. It was all very sudden at the end, but we were well prepared, and for that we thank you.”

I called the patient’s daughter later that afternoon and we chatted about what had happened. I don’t think we used the word frail at any point in her father’s journey, but she knew what we meant, and I think it did help. It was also lovely to be able to talk afterwards and listen to how the last chapter of the story had unfolded. It is rare as hospital doctors that we get to do this kind of post bereavement support and for me, it was well worth while being home a little late (again) that evening.

Every doctor I’ve met has tales of when things go well, and we all have our share too of when they haven’t. We must never be complacent, and a strategy that works with one family may not work with another.

We need to learn a lot of facts as doctors, but there is also an important place for the use of stories in medicine. We can learn and teach what has worked for us, and consider how others might adopt and adapt similar approaches.

I had another text, more recently, from a previous trainee. Also a happy story, they wanted to tell me of a scenario in another hospital in another city, where they explained to a family the fragility of another paper boat. Intense medically focused discussions had failed to convey the precarious nature of the situation, but the visual image of a brightly painted origami boat had been something of a breakthrough. I was touched by the kindness of the younger doctor that they thought to feed back to their former teacher in this way.

I’m still not sure what the best way to define Frailty is, but I’ve tried a few ways of describing it in the clinical situation. I’d love to hear tips from other people, in particular from patients and relatives, about what has worked best for them.

Patricia Cantley works as a consultant physician in the Midlothian Hospital at Home Team, offering an alternative to hospital admission for frail and older patients. She also works in the Royal Infirmary in Edinburgh and in the Community Hospital in Midlothian. She tweets under her married name of Elliott as @Trisha_the_doc

This blog originally appeared on the British Geriatrics Society blogsite on the 9th July 2018. Many thanks to Patricia for the permission to republish on dghealth.

‘What I am told I forget…… by the Renal Team

…what I am shown, I remember.

              …what I do, I understand.’

Confucius was credited with many words of wisdom in his 72-years.  I couldn’t vouch for the authenticity of them all – but if he did utter these words he was indeed a man before his time.

The truth behind these words was apparent to me at our recent Kidney Care Planning Education day. The Kidney Care Planning Service has undergone a bit of a re-incarnation in the last couple of years. Formerly known as the Pre-dialysis service, it is simply the care of patients with an eGFR of less than 20mls/min, as they are more likely to progress to end stage kidney failure and need to plan for such an eventuality. However, the term ‘pre-dialysis’ implies that these people are all heading towards dialysis – when in fact many will choose an alternative path. The younger fitter patients should be hoping to get a pre-emptive kidney transplant from a relative or friend, while some of our elderly, frailer patients may well not benefit from dialysis at all and will survive just as long on conservative (nondialytic) care. So when Tanya Harkness took up the mantle of lead Nurse for the pre-dialysis service, she quite rightly felt a new name was required. Many renal units use the term Low Clearance Clinics, but a straw poll of non-renal staff suggested this was more reminiscent of a rehabilitation clinic for inattentive bus drivers… So, after much discussion amongst the renal team, the more accurately named Kidney Care Planning (KCP) service was born.

The aim of the service remains unchanged and while we do take bloods and treat symptoms, easily 80% of what we do is talk. More specifically we provide as much information as we can to help every person decide which treatment option is going to suit them best. We do this with clinic visits and home visits. We provide information leaflets, website addresses and even YouTube videos – all with the aim of imparting information. Yet still we are sometimes asked a question that blindsides us – that either leaves us thinking ‘How did you not know that from all the conversations we have had?’  or ‘Crikey- that’s a good question that I have no idea how to answer!’ Because at the end of the day none of us handing out this information have ever experienced what they are going through – the actual treatments, the fear and anxiety, the dread of what their lives will become or the understandable desire to block it all out and pretend it’s not happening.

Which brings me back to Confucius! The subject of teaching is vast, with as many different approaches as there are pizza toppings. Yet 500 years BC, Confucius nailed it with this simple truth – when we actually do something, we come to understand it. So who better to teach our patients, than other patients who have been in the same boat.

We have held education days in the past, usually in a hotel function room with talks given by members of staff. Tanya was keen to resurrect the concept, but made it quite clear from the outset that there was ‘No way on God’s earth’ I think was the phrase that she was ‘EVER’ standing up in front of a room full of people to give a power point presentation. (Why not, I have no idea as I am sure she would be excellent….but there we are!)

So a new format was devised between the whole community team – a less formal approach, like an open day, where patients could turn up and wander at will from room to room – talk to the team leads, watch demonstrations, see the equipment and most importantly meet other patients.

