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Welcome to our Rehabilitation Service Information for patients, families and Carers Jade Ward Edgware Community Hospital Burnt Oak Broadway Edgware Middlesex HA8 0AD Marjory Warren Ward Finchley Memorial Hospital Granville Road North Finchley N12 0JE Version 3 1 Contents Your hospital Stay Who will deliver my rehabilitation programme? Your ticket home checklist On the ward When can I leave the hospital? What will I be given to take away with me? Once I have left the hospital What if? Your experience Notes Version 3 2 Our Rehabilitation Service We aim to provide a high quality individualised rehabilitation service which supports your wellbeing and independence whilst respecting your decisions and choices. Our team aim to work in partnership with you, your family and cares and to support you in reaching your optimal level of independence. We aim to provide a safe and effective service and an outstanding patient experience. Our MDT will focus on: Assessment Treatment Goal Setting and achievement Discharge Planning Your goals will be set prior to your admission to our unit and will form the basis of your rehabilitation programme. Version 3 3 Day-to-day rehabilitation service You will be allocated a key worker during your stay. A key worker is the person who will be primarily responsible for the organisation and planning of your rehabilitation stay and who will be your main point of contact for co-ordinating meetings and discharge planning. You will be provided with a timetable. This timetable is individualised to meet your needs and will detail the times which therapists will come to see you. It will also reflect any group activities or recommended meetings. If you wish to have a quiet time added to your timetable you can advise your key worker of this. Your therapy session may take place in a variety of settings including: therapy gym, bathroom, unit dining room, your home, upon arrangement. During your time at the unit, MDT members may recommend referrals to other specialist community teams to ensure your full rehabilitation needs are met. Version 3 4 Your hospital Stay What do I need during my hospital stay? Before coming to the ward, please ask a family member, friend or carer to bring the following to hospital: Comfortable loose-fitting clothes as day wear Any medicines that you are taking, including inhalers, your steroid card and warfarin book (if you have these) Well-fitting footwear and a spare set of clothes Toiletries including a set of night clothes Glasses, dentures and hearing aids with batteries, any walking aids you may use at home We actively encourage all patients to be dressed in their day clothes during the day. If you require assistance with any of the above please seek assistance from your current ward. Version 3 5 Please do not to bring: Any jewellery, valuables or large amounts of money Large bags or suitcases The Central London Community Healthcare Trust will not accept responsibility or liability for any loss or damage to a patient’s property under any circumstances, unless it has been handed in and signed for by a member of hospital staff. Visiting Times: Regular visiting is encouraged between the hours of 2pm to 8pm. We ask that visitors are mindful of other patient’s privacy and of noise levels to ensure other patients are not disturbed. If you are unable to attend during these hours please discuss with the nurse in charge. Version 3 6 Your ticket home checklist A ward nurse or your key worker will help you complete this form: What is my expected date of discharge (EDD) ______________________________ Question Yes No A family member/friend or carer will be able to support me (if needed when I leave hospital? Did I bring in any of my own medications in with me and do I need to take them home? Do I have the contact numbers for the services arranged and do I know when to expect to be visited? Do I have my house keys or know my Key safe code? If not who has my house keys Have I got everything in place for me to return home? If not what do I need to do? Do I need someone to prepare my home for me if appropriate (food, heating etc.) Version 3 7 Has the medication that I am taking home with me been explained to me? What additional service(s) will I be provided with? Please Contact details (eg tick telephone number or email) District nurse Home care service Intermediate care Enablement Other Version 3 8 Who will deliver my rehabilitation programme? Your rehabilitation programme will be delivered by many members of the multi-professional team, for example, your exercise programme will be prescribed by a physiotherapist, but the exercises may be performed by a Rehabilitation Support Worker or the nursing staff. Our rehabilitation team encourage you to be as independent as possible and will assist you to do as much as you can for yourself. We encourage your family members or carers to be involved in your rehabilitation. This may be by helping you with your exercises while they visit you, for example. Version 3 9 On the ward: Mealtimes on our wards are generally served as follows: Breakfast lunch dinner 8-9 am 12-1pm 5:30-6.30pm If your diet is restricted for medical reasons or you have any dietary requirements, please discuss this with your nurses. We have a number of support services available, including a multi-faith room for prayer or quiet reflection If you, your family member or carer wish to speak to the doctor, please ask your nurse and they will arrange this for you. Free Wi-Fi is available on all our wards and units, please ask your nurse for further information You can use your mobile phone on the ward, but please be mindful as loud music or conversations can disturb other patients within your area. Some wards have a volunteer trolley service which has basic supplies available for purchase ie some toiletries or some have a local pharmacy on site We run a library service from the wards please ask staff for details Version 3 10 There are coffee shops available at Edgware and Finchley for your visitors to get beverages When can I leave the hospital? A member of staff (Your keyworker) will usually give you an approximate date for when you will be able to leave the hospital (also known as an expected discharge date) within 24 hours of your arrival on the ward. Your keyworker will keep you informed of plans and any changes relating to your discharge and they may organise a ‘family meeting’ with you to discuss and agree future plans in more detail Please note that our length of stay for general rehabilitation is 2-3 weeks from admission. We aim for you to be discharged from the ward as soon as you are ready. This is so that you can retain your independence and mobility whilst also being protected from hospital acquired infections. You will usually expect to be home for lunch on your day of discharge. We encourage your friends or relatives to arrange transport but we can also organise this if needed. Version 3 11 We are here to help and will work with you to ensure the necessary arrangements are in place. What will I be given to take away with me? Discharge Summary Letter This is a letter giving the details of your hospital treatment and the medicines that you need. A copy of this will also be sent to your GP. Keep it safe and show it to those involved in your care. Medicines: If necessary, we will provide a supply of medicines for up to 14 days only. The pharmacist or nurses on the ward will explain any instructions that you need to follow Further prescriptions should be obtained from your GP. Equipment: You may be given equipment to take and use at home, e.g. walking aids. We may also need to arrange for some equipment to be delivered to your house before you are discharged, someone will need to be present in your home to receive these goods. Please liaise with your family or carers to arrange this. Supplies: A short-term supply of things you will need at home will be provided, e.g. stoma or catheter products, Version 3 12 syringes, dressings. Further supply of these should be obtained through your GP. On the day of leaving hospital If you are returning home Before you leave, make sure you: Arrange your transport home – if you require a taxi, please speak to a member of staff, as hospital transport is only available for eligible patients. Have your discharge letter and medicines, and understand how to take them. Check if you need a follow-up appointment. Ensure that you have your house keys. Take all your belongings with you when you leave the hospital Ensure that you have asked your family members, carer or neighbour to get some basic food provision so that you can have a snack or make a cup of tea or coffee. Version 3 13 If you are unable to go home The ward team and your key worker will discuss your care requirements with you and will consider available options, which may include: Care packages (long-term) Placement in a care home Transfer to another care facility A temporary care package or placement If you require a care home or nursing home placement you will be provided with a choice of one home if you choose not to take this you will have the opportunity for a second option, it is not be possible to wait in hospital once you no longer need hospital care.
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