Download Sunderland Royal Hospital Welcome to the Acute Medical Unit

Sunderland Royal Hospital
Welcome to the Acute Medical Unit
(AMU)
Portfolio of Learning Opportunities
(POLO)
Student: …………………………………...
Mentor: …………………………………….
Date: ……………………………………….
Produced: August 2012
Review Date: August 2013
1
Contents Page
Page
Introduction
3
Ward Philosophy
4
Ward Layout and Facilities
5
The Unit
6
Mentors
6
Shift Patterns
7
Visiting Policy
7
Admissions
8
Transferring Patients
10
Discharging Patients
10
Staff
11
Other Members of the Multi-professional Team
11
Nurse Practitioners
12
Named Nurse
12
Common Medical Conditions in AMU
13
Diagnostic/Treatment Procedures
13
Telephone Numbers
14
Learning Opportunities
15
Learning Zones
18
2
Introduction
Welcome to the Acute Medical Unit (AMU). We hope that you enjoy your
experience with us and gain valuable knowledge and skills which will help you
successfully fulfil your learning outcomes. We hope you take advantage of the
learning opportunities to help develop and enhance clinical skills.
The Acute Medical Unit aims to facilitate the assessment of those who may
require emergency admission to hospital. Patient’s enter the emergency
assessment unit via a range of sources such as Accident and Emergency, GP
surgeries, Minor Injuries Unit, Urgent Care Team, 24/7 Team, Sunderland Eye
Infirmary, Cherry Knowles Hospital and sometimes consultant clinics. Patients’
have rapid assessment by our medical staff, necessary investigations and
treatment is initiated. It is a short stay unit and once patient’s are reviewed by a
consultant and a provisional diagnosis has been made they are then allocated a
transfer destination and are moved when the bed is available. However if upon
review they are medically fit, they can be discharged straight from the unit with
follow up care.
3
Ward Philosophy
‘The Acute Medical Unit aims to facilitate the best possible nursing care for
patients admitted with acute medical conditions. We believe each patient is
entitled to the highest standard of care delivered by an appropriately trained and
competent practitioner. We work as part of a multi professional team and
appreciate each member has valuable contributions and we encourage
involvement and further education. As professionals we are committed to treating
patients with care and take into consideration their physical, psychological,
spiritual and social needs, essentially providing holistic care.
We realise the importance of providing a safe environment for both patients’,
relatives and staff and follow procedures and protocols to ensure guidelines are
adhered too. The medical team strive to deliver evidence based care for the
assessment, diagnosis and treatment of patients. We regularly review and
evaluate care by means of audit, appraisal and meetings to enhance and
improve the care we deliver.’
4
Ward Layout and Facilities
The unit comprises of fifty beds of which there are seven six bedded male and
female bays and eight side rooms. Each bay has piped oxygen, wall suction,
hand-washing facilities and each bed has its own personal television. There are
also sufficient washing and toilet facilities throughout the ward.
The WRVS trolley visits the ward on a daily basis to offer snacks and
newspapers. There are information racks on the entrance and exit to the unit
which provide useful leaflets for patients’ staff and relatives.
We have GP awaiting area which patients can wait until a bed is available on the
main ward. This is ran by nurse practitioners and is available 8am until 10pm.
Attached to AMU we have the Rapid Assessment Treatment Unit (RATU) and a
Surgical Assessment Treatment Unit (SATU) which is ran by Nurse Practitioner’s.
These areas of care help the quick assessment of patients with a medical or
surgical condition and aims for fast track treatment to enhance patient flow and
reduced the amount of inappropriate admissions.
We have a Deep Vein Thrombosis Clinic (DVT) that is attached to the unit which
is nurse led. Patients can be fast tracked by GP, A&E, walk-in clinics and bloods
can be taken and an ultrasound scan can be arranged according to clinical need.
