Clinical Investigation Unit

CLINICAL INVESTIGATION UNIT

STUDENT ORIENTATION PACK WELCOME TO THE CLINICAL INVESTIGATION UNIT/SHORT STAY MEDICINE

Welcome to the Clinical Investigation Unit and Short Stay Ward in Ninewells Hospital. This pack is designed to enable you to settle into our unit. We hope it is helpful.

HISTORY

This unit was opened in February 1997.

Its purpose was to allow all non urgent medical investigations to go ahead.

This now means that medical beds should be available for acute medical care.

Before the unit opened some of these non-urgent investigations had to be postponed due to bed

Shortages as emergency admissions naturally took precedence

THE UNIT

The unit has 20 beds, made up of 5 bays with 4 beds in each bay with 4 recliner chairs and 2 trolleys in bay 6.

We function as CIU with 8 beds, 4 chairs and 2 trolleys over 5 days and 12 Short Stay Medical

patients 24/7

We are open over the weekend with 12 patients and staffed accordingly.

There is 1 treatment rooms available for patients who do not require a bed, this room is also used by medical staff

Patients are admitted from waiting lists, clinics, fast track and post take from AMU ORIENTATION CHECKLIST

1. Introduction to other members of Ward Team and identify other members of the multidisciplinary team.

2. Tour of the Unit to locate:

1. Nurse call system, light and radio/TV function 2. Emergency buzzers 3. Cardiac arrest trolley 4. Fire evacuation route 5. Fire extinguishers 6. Fire alarm 7. Fire blanket 8. Clean utility room 9. Disposal room 10. Kitchen 11. Secretaries office 12. Safe storage personal belongings 13. Location of a) Policy manuals b) Ward protocols c) NMC documents d) Patient information 14. Allocation of valves oxygen/air 15. Bottom door locked at all times for staff/patient security. 3. Discuss Ward Philosophy

4. Set date for discussion of objectives

Signature of Mentor

Signature student nurse: Date Completed:

FIRE PROCEDURE  Recognise/interpret fire alarm(Code 5 and code 10)  Discuss role of nurse during fire alarm  Evacuation point

Signature student nurse: Date Completed:

CARDIAC ARREST PROCEDURE  Identify/locate equipment, oxygen, suction, emergency trolley  Discuss role/procedure to be followed

Signature student nurse: Date Completed: THE NURSING STAFF

The Senior Nurse is Hazel Mudie.

Registered Nurses are named nurses after completing core objectives.

You will be allocated two preceptors.

The role of the preceptor is broken down into 3 main components

1) ORIENTATION

2) SUPPORT/GUIDANCE -Through the experience of the preceptor you will be given support and education.

3) OBJECTIVE SETTING / APPRAISAL - The preceptor should facilitate the setting and achieving of both core and specific objectives. Teaching by the preceptor is important but you will be encouraged to decide on your own personal.

Mentorship is a partnership to allow a good and productive working relationship between both preceptor and colleague

YOUR MENTORS ARE:……………………………….…………………………………..

SETTING OBJECTIVES During your placement in the Clinical Investigation Unit you will spend the first week being orientated to the unit. This will involve meeting the nursing team, working through the orientation pack checklist and becoming familiar with admission and other relevant documents used within the Unit.

2nd Year Students You will work with your mentor to decide upon some realistic objectives, relevant to your stage of training, i.e. improving communication skills, beginning to accept responsibilities and gaining a greater understanding of commonly performed investigations.

3rd Year Students You will be encouraged to set your objectives and your mentor will supervise you with your own caseload of patients and help you to meet your objectives. There will be emphasis placed on achieving managerial experience during this placement which will involve time management, Prioritising needs, passing on of information, working within a multidisciplinary setting and a holistic approach to patient care.

Your mentor will meet with you on the Friday of each week and spend time discussing your achievements for that particular week and your needs for the following. You will then make a plan for the following week and document it on the relevant planner, which will ensure that the rest of the team within in the unit is aware of what you are doing and can assist in accommodating your needs. MANUAL HANDLING ABILITIES  Discuss knowledge of safe manual handling, read manual handling policy.  Discuss/demonstrate equipment in Unit  Use equipment.

Signature student nurse: Date: HEALTH AND SAFETY  Read health and safety policy  Ensure aware where all health and safety information kept/unit workplan.  Reporting hazards  What to do in event of accident to patient, staff or visitor.  Completing IR1 Forms competently  Ensuring safe environment for patients, staff and visitors.  Safe food handling, use of food trolley.

Signature student nurse: Date: INFECTION CONTROL  Identify Infection Control Policy and Infection Control Training(ICTAP in computer)  Discuss and read hand washing, linen disposal, waste disposal policies  Management of MRSA  Unit cleanliness  Cross infection  Use of gloves and aprons  Hand hygiene audits  Commode audits  Responsibility toilet checks each shift

Signature student nurse: Date: NURSING DOCUMENTATION  Discuss location of documentation  Discuss confidentiality aspects  Discuss documentation content and layout  Perform admission assessment( CIU and General)  Aware discharge policy and folder location  Discharge patient  Integrated Care Pathways(Bronchoscopy and endoscopy procedures)  Dependency score  Waterlow assessment  Falls risk/manual handling risk assessment  Care plans  Drug kardex(TPAR)  Diabetes chart  Anticoagulation chart  TPR/ SEWS chart  Fluid balance chart  Continuous infusion chart  MUST Assessments  Traffic Lights assessments

Signature of student: Date:

THE NURSING STAFF ARE:

CN Fiona Kennedy CN Amanda Petrie SSN Vikki Murray (on maternity leave) SSN William Fry SSN Jeni Graham SN Kirsty Bruce SN Catriona Davidson (on maternity leave) SN Aisling Moran SN Lacey McKenna SN Catherine Meldrum SN Helen Nelson SN Suzanne Moir SN Fiona McCluskey SN Lesley MacDonald SN Lori Clark SN Laura Hay SN Ashleigh McFarlane SN Kirsty Bruce SN Emma Curry (on maternity leave) EN Janet Bell SN Suzy Ferguson SN Lynsey Harris SN Alison Campbell SN Natasha Davis

HEALTH CARE ASSISTANTS

Band 2 Pamela Johnson Margaret Clark Sharleen Lawson Sheila Welsh Carly Petrie ( on maternity leave ) Arlene Leahy Moira Lynch Kirsty Lobban Pamela Armit

Band 3 Christine Smith Blair Small

WARD ASSISTANTS Sheila McCabe Gillian Borthwick

THE MEDICAL STAFF Each patient is admitted under a medical consultant whose team will be responsible for the medical decisions for the patient, FY1 from individual wards to do medical duties required. We have our own FY2 for Short Stay Medical Patients

THE SECRETARIES Kathryn Soutar

PHILOSOPHY The Clinical Investigations Unit is a unique development, where as a team we reflect on our values and beliefs.

Our purpose is to create a relaxed and caring environment. We strive to reduce fears and anxieties by providing support and information therefore promoting informed choice.

As a team we believe in respecting individual’s rights and the decisions they make. As partners in care we aim to mutually identify and assess individual needs, which will allow us to deliver high quality patient centred care, which is evidence, based.

Our goal is to encourage a comfortable and friendly atmosphere. Collectively we aim to provide specific information through Named Nursing and reflective practice.

Statement of Values in Relation to the Education of Students. We encourage students to ask questions and will always try to answer them. We however expect students to assist with their own learning by developing a questioning approach. We look forward to hearing your views and suggestions about how we can improve the learning experience within Clinical Investigations Unit for our students.

We will- Treat all students with respect as they will our team. Treat students as individuals acknowledging their needs and encourage participation in formulating care management plans. Encourage students to feel part of the team by involving them in assisting and directing healthcare professionals in providing patient care. Recognise and value the contribution of all students in the process of planning and carrying out patient care, assist them to achieve/maintain knowledge and skills in order to provide safe and effective care. LIST OF COMMONLY PERFORMED TESTS/INVESTIGATIONS RENAL

Renal biopsy A tissue sample of the kidney is taken under local anaesthetic and sent for analysis.

GFR “Glomerular filtration rate”, calculated following an injection of radiopaque dye and the collection of blood samples at set times.

Renal angiogram A catheter is inserted through an incision in the groin and fed through the main artery to the kidney where dye is injected, the blood supply to the kidney then becomes apparent under x-ray conditions.