The date was chosen to coincide with a visit from Ewen Maclean, Kidney Care UK Patient Support and Advocacy Office, Scotland. Ewen, himself a renal patient, is a mine of information about the support available to kidney patients, grants and how to apply for them and the political landscape that shapes kidney care in the UK.

We no longer had need of a hotel function suite – if there is one thing we are not short of at Mountainhall it’s space! (And the parking is pretty easy too – sorry!!) So, we sent a personal invitation to all our KCP patients, laid on refreshments and opened up the old pre-assessment unit for the day.

The Renal Community Team (Left to right): Fiona Gardiner (Renal Dietitian), Robert McLemon (Transplant) Ian Mottram (Haemodialysis – both home and in-centre), Wendy Brown (Peritoneal Dialysis) Margaret McDonald (Clinic Health Care Assistant & Phlebotomist), Linda Stiff (Vascular Access), & Tanya Harkness (Kidney care planning).

As well as written information everyone had something practical for patients who attended and the responses we had were truly illuminating. Ian had a haemodialysis machine with all the lines and bucket of dialysis fluid set up and received the comment ‘Oh, I didn’t realise it would be so small-I assumed it’d be really big.’ And why not –historically dialysis machines took up a whole room, which must be a really intimidating thought if you are going to be hooked up to one- but it has NEVER occurred to me to comment on the size of a dialysis machine in my many dialysis related conversations.

Robert had asked 3 transplant patients, with more than 50-years of experience between them to attend. I am not sure if any of them showed their scars where the transplant was placed but they had experienced all the ups and downs of transplantation and immunosuppressants so there was no glossing over the bad bits.

Linda was showing patients how to feel  their fistula and what to listen for – explaining how the noise it makes can change if a stenosis is forming – and she was able to give those with a fistula their own stethoscope to involve them in their own fistula care.

Our renal dietitian was also on hand to give practical advice on managing fluid balance, as well as providing visual aids on potassium, phosphate and salt restrictions-something that renal patients universally struggle with!

One of the biggest successes of the day came from Wendy who had persuaded one of her Peritoneal Dialysis (PD) patients & their families to come and chat so they finally actually knew what the PD catheter looked like when it was inserted and could see for themselves how an exchange worked. But more importantly they could ask someone having the treatment what it felt like, how it impacted on their lives, whether it interfered with their sleep, whether it actually helped! One of our patients who had been set on coming to the hospital for haemodialysis when his time comes, has now changed his mind. We have been sure for many reasons that he would be best suited to PD, but fear was driving his decision. One hour watching a gentleman of his own age performing an exchange and listening to his stories of how life continues almost as normal around PD, has achieved what 5-years of reassurance from us could not…

The feedback Tanya received was overwhelmingly positive, but patients are generally nice, so it is the more subtle signs that have persuaded us this is the right approach. The questions and comments patients have since made in clinic prove that they have valued and retained some of the information they learnt that day. One patient commented how reassuring it was to see dialysis patients who looked well and still lived a normal life. And I hope through this some of the fear for the future has abated.

I expect in the future we will still be blindsided by hitherto unasked questions, but it is not only the patients who are learning, as I finish with yet another Confucius quote:

‘He who knows all the answers, has not been asked all the questions!’

We would like to express our sincere gratitude for all the patients and families who came that day, especially for those who came to share their experiences with patients in the early stages of their kidney care planning journey. We are also grateful for the patients who gave their consent for us to take photographs and use them in this blog.  We hope to make “Kidney Care Planning Education day” an annual event from now on.

 

Other useful renal websites:

Patient focussed resources:

Kidney Patients UK / The National Kidney Federation, the largest kidney patient charity in the UK, run by kidney patients for kidney patients, website provides lots of useful information.

Kidney Care UK – formerly the British kidney patient association, very helpful brochures available online.

Think Kidneys – NHS England’s campaign to raise awareness of the importance of kidney disease. Lots of useful resources can be accessed with just a few clicks from this page.

Clinician focussed resources:

Renal Fellow Network – A USA based website with worldwide contributions distilling vast amounts of renal knowledge into bitesized articles, a great resource to start learning about renal medicine.

UKidney – online education on Nephrology, hypertension and kidney transplant.

#NephJC is a fortnightly Twitter-based Nephrology Journal club with visual abstracts, free access to the articles provided by major journals and regularly includes participation by the authors and other worldwide experts in the field.

 

This blog was written by Dr Alison Almond, Associate Specialist in Nephrology, with contribution from rest of the Renal Team, NHS Dumfries and Galloway.

