Monthly archives: December 2019

Heartbeat: The race against antibiotic resistance – are you a guardian?

Antibiotics are lifesaving medicines which have revolutionised the practice of medicine and contributed to the increases seen in life expectancy over the last century. However, despite antibiotics being so vital to human health, there have been no new antibiotics developed by the pharmaceutical industry for over 30 years.

Alongside the lack of new antibiotics, resistance is increasing to the current array of antibiotics so there is a desperate need to use them more appropriately. To raise awareness antibiotic use, this month we took part in Antibiotic Awareness Week with colleagues setting up stalls at both Sandwell and City Hospitals to remind colleagues of their duty in managing antibiotic use.

To find out more about Antibiotic Guardianship, Heartbeat spoke to Conor Jamieson, Pharmacy Team Leader – Antimicrobial Therapy, he said: “Antibiotic resistance is one of the biggest threats facing us today and the overuse or misuse of antibiotics is making the problem worse. Without effective antibiotics, many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, transplants, even chemotherapy all rely on access to antibiotics that work. To slow resistance we need to cut the use of unnecessary antibiotics.

“The key points to remember are that antibiotics are not harmless; they are medicines in their own right and can have serious side effects, as well as important drug interactions. Inappropriate use of antibiotics may cause patients to become colonised or infected with resistant bacteria.”

Research published in The Lancet in 2018 shows that 33,300 patients die each year due to antibiotic-resistant infections in Europe. If we don’t change how we prescribe and use antibiotics, by 2050 there will be an extra 10 million deaths each year worldwide due to resistant infections, with an associated economic cost of £66 trillion.

All medical, nursing and pharmacy colleagues can play their part in antibiotic stewardship, ensuring that every prescription for antibiotics has the indication, duration or a review date documented. Antibiotics should be reviewed regularly to make sure they are still needed. We need to change the focus from ‘Is it safe to stop antibiotics?’ to ‘Is it safe to continue antibiotics?’

Always check a patient’s drug allergy status before prescribing or administering any antibiotics. Always check for drug interactions before prescribing them. Make sure the dose is appropriate for their weight and renal function. You can report adverse reactions to medicines via the Yellow Card Scheme.

So what can individuals do to help tackle antibiotic resistance? It might seem to be an overwhelming problem, like climate change, that individuals are powerless to do anything about, but that is not the case. Simple actions can help protect you, your family and loved ones – don’t ask your GP for antibiotics for a cold, flu or sore throat, they don’t work against viruses, and avoiding taking antibiotics when they aren’t needed is a great way to avoid the side effects they cause; antibiotics can alter the balance of bacteria in the gut and can have longer-term health implications that we are only beginning to realise. Ensure you and your loved ones are up to date with their vaccines. Practice good hand hygiene.

Sign up to become an Antibiotic Guardian – Antibiotic Guardian is a campaign run by Public Health England and a range of partners. Health professionals, patients, health leaders and those who work with, own or treat animals are being encouraged to visit www.antibioticguardian.com and choose a pledge that they can fulfil and play their part in protecting some of our most precious medicines.

Countdown to 2020

With only one more sleep until the New Year, we are all focussed on getting our patients who are medically well home to enjoy some time with their friends and family. We all do a great job discharging patients over this time of year and this year we need to do even better if we are to have the beds available and safely staffed for those patients who will need to be admitted.

Every day we need to get a few more discharges out of our acute sites: Six more every day at Sandwell and three more every day at City. Our community teams are also working hard to make sure that they can help patients get home.

If you have a problem discharging a patient who is medically fit please escalate this to the ward management team in-hours and the duty CNP out of hours. There are a number of schemes in place to help avoid admission and support you to discharge patients home.

• Does your patient need a specialty review? Could they go home but be seen by the right consultant tomorrow? If so then book them into one of our hot clinics. You can do this by calling ext 4112. The phone line is staffed 24/7.
• Think Glucose assessments are now being done earlier in the day. But could your patient have this tomorrow as an outpatient? If so they can be discharged and you can book the Think Glucose assessment by calling ext 4112.
• If your patient needs a transport crew of four to move them safely then we have extra staff on in transport to help. Remember to book your transport in advance and as early as possible.
• Are you having difficulty discharging your patient on Capman? Contact your super user who will be able to help.

Over the last 24 hours colleagues in ED used the 4112 hot line to get outpatient appointments to a number of specialty clinics, see below the numbers and specialities already using this facility:

Is something getting in the way of discharging your medically fit patient? Please ensure you escalate this to your ward leaders in hours and the duty CNP out of hours.

Adult safeguarding Level 3 training

We’re hosting adult safeguarding level 3 training aimed at clinical band 8As and above at Sandwell Education Centre.

Note: Other clinical colleagues at the Trust are also welcome to attend.

Sessions can be booked through ESR. For more information please contact call ext. 2751 or email r.begum19@nhs.net.

Equipment checklists distributed to clinical areas

The deteriorating patient and resuscitation team has now distributed the 2020 emergency equipment checklists to all clinical areas across the Trust. Trolley audits will be measured with the 2020 checklist meaning emergency equipment must be stocked ready for use at all times and checked daily.

Note: Area managers should ensure that the emergency equipment trolley is equipped accordingly.

For more information, please contact elizabeth.bennett9@nhs.net.

Drug shortage notice: Adcal D3 caplets

There is a current shortage of Adcal D3 caplets (750mg/5microg) with no likely date of re-supply available at the present time.

Adcal D3 chewable tablets (1.5g/10microg) are available as an alternative. Please be aware of the differing strength –  1 chewable tablet = 2 caplets. The usual treatment dose of Adcal D3 chewable tablets (1.5g/10microg)  is 1 tablet twice daily.

Prescriptions for Adcal D3 caplets (750mg/5microg) will therefore need to be changed to chewable tablets.

Note: When searching for Adcal on Unity, the chewable tablets (1.5g/10microg) can be found by entering ‘Adcal’ in the search box and clicking on the Advanced Search icon.

For more information please contact the pharmacy department on ext. 5259.

Body tone classes at City

Starting Tuesday 14 January, we will be offering body toning classes at City Hospital Gym Ellis House, 5pm – 6pm.

The class offers effective and fun exercises that will keep you fit and your motivation high. The exercises aim to give your body an all over workout and welcome all levels of fitness. They’re a combination of cardio resistance and core exercises.

Would you like to join one of our Trust gyms?

We’re hosting gym induction days at our newly refurbished City Hospital gym (behind ED) and our Sandwell gym in Trinity House:

• City gym – Thursday 16 January, Tuesday 11 February and Thursday 27 February, 11am, 12pm, 1pm, 3pm, 4pm and 5pm
• Sandwell gym – Tuesday 21 January 11am, 12pm and 1pm

The gyms will be open 24 hours a day, 7 days week and are free for colleagues, however before you go are able to use the facilities you must have an induction.

If you’re interested in signing up, please complete the following forms:

• Gym Membership Application Form
• Gym Disclaimers
• Sandwell_Gym_Induction_PARQ1

Upon completion forward the application to jatinder.sekhon@nhs.net or post to occupational health and wellbeing service. If you have any questions, contact the occupational health and wellbeing team on 0121 507 3306 option 4.

Safety tips for travelling to and from work in the dark

As the evenings draw in, colleagues find themselves travelling to and from work in the dark. To help you stay safe here is a list of recommendations on what to do.

Ensure you lock your car – Wind up your windows and lock your car as you leave.

Walk with a friend/colleague – Find a friend/colleague who will be taking a similar route. If you are parked on our sites and finish work in the early hours of the morning, you can contact our security team who will be happy to escort you to your car. If security colleagues are tied up with other matters they may be able to instead offer to monitor you on CCTV if you feel that would provide you with additional safety.

Charge your phone – Make sure your phone is fully charged before setting out so that it’ll be working should you need it.

Plan your route – Try to stick to well-lit areas where you know it is likely that there will be people around.

Be alert at all times – Avoid wearing headphones and items of clothing that obscure your vision. When travelling along a road it is safer to walk in the direction of oncoming traffic, so you are visible to drivers.

Keep expensive items hidden – Keep expensive items such as mobile phones and iPods away from sight.

Carry a deterrent – Having a deterrent such as a screech alarm or personal safety device can give you extra peace of mind.

Remember to keep where you work secure – Before you leave work, close the windows to prevent any intruders breaking and entering.

If you do encounter any issues call the police. If you are on our sites then call the security team on 2222.

Reduced opening times at education centres during the festive period

There will be reduced opening periods at Sandwell Education Centre and the Postgraduate Centre at City Hospital during the festive period. Please see below for details.

Sandwell Education Centre

• Monday 30 December – 8am – 4pm
• Tuesday 31 December – 8am – 4pm
• Wednesday 1 January – closed

Postgraduate Centre, City

• Monday 30 December – Wednesday 1 January – closed

Do you have concerns regarding human trafficking or modern slavery?

If any concerns arise regarding human trafficking or modern slavery please contact the safeguarding team as soon as possible on ext. 2612.

If you’re trying to reach the safeguarding team out of hours, do not disregard the concern. Instead please contact the local authorities or Salvation Army. If you believe the case is more urgent, contact the police. Please see contact numbers listed below:

• Sandwell local authorities: 0121 569 2266 or 0121 569 2355
• Birmingham local authority: 0121 675 4806
• Salvation Army: 020 7367 4500

Chief Executive’s Message – Friday 27 December

Thank you to everyone who has worked through Christmas, into this weekend, and towards New Year. I am especially grateful for anyone who has stayed on or cross covered for sickness which continues to be above 5 per cent and is very, very high in a small number of areas. When the Trust Board next meets (at Rowley Regis on Thursday) I know that the focus will be on the 700 vaccinations we need to complete to reach herd immunity from flu. At the same time, I know going into 2020 that our staffing position is improving, because I can see the new starter numbers, the number of students accepting offers, and the progress being made with nursing associates. It is really encouraging to hear of longstanding colleagues working at band 2 level in our Trust who can now see a quick route to the skills needed as a band 3, and a career path to registration if that is what they choose. At the same time we are investing in the mental health skills and training of all our ward-based HCAs as we look to make sure we can match the acuity and complexity of the admitted population we now serve.

It is really important that in the year ahead we work to support and sustain everyone in our workforce. Our retention plans will look again at how we support flexibility in retirement and our pension seminars will be advertised in January, taking in evolving guidance about tax rates and arrangements.

That emphasis on you is why we are wanting to tackle violence against employees using evidence based interventions. Body cameras will become an increasing part of some parts of our workforce and workplaces. The evidence seems to show both a calming effect and a confidence building one. Elderly care wards, maternity and our community wards are, I understand from the staff-led working group, going first before Easter with this programme. Of course protective measures are not a substitute for decency and the right values, and so we will make sure that our Mutual Respect and Tolerance guidance is reissued, and that a central register of ‘red carded’ visitors and patients is maintained.

Next year does see the launch of our next phase Public Health programme on eating well, being well, and physical exercise in the workplace. We started consulting on this in June 2019 so it has had plenty of chance to germinate and take on board everyone’s ideas. You saw the planned investment in outdoor exercise equipment in our grounds and gardens consultation in November, and our indoor gyms are now both open and free. Vegan options are more commonplace in our outlets now, and I sense that Slimming World has been a really effective addition to