RESPIRATORY

Bronchoscopy a bronchoscope is passed via the nose or the throat into the lungs and into the bronchi for examination. Biopsies, brushings and lavages can be performed during this procedure.

PDT “Photo dynamic Therapy”, a laser treatment used via the Bronchoscope to reduce the size of a tumour. Patients must not be exposed to sunlight during treatment.

Lung Biopsy a small part of lung removed under ultra sound scan.

CARDIOLOGY Angioplasty A catheter is inserted through an incision in the groin or wrist as for cardiac cath below, once narrowing’s identified they are stretched with a balloon and a metal mesh scaffold (stent) is embedded in the vessel wall.

Cardiac Cath “Cardiac Catheterisation”, also called coronary angiogram. A catheter is inserted through an incision in the groin or wrist and fed through the main artery to the heart. A radiopaque dye is then injected into the blood supply which makes the blood supply to the heart muscle apparent under x-ray conditions.

Cardioversion an electrical countershock to restore a normal “sinus” rhythm. Carried out under general anaesthetic.

TOE “Trans-oesophageal echocardiogram”. A camera is passed down through the oesophagus to behind the heart where an echo probe picks up sound waves to produce a picture of the heart and valves

Pacemaker Insertion Performed under local anaesthetic. One or two wires are inserted into the chambers of the heart through the sub clavian vein. The wires are attached to the pacemaker box, which lies under the skin On the front of the chest, just below the collar bone ENDOCRINE

On Tuesday mornings we carry out various endocrine blood tests. These tests take from 1-4 hours and include

SST Short synacthen test TRH thyrotropin releasing hormone LHRH leutinising hormone releasing hormone ITT insulin tolerance test GTT glucose tolerance test CPFT’s complete pituitary function tests – which include: TRH, LHRH, ITT

GASTRO-INTESTINAL

OGD “Oesophageal gastroduodenoscopy”. Also called gastroscopy.this is an endoscopic examination of the upper alimentary tract.

Colonoscopy This is the use of a fibreoptic colonoscope to view the colon

Flexible Sigmoidoscopy This is the use of an instrument to view the rectum and sigmoid flexure of the colon

ERCP “Endoscopic retrograde cholangiopancreatography”. The introduction of a contrast medium via an endoscope into the pancreatic and bile ducts – During the procedure stones can be removed, sphincterotomies can be done, or stents can be inserted.

PEG “Percutaneous endoscopic gastrostomy”. A surgically established opening between the stomach and abdominal wall for artificial feeding.

Liver Biopsy a small part liver removed under ultrasonic scan.

Barium Enema X Ray examination of the large bowel. Barium is passed through a tube in the rectum then films will be taken.

Oesophageal Dilatation same as OGD, then small balloon within endoscope is inflated to Stretch oesophagus. (Bougie may be used)

Oesophageal Banding same as OGD, then bands attached to varicies if required.

Oesophageal Stent same as OGD, then stent inserted via endoscope at identified stricture

SBAR For good communication about patients between all health professional use the SBAR tool.

Before call: 1) Assess the patient 2) Know the admitting diagnosis 3) Read the most recent progress notes and the assessment from the prior shift 4) Have appropriate documents available, eg nursing and medical records, SEWS chart, drug Kardex, allergies, iv fluids and resusication status.

Situation State your name and unit I am calling about Patients name The reason I am calling is:

Background State the admission diagnosis and date of admission Relevant medical history A brief summary of the treatment to date

Assessment State your assessment of the patient Eg vital signs, SEWS score, mental score etc

Recommendation I would like (state what you would like to see done) Determine timescales Is there anything else I could do? Record name and contact number of person you are speaking to.

DON’T FORGET TO DOCUMENT THE CALL IN THE NURSING NOTES

This is a working example

You are calling hospital at night. Situation Hi this is nurse brown from CIU I am calling about Mrs Patient, give DOB and CHI The lady has a temperature of 39 degrees

Background This lady came in 3 days ago with a chest infection. She is an Insulin dependent diabetic. So far she has been stable since admission, she is on 24 % oxygen As required

Assessment She has a sews of 4, a temperature of 39 degrees and pulse of 113 bpm.

Recommendation I would like you to review this lady, within the next hour. Can I give her 1 gram of paracetamol Is there anything else you would like me to do for this lady?

H Mudie SnN and work colleagues CIU Feb ’02 Updated February 2015