 

Dementia Awareness by Julie Garton

Dementia Awareness Week runs this year from 4 – 10 June. There are lots of events across the region supported by a wide range of individuals and organisations. This year, I’ll be promoting the use of a document called ‘This Is Me’ within acute hospitals and asking Dementia Champions and other colleagues across NHS Dumfries & Galloway settings to join in.

When someone with dementia comes into hospital, a care home or is receiving care at home, they and their family/friends may be asked if they have a ‘This is Me’ document.

What Is ‘This Is Me’?

‘This Is Me’ is intended for use by anybody with dementia, delirium or other communication impairment.

It aims to provide important personal information about the person from their perspective and those who know them best (family/caregiver) to help enhance the care and support given when the person is in an unfamiliar environment.  It’s crucial that we understand the person as an individual and take their personal history into account, helping us to communicate and engage with the person, which in turn can help us to prevent/alleviate stress and distress.

What are the benefits of ‘This Is Me’?

For the person, their families/caregivers – if the person with dementia has memory and/or communication problems, then a ‘This Is Me’ guides and supports staff to provide care in a way that respects the person’s choices, preferences and routines. ‘This Is Me’ can be a great opportunity to ask and find out information, that as family members we may not know – provoking good memories and conversation. In addition, a ‘This Is Me’ or similar may reassure people with dementia and their caregivers that we see behind the dementia and respect that person.

For staff – for professionals, it can help us deliver person centred care, and importantly, reduce the times we ask for the same information – the detective work has already been done.

Where can ‘This Is Me’ be used?

‘This Is Me’ can be used anywhere, in hospital, care homes, in primary care, respite care and is offered during Post Diagnostic Support.

When should it be completed?

‘This is Me’ always offered during Post Diagnostic Support but can be completed at any time.

Are there issues around confidentiality/sharing this document?

The document is the property of the person and/or their main care giver – it is not a clinical document and does not belong to any professional or service, the person/care giver decides what information is included and shared.

Once completed, the document should be kept in a place that is easily accessible for those providing care, for example, at the bedside, in a care plan. The information can help staff understand the persons’ baseline abilities, lifestyle, routines, likes/dislikes and gives great opportunities for conversation and engaging with the person.

What happens to the form if/when the person is discharged or transferred?

As it belongs to the person, it should go with them on discharge/transfer, and it’s also useful to check with the person and /or their main carer that the information remains up to date and relevant.

Living Well with Dementia

It’s important to understand that many people are able to live well with dementia, leading active and fulfilling lives for years after they first experience difficulties and receive a diagnosis, but coming into hospital can be daunting for all of us, and for people with dementia , this can be a frightening experience.

Whilst these days, a person with dementia may only be in hospital for a short time, how we communicate and support them will have an influence on the impact of the whole care experience and how quickly they can return home. We know that older people with dementia are more likely to be discharged to a care home than older people without dementia, have longer hospital stays and experience more falls and pressure ulcers.

We know that in Scotland around 93,000 people are living with dementia and we think around 25% of all acute hospital beds are occupied by people with dementia (Alzheimer’s Research UK, 2018), yet mostly, people arrive into our services without a document such as This is Me even if they have one at home.

“This is Me gives me golden information about an individual. The nuggets of information are priceless in helping to smooth the way to getting to know the person behind the dementia”

Gillian, Staff Nurse

‘This Is Me’ is just one of a range of tools that can support centred care, Getting to Know Me, Life Story work and a wide range of personal profile tools are available, many online, helping professionals to see the person, not just the patient.

I ‘m keen to hear about your experience/s of using This Is Me in your workplace – please contact me or, if  you would like more information about This is Me or would like a copy, please contact me at jgarton@nhs.net or 01387 246981.

Julie Garton, Alzheimer Scotland Dementia Nurse Consultant

Dietitians do Prevention by Laura King

Next week sees the return of Dietitians’ week and the theme this year is ‘Dietitians do Prevention’ with each day having sub-themes. Follow #DietitiansWeek on Twitter, Facebook and Instagram for some insights into our involvement in a wide and varied range of preventative activities.

Here in NHS D&G we have dietetic teams working across these areas which may come as surprise to the majority of folk working in the acute hospital who perhaps associate us mainly with artificial feeding and oral nutritional supplements for those who have scored 2 or more when nutritional screening is done on the wards.

As a small team we recognise that we have to play a role in educating and enabling patients, their families and carers to prevent over and under nutrition by supporting self-management, the dietitian can’t come shopping with you, cook your meals and help you to eat them and make the best choices, so we have to rely on using our communication skills to educate and inform patients and those close to them to help have a healthy, balanced diet that meets their needs.

We factor in ‘what matters to you’ and our assessments incorporate a huge range of factors as this poster illustrates:

Our Team works in the following areas all of which have significant roles to play in prevention:

Community Nutrition Support  (Kerry, Alexandra, Jackie, Jennifer, Lis, Dillon and Carole) – We provide practical, evidence based dietary advice, specifically tailored to each individual. Through dietary advice we aim to prevent and treat a wide range of medical conditions and empower people to make appropriate diet and lifestyle choices. Community Dietitians see patients in a variety of settings including community hospitals, nursing and residential homes, clinics and patient’s own homes. Our role identifies, prevents and manages malnutrition in the community. We liase with individuals to create realistic and achievable goals to optimise/improve their dietary intake.

Various medical conditions require an individual to be provided with their nutrition via a tube. We are responsible for managing these patients in the community, either in their own home or in a nursing home/community hospital setting.

We deliver educational talks on various topics including cardiac rehabilitation, stroke, Parkinsons disease and pulmonary rehabilitation.

Renal (Fiona) – Supporting patients with advanced kidney disease in managing complex nutritional requirements. Preventing further complications that can arise from inability to excrete electrolytes and fluid overload as well as avoiding weight and muscle loss for this group of patients who have increased requirements for protein once dialysis has commenced.

Gastro (Gemma and Sarah) – Preventing complications from poor management of coeliac disease such as the obvious GI disturbances through to the ‘hidden’ consequences such as increased risk of bowel cancer and oesteoporosis. Supporting patients living with inflammatory bowel disease to manage their symptoms and optimise their health and well being. Preventing the often crippling effects of irritable bowel syndrome by supporting patients to use the low FODMAP diet to identify trigger foods and modify their diets in a safe and sustainable way.  Preventing malnutrition in liver disease which is often masked by fluid shifts.

Paediatrics (Mhari, Anne and Tracey)  – Supporting parents & their child in managing children with complex needs, tube feeding, diabetes, gastroenterology issues, cystic fibrosis, weight management, faltering growth and allergies – preventing short and long term consequences of under nutrition.

Diabetes (Katy, Nicola, Sally, Sheena, Wendy): We are an integral part of the diabetes multi-disciplinary team providing a dynamic and evidence based service. We deliver quality assured education, and aim to support patient driven care and safe self management to those living with diabetes and their family. We also provide continuing education and support for health care professionals working with individuals with diabetes.

Weight Management (Katy, Nicola, Sally, Sheena, Wendy): We provide person centred, safe and evidence based advice to individuals with complex needs and requirements. This encompasses a variety of approaches to help aid weight loss and improve quality of life.

Mental Health and eating disorders (Sam and James) – Supporting recovery from mental health crises and from the consequences of living with disordered eating behaviours.

Catering (Debbie)- Working with Catering to achieve menus for inpatients across the region that offer a varied, balanced diet to support their recovery and prevent complications such as poor wound healing and  pressure ulcers. Also ensuring guidance for Catering teams to create therapeutic or special menus for patients’ individual dietary requirements. Training staff who make and deliver food, fluid and nutritional care to patients in hospital.

Acute (Laura, Anneka, Laura, Jennifer, Laura and Sheree) – seeing patients identified as being at risk of undernutrition to assess their individual needs and support recovery. Preventing increased length of stay, poor wound healing, pressure ulcers and other complications of malnutrition and providing advice for discharge to help patients stay well and continue their recovery once home with or without the support of the community dietitians as appropriate.

All this activity is coordinated and supported by our Head of Dietetics (Lorna).

The acute team are planning to pilot some staff education sessions on B3 and D7 to support ward staff in preventing malnutrition as well as identifying the patients who need our one-to-one support, so please get in touch with Dietetics on 01387 241568 if you would like to know more, want to arrange any training on your wards or if you have any questions about this blog post and what we do.

Meanwhile here are some pictures of the acute team (Anneka, Jennifer, Laura and Laura) ….

Laura King is Lead Acute Dietitian at Dumfries and Galloway Royal Infirmary

What Matters by Ken Donaldson & Alastair McAlpine

I recognise that it is a bit cheeky of me to put my name to this as I haven’t written any of it. A few months back I was scrolling through Twitter and came upon this thread that really moved me. The messages are simple yet immensely powerful. I have therefore simply taken some screenshots from Twitter and published them here. As you can see this is by a Doctor called Alastair McAlpine who is a Palliative Paediatrician in Cape Town, South Africa. Read on…..

Cant Thank Everyone Enough

You don’t have to look very far these days to realise that the NHS is under significant pressure; the local bulletins, national news and local papers are all talking about ‘Winter Pressures’ and ‘Flu Outbreaks.’ This, along with staff shortages and capacity issues, would make many of us dread going in to hospital or having a loved one admitted however I recently had to witness my husband spend the festive period in the new DGRI and I was so impressed by his, and my, care that I wanted to write about it.

On the 19th of December my husband was referred up to X-Ray for a CXR. This rapidly became a CT scan and then direct admission to the Combined Assessment Unit. This itself was a massive shock for all of us and a very scary time. However the staff in X-ray were amazing and made a frightening experience a tiny bit more acceptable by their kindness and attention. Thank you to all of them.

When we arrived on CAU it was obvious that it was a very busy place. For the staff to be working under this pressure in a new environment beggars belief but they did so with equanimity and charm. The care my husband got was excellent and I wish to thank Moira and all the other nurses who were fantastic as well as the Health Care Support Workers (many cups of tea which were never too much bother) and also Drs Ali and Oates. Dr Oates your visit on Christmas Day meant a great deal to us.

After CAU we moved up to Ward B2 and the outstanding care continued. I came in at 8.30am and left at 9pm and having a single room and open visiting meant I was able to stay with my Husband at all times which meant so much to us especially during this time of uncertainty. We could cry in private and talk in a way we could never have in a 4 bedded bay. Once again the staff were amazing – all the staff nurses, HCSWs and Domestics got used to seeing me around and, despite being extremely busy over Christmas and New Year, catered to our needs. They brought blankets and cups of tea – the small things which can mean so much – without us having to ask, in fact they were so busy we would not have asked for anything. Dr Gysin listened to our moans with patience and kindness and ensured that my husband got home as soon as possible, just after New Year.

We have just started a journey which will now mean trips to Edinburgh for more tests and possible treatment. This was always going to be a hard time but the caring and compassion we experienced whilst in DGRI over the festive period has made it that little more bearable.

Thank you

The Pneumonia in Bed 5 by Sian Finlay

Although it is sometimes easy to forget it amongst the busyness of front line clinical duties, I am a person.  I suspect many of you are too.  Occasionally I am unwell, but I consistently find that I still remain a person during this period – I have never yet become a disease!  So why is it that when patients come into our care, we so often default to calling them by their diagnosis instead of their name?  Go onto any ward and I guarantee it will not be long before you hear someone described as ‘The Chest Pain’ or ‘The Pneumonia’.  Many handovers will include phrases such as ‘He’s a UTI’.

No, he isn’t! He’s a PERSON who has a UTI!

A common (and potentially even worse) variant of this is the ‘bed number’ name, exemplified by ‘Bed 3 needs the commode!’  Sometimes attempts are made to justify this practice with the excuse that it protects confidentiality, but let’s be honest here.  The truth is that it simply demands more mental effort to remember the patient’s name and we are taking a short cut.  All very understandable in a busy environment, and I really don’t blame anyone.  You might think it is just semantics anyway – what does it matter if we call someone ‘The GI bleeder’?  Well I argue that it does matter.   More than you think.  These patients are people, no less complex and emotional and fragile than you or me.  By depersonalising them, we are subtly starting down a path which allows us to forget this; which allows us to view them as tasks in our day rather than the individuals they are.  If you are unconvinced, try this little exercise; read these 2 sentences and see if they elicit the same emotional response in you:

Bed 5 is agitated.

Tommy is agitated.

Would you agree that the second sentence immediately makes us feel more empathy and compassion towards its subject?

Many people will be aware of the late Kate Granger, the inspirational doctor who responded to her diagnosis of terminal cancer by establishing the ‘Hello, my name is..’ campaign.  Sadly Kate died last year, but her campaign lives on and has touched many of us in the healthcare profession.  But Kate’s work didn’t begin and end with wearing a smiley badge with our name on it; it is in essence about remembering the humanity of our patients and treating them as fellow human beings.  And I can only imagine Kate’s fiery reaction if she ever overheard herself being referred to as ‘Bed 5’!!

But we are all under pressure.  What if we genuinely can’t remember the patient’s name and are just trying to communicate information quickly?  Surely that doesn’t make us uncaring?  Of course it doesn’t, but in times of acute amnesia, we could at least say ‘the man with pneumonia’ rather than ‘the pneumonia’.  And that should only be a holding measure until we can remember his actual name – surely essential for safe communication anyway!

I hope I have convinced you that words do matter.  The phrases we use set the whole tone for the level of kindness and empathy we expect in our clinical areas.  So if any of this resonates with you, I hope you will lead by example.  Look at your patients and remember they have hopes and fears and histories and personalities…and almost always names!!

Sian Finlay (aka ‘The Migraine on ward 7’) Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

• every person is born with worth and dignity
• every person has the ability to choose between doing good and doing wrong
• every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway