SW Newsletter #39

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July 7th 2008

Welcome to the Star Wards’ newsletter and a warm welcome to the new members of the Star Wards’ community. I hope that not too many of you have had lovely summer garden parties, fetes, spacehopper races etc drowned out.

There’s an exciting new grants programme which some members might want to apply to. Ecominds is run by Mind and funded by the Big Lottery Fund, with £7.5 million to distribute to around 125 new and existing projects around England focusing on mental health and the environment over the next five years. Ecominds aims to help people with direct experience of mental distress become involved in environmental projects that improve mental and physical health, and local communities. They give examples of projects which many wards are already running such as community horticultural projects, walking groups, producing artwork in public places and in enclosed spaces (eg sculpture in hospitals), learning new environmental skills (eg making garden furniture). It’s unclear from the information on the website whether NHS hospitals are eligible for direct applications, but partnerships with local voluntary organizations (especially Mind groups!) will be much more likely to succeed.

For more information see www.mind.org.uk/ecominds

Alexander House Ground Floor, Royal Bethlem Hospital

When I arrived at Alex House, at the front door to the unit, I met an ugly, wrinkly, cute pug. With an attractive smooth, sophisticated nurse. It turns out that the ward consultant brings her dog in two days a week, much to the patients’ pleasure. For example, the ward manager, Amanda Pithouse, told me that a manic patient who’d been on the go for a week, day and night, sat down for the first time with the dog on her lap.

Alex House has been an acute female ward since 2006 when two mixed wards changed to 1 all male, 1 all female, following a service review. They extended the therapeutic programme and worked on substantially improving the environment eg creating a visitors’ lounge from the smoking room. In the main lounge they got rid of info on notice beards to make it more homely and notices are now in corridors. The female lounge is now a relaxation room. They’re getting all new bedroom furniture, curtains, bedspreads, mirrors, wardrobes, vanity tables etc. The “Put it up team” do odd jobs, eg put up units in art room for Internet and artwork and this seems to work well.

The ward is (invisibly) zoned to reflect levels of care needed; one end is for more intensive care. They use a traffic light concept on admission – eg a red zoned patient will be allocated a nurse for the shift, green (near discharge) patient is supported by an HCA. This is a simple and excellent concept. The ward was still undergoing a major redecoration, and building refurbishment and staff and patients are coping remarkably well with the disruption.

In the resource room (and how fab that is), a staff nurse created a Wall of Information including community resources and women-specific resources. The Wall of Information has a big sign: Services you may need after discharge and a series of laminated A4 posters, each with information, created by staff, about local and national services. The room also has a PC for staff to use to help with relevant information gathering. Other wards take samples of the info to benefit their patients.

The art room provides Internet access, which (not one member will be surprised to hear) was a huge performance to set up. They were given conflicting advice about how to secure Trust approval and finally discovered there’s an application form. It involved lots of follow-up phone calls to fix up computers, broadband, phone line, router etc. But it was worth it! They run an Internet Café once a week, with tea, cakes and Internet access; the OT tech runs it, and patients can also use it in timed slots during the week. Nurses are supporting and monitoring it eg to prevent manic spending. They’ve developed an Internet policy, based on preparation done by Lisa the OT.

The kitchen is used for ADL assessments and breakfast cooking at weekends. The relaxation room is very lovely and modern in a distinctly IKEA way, with music and a library. Senior ward staff and patients painted the walls, and made their own fabric ‘painting’ on canvas to co-ordinate with Lisa’s custom-made cushions.

There’s no seclusion room. Great. (Funnily enough, my handwriting software translated my scribbles for this as:  • sinkhole Non.)

They wanted to make the therapeutic programme gender specific. There are guidelines for staff about Protected Therapeutic Engagement Time including therapeutic benefits for patients, resources available and what qualified and unqualified staff can/should do during that time. The more complex MH groups are run by qualified staff and activities’ groups by unqualified staff. The therapeutic timetable had been OT led Mon – Fri 9-5 with Lisa, full-time OT, and a part-time OT technician. The expanded programme includes nurse-led activities, partly to free up Lisa to do outreach work with patients being discharged.

An OT contact who works for the London School of Fashion volunteers to support arts’ activities, partly as a way to maintain her clinical practice, and is also a trained art therapist! Her groups include:

  • Felt – tactile, valuable for discussing feelings
  • Knitting – already quite a bit going on in the ward
  • Crocheting – no longer retro but hip!
  • Digital photography.

The ward pays for a yoga, Tai chi, relaxation session-leader once a week. And Lisa found a volunteer to do reflexology with patients. The Well Woman clinic is run by SH0 and a qualified nurse.

Other weekly groups, run by HCAs, sessional freelancers etc include:

  • Healthy Living
  • Moving on
  • Swimming
  • Walking
  • Meeting with pharmacist
  • Gym
  • Art therapy
  • Cooking
  • Feeling good
  • Smoking cessation
  • Music appreciation
  • Dog-walking!
  • Cinema night
  • Gardening
  • Sports
  • Creative writing

This doesn’t leave a lot of time for ruminating, fractious incidents etc.

Link workers (service users) visit fortnightly and run meeting with patients. There are

3 carers’ clinics a week! These are at different times of day/week and include personal assessment/consultation. Use Barnardo’s pack for young carers, which includes a DVD.

They worked with Rethink to develop a carers’ pack which is sent out by the ward clerk soon after patient admission. Visiting isn’t allowed during protected time although is generally flexible and is up to 8.45pm.

Staff designed 6 lovely glossy information leaflets, and the flowchart has colour-coded stages which match their leaflets! They even designed a logo for the Independent Route, a flow-chart of the care pathway, admission to discharge. The leaflets are printed on the ward so they can be regularly updated. They spent £300 for a printer from a grant of £800 for World Mental Health Day. (The Independent Route won a clinical governance award.)

Lots of staff have gone on enhanced skills training, including CBT. Patients benefit considerably from the ward being part of the Royal Bethlem Hospital and on-site specialist services include those for anxiety and for eating disorders. Staff supervision includes a fortnightly staff support group interestingly, facilitated by the chaplaincy, in secular mode.

They have protected medication time which Amanda says was inspired by Star Wards. (Always good to know we’re having an impact!) There are clocks in all bedrooms so patients know when their allocated time slot is coming up and each bedroom has a poster with their time slots. There’s a gap at the end of each medication session for people who haven’t managed to get there unprompted.

In accordance with best practice in preventing patients going missing, there’s a signing-in and out book in a holder on the main door out of the ward, which also features a brilliant laminated A4 poster, created by the patients’ group on: “Coping with Ward Round stress” !!

What a spectacular ward! And one that is based in a dull old building but nevertheless shows that it is possible to run exemplary services even when hampered by inappropriate physical design. Because she’s so fab and efficient, Amanda has already given us their excellent guidelines, policies etc to share with members and these are on our website at:http://starwards.org.uk/?p=187

For further information, or just to shower praise on Amanda, you can contact her by email:[email protected]

And finally, please do register as soon as possible for the Star Wards Festival, which is happening on September 9th in London: www.starwardsfestival.org.uk


All the best