Thanks to the Care of the Elderly team on Ward 9 of Solihull Medical Day Hospital, visits can actually be something their patients look forward to.
What patients and their families really appreciate about staff nurse Katherine Roberts and the rest of the team – geriatric consultants (two full-time, two part-time) Drs Susan Powell, Martha Pinkney, Robert Wears and Peter Hanna – is their kindness and professionalism, and the way they take time to make people’s lives as comfortable as possible.
It contributes to a “wonderful atmosphere” – in the words of the daughter of one patient – far removed from tiring and distressing acute hospital visits that may involve difficult journeys and spending time in crowded waiting rooms.
The service has yet to reach its full potential and faces a struggle to expand, says Katherine. But the team all do what they can, often in their own time. Katherine’s hours may be 8am-4pm Monday to Friday, but if a patient stays late, so does she.
As well as seeing patients referred by GPs, the consultants go out into the community with regular visits to care homes – a bit like doing a ward round – and people’s own homes, doing as much as possible to prevent hospital admissions.
Much of Katherine’s time is spent with patients who need regular rapid infusions (blood transfusions) to tackle iron deficiency anaemia. A blood transfusion can take six hours, and it’s nicer having the treatment here than in hospital.
“This is something she always does with such efficiency,” says the daughter of one patient. “She checks to make sure the blood is correctly ordered and that it arrives on time. After the tests on a Monday, Katherine phones us with the results and arranges the time for the Wednesday transfusion.
Patients and their families praise the time the team take to listen and explain, and how they’re always looking for ways to minimise inconvenience and discomfort. For instance, consultants use the opportunity of a patient having a regular transfusion to talk to them about any issues to save a separate clinic visit.
The consultants’ clinics are pretty much non-stop. They all cover core health issues for older people, and in addition each individual consultant has a specialist area – such as Parkinson’s disease – for which they have undertaken extra training and research.
For example, relatively recent arrival Dr Peter Hanna has a particularly interest in preventing falls (and subsequent hospital admissions), and is starting a new clinic to tackle contributing factors through simple measures, like reviewing medication that may cause a drop in blood pressure.
But trying to introduce a new clinic into an already well-used facility is tricky. It’s a “constant battle” for space in the unit, which the team share with rheumatology. “Ideally we would run the falls clinic in the morning, but there’s no room available then, so we’ll offer it in the afternoon, which means I’ll be managing two clinics on the same day without a break,” says Katherine.
What Katherine brings to the team is a massive range of experience in various settings from a 40-year nursing career. “What I’ve learned from all those different areas contributes to what I can do now.”
Having said that, after four years with the team, she finds care of the elderly so rewarding she wishes she’d specialised in it before. “It covers such a wide range of conditions. People who walk through the door can have pretty much anything wrong with them.”
Since joining she’s done lots of learning on the job and through her own research. Without cover or funding, formal training’s not really an option, but occasionally meeting colleagues across all aspects of elderly care at Royal College of Nursing conferences is extremely “enlightening”.
The best thing about the team is the “incredible” support they offer each other. They don’t see someone as just an older person, but as people who deserve the best quality of life they can achieve.
“They are so passionate about that, and have so much faith in me,” says Katherine. Consultants are always available to offer advice, and especially support to start something new, like managing the risk when they first began the iron infusions. They all learn from each other. There’s not enough time for the team to meet and discuss general issues, but they’re always emailing each other and speaking on their mobiles.
The ethos of the team revolves around links with the community and working in partnership with patients. No matter someone’s age or condition, Katherine and the team still make sure they understand what their BP is, for example, and what the figures mean. Consultants make themselves available to visit any care home residents staff are worried about.
This approach is just one reason the care of the elderly team are so appreciated by their patients.
It feels like nothing is too much trouble. Just knowing patients and their families, and remembering individual cases without having to refer to their notes, makes a difference. So does taking the time to explain everything clearly and openly.
Not surprisingly, it can be a challenge for Katherine and her colleagues to switch off. “We get too involved and it’s hard to stop.”
A lot of the team’s current work has evolved from the popular ‘virtual ward’ approach, with a multi-disciplinary team looking after a group of patients in the community, but which was phased out due to lack of resources.
The team would like more rapid access clinics so that older people in the community can get same-day appointments through their own GP, or at least have the chance to speak to a consultant.
The issues are lack of space and money, especially for more staff – and not enough time to do everything they would like. It’s a great model, but what they really need are additional nurses.
The ideal situation would be to have a dedicated medical day care unit for the elderly, with doctors, nurses, physio and other therapists, cardiology and respiratory specialists so that older patients can be seen by lots of people and services in the same place.
At the moment the team work closely with the rapid response service in the ward next door, and registrars and junior doctors on inpatient wards are always willing to help too.
The secrets of our success
- Be mutually supportive and learn from each other
- Hold a strong, shared view of the patient as an individual
- Be adaptable and accessible to meet patient needs
- Work in partnership with patients
- Maintain community links and use community insight to develop services
- Make the most of each team member’s experience and interests