5
The Unit
A staff nurse is allocated a bay and two connecting side-room’s per shift. In
principle each shift has seven staff nurses and up to five health care assistances.
The co-ordinator, usually the most senior nurse on duty will oversee the running
of the ward and their responsibilities consist of range of duties. They are
responsible for the skill mix and the staff ability. They are made aware of the
acutely ill patients and help deal with them effectively. They allocate patients to
beds available within the hospital and handover patients to appropriate wards.
Generally they deal with any problems which arise on the unit.
We have a bed bureau system which take referrals from departments that require
admissions and then the allocations of these are made with the help of patient
flow co-ordinators (formally known as bed managers.) They liaise with other
wards to create beds and facilitate movement.
Mentors
Before starting placement on the unit you will be assigned a mentor whom will
guide and support you through your placement. Your mentor will be a permanent
member of staff and will have successfully completed the mentorship course. As
they have been prepared for this role they will be familiar with the competency
system. The assigned mentor will help the student develop their knowledge and
skills under close supervision. They will help inspire and motivate the student and
encourage participation to achieve learning opportunities.
It is expected you work with you’re a mentor for a minimum of 50% of the time
and when your mentor is not available you will work with you co-mentor. Due to
personal commitments shifts are negotiable within reason although required
hours must be met each week.
Practice Placement Facilitator: Sonia Malt
6
Shift Patterns
Early 7.30am - 4.30pm
Late Shift 12.30 – 8.30pm
Night Shift: 8.15pm – 7.45am
Occasionally shift patterns are altered slightly to meet the needs of the unit.
Visiting Policy
Sunderland Hospital has a restricted visiting policy. The daily visiting hours are
as follows:
2pm - 4pm
6pm – 8pm
The hospital promotes a protective mealtime initiative, which enables patient’s to
enjoy their meal free from interruptions and distractions.
7
Admissions
AMU is a very busy admission unit and it is essential that an efficient and
accurate assessment is carried out on each patient entering the unit.
When a patient is admitted to the unit initial observations must be taken first. This
is temperature, blood pressure, pulse, respiration rate, CNS, oxygen saturation,
pain and sickness score. This will create an ‘Early Warning Score’ (EWS) which
must be recorded on admission documentation and the main white board. A
blood sugar reading must also be taken and documented. If arriving from GP
surgery an Electrocardiograph (ECG) must be taken and the patient must be
screened for MRSA. The labels can be printed from the ‘order entry’ section on
the computer system and must be sent to the laboratory to be tested. The patient
should be given an electronic name wristband and red allergy band if
appropriate.
All patients admitted to the unit must be placed on the HISS computer system.
This is accessible through the ‘Admission Module’ and once their details are
added and confirmed, together with a printout their details can be placed with an
admission booklet. The first 3 pages of this booklet must be completed. It
requires a brief description of the reason the patient is admitted any past medical
history the patient may have. Their communication needs, elimination needs,
breathing needs, mobility requirements, sleeping needs, their social
circumstances and also their smoking and alcohol habits is also required. In
addition a property list must be taken i.e. jewellery, money and clothing. This
documentation must be placed in the ducket to be seen by the doctor for clerking.
Once the written documentation is completed the assessor can enter an
appropriate evaluation on the ‘HISS’ computer system using the ‘emergency
update template.’
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The following assessments are also required for each admission:

Braden
(Risk of pressure sores)

Pilling
(Moving and Handling)

MUST
(Malnutrition and BMI)

IV Device
(The insertion of a ventflon)
4 x daily

Falls Trigger Tool
(Factors contribution to the risk)

Falls Risk Tool
(If score 3 or above on trigger/over 65yr)

IC Risk
(Infection control- MRSA swobs)

Catheter Insert Surveillance (If required)

Pressure Ulcer
(If required)
It is important theses assessments are completed accurately for the health and
safety of both staff and patients.
Each patient entering the unit must be placed under the care of a consultant and
this varies according to the day and time.
This can change on a weekend according to the admitting on call consultant.
Each admitting consultant has a pneumonic and there is a list available at the
nurses’ station.
9
Transferring Patients
The AMU co-ordinator works closely with the bed managers and once a bed has
been identified and a handover has been given to the receiving ward a patient
can be transferred. Their belongings must be checked using on the admission
booklet and a ‘Transfer Form’ must be filled in and sent with them. Their details
must also be entered into the ‘Transfer File’ located at the nurses’ station.
Discharging Patients
Once a consultant has reviewed a patient and they are medically fit they can be
discharged straight from the unit. A discharge letter must be completed and a
copy must be given to the patient to forward to the GP. Our ward clerk also faxes
a copy to the GP surgery for confirmation. If they are prescribed medication or
usual medications are altered then doctors and nurses must liaise with the
pharmacist to convert medications and prepare them for the patient. A copy of
their prescription is also sent to their GP to inform them of the changes.
Transport for the patient should be arranged and ensure the care is in place for
them at home should they need it. A print out of all documentation should
completed and filed with their notes. Finally they must be discharged from the
system and their name must be documented in the ‘Transfer File’ located at the
nurses’ station.
There has been a recent drive to utilise the use of the discharge lounge.
Therefore if patients are medically fit for discharge and are awaiting medications
and transport this service is available as it makes ward beds more available.
10
Staff
Matron
Grey and Red Uniform
Sister /Ward Manager
Navy Uniform
Junior Sister
Navy Uniform
Nurse Practitioner
Maroon Uniform
Staff Nurse
Blue uniform (female)
White with blue epaulets (male)
Health Care Assistant
Beige Uniform
House Keeper
Grey with Maroon Uniform
Ward Clerk
White Uniform
Student Nurse
White Uniform
Other members of the Multi-professional Team

Physiotherapists (chest) – assess respiratory needs and provide chest physio

The interface team – comprises of physiotherapists and occupational therapists
which work collaboratively to assess patients mobility and home circumstances to
enhance their safety

Porters – transport patients to different departments within the hospital as
required. From 4pm AMU has a porter assigned primarily to the unit.

Dieticians – asses the patients dietary requirements and offer advice and
care plans to help improve their nutritional intake

Pharmacists – check medication and supply the required amount. They
educate patients and provide advice and support to nurses and doctors
regarding medication

Ward Clerks – carry out filling and ensure medical notes, are tracked to
the ward, book scans, answer telephone calls

Housekeepers - help to maintain the high standard of cleanliness on the
ward and deliver meals and drinks to patients. They also help transfer
patients to other wards and departments.
11

Deliberate Self Harm Team (DSH) - assess patients psychological state of
mind once medically fit and can arrange support for discharge
Nurse Practitioners
AMU has a hugely valuable and experienced group of Nurse Practitioners based
on the ward which have undertaken further training and completed the clinical
skills course. Their role consists of:

Clerking patients and undertaking treatment and investigations

Attending consultant ward rounds

Ordering and investigating diagnostic procedures

Taking referrals for admissions from A&E, GP Surgeries, Urgent Care
Team and Minor Injuries Unit

The organising and running of the nurse led DVT Clinic, RATU, SATU and
the GP assessment area.
Named Nurse
AMU operates a named nurse policy as it is a valuable method of managing and
caring for patients.
Their responsibilities consist of:

Co-ordinating the plan of nursing care, including assessments

Identifying and ordering initial investigations

To have in-depth knowledge if the patients condition

Communicate with relatives ensuring information is provided and options
are discussed

Ensure the ‘Essence of Care’ Standard is adhered too

Liaise with other health care professionals and members of the multiprofessional team

Evaluating the effectiveness of care delivered
12
Common medical conditions in AMU
AMU takes acute medical admissions 24 hours a day, 365 days a year and it is a
very busy unit. It caters for patients with a variety of medical conditions offering a
unique experience to students.
In preparation for arriving on AMU it would be helpful to familiarise yourself with
medical conditions which are common in acutely ill patients.

Headache

Deep Vein Thrombosis

Collapse

Pneumothorax

Diarrhoea

Myocardial Infarction

Vomiting

Angina

Seizures

Left Ventricular Failure

Renal Failure

Unstable Diabetes

Self Harm

Meningitis

Pulmonary Embolism

Pleural Effusion

Overdose

Exacerbation of

Gastro-Intestinal Bleed
COPD/asthma
Diagnostic/Treatment Procedures
To enhance your learning opportunities it would be beneficial for you to
understand and if possible observe and assist the following procedures:
Urinary catheterisation

CTPA

X Ray

Electrocardiograph (ECG)

CT Scan

Echocardiogram (ECHO)

MRI SCAN

Venpuncture

Lumber Puncture

Cannulation
13
Telephone Numbers
Internal
External
0
(0191) 5656256
49734/49735
(0191) 5699734
Fire
333
N/A
Cardiac Arrest
2222
N/A
Security
777
N/A
Main Hospital Switchboard
Acute Medical Unit
All other frequently used numbers can be found on a list behind the nurses’
station and in the hospital telephone directory.
All internal ward extension numbers in the hospital start with the prefix 497
followed by the ward number. All external telephone numbers begin 56997
followed by the ward number.
All bleep numbers begin with 5. When using the bleep system the number should
be dialled and then wait for two rings and replace the handset and wait patiently
for a reply.
14
Learning Opportunities
Learning Opportunity
Resource
Interpersonal Skills
Use of the telephone:
Making calls

Receiving calls

Transferring calls

Use of the bleep system

Use of the fax machine
Ward Staff/Ward Clerk
Computer Skills

Admit a patient

Complete assessments

Complete nursing
Registered Nurse
documentation

Transfer a patient

Discharge a patient
Communication Skills
Talking to:
Patients

Relatives

Staff
Ward Staff
Clinical Skills
Patient Hygiene:
Mouth care

Hair care

Nail care

Pressure area care

Continence care

Showering/bed-bathing
Registered Nurse/Health care Assistant
15
Record Vital Observations:
Blood Pressure

Temperature

Pulse

Respiration

02 Saturations
Registered Nurse/Health Care
Assistant/Critical Care Outreach
Early
Warning
Score
(EWS)
Record Physiological Observation:
Blood Glucose
Registered Nurse/Health Care

Fluid Balance
Assistant

Weight

Urinalyses

Peak Flow
Use of medical device:
Baxter Pump

Syringe Driver

ECG Machine

BP Machine

Peak Flow Meter

Cardiac Monitor
Registered Nurse
Registered Nurse/Health Care
Assistant
Moving and Handling
Use of:-
Registered Nurse/Health Care

Hoist
Assistant/Back Care Facilitator

Slide Sheet

Pat Slide
Administration of Medication:
Oral

Intramuscular

Subcutaneous
Registered Nurse/BNF/CHS Policy
16

Intravenous

Rectal

Sublingual

Inhaled

Topical
Registered Nurse/BNF/CHS Policy
Procedures:
Catheterisation

Venapuncture

Cannulation
Registered Nurse
Control of Infection

Hand Washing

Aseptic Non Touch Technique

Barrier/Isolation Nursing

Safe disposal of waste/linen
All ward staff/Infection Control/Link
nurse/Surveillance nurse
17
Learning Zones
Deliberate
Self Harm
Team
AMU
Nurse
Practitioners
A/E
SATU
Deep Vein Thrombosis
Clinic
Intensive Care Unit
Critical Care Outreach
AMU
Specialists Nurse:
 Alcohol Liaison
 Diabetic
 Stroke
RATU
Bed Manager
Speech and
Language Team
(SALT)
Occupational Therapist
Dietician
Chest Pain
Assessment
Unit
Pharmacist
Physiotherapist
Control of Infection
18
Interface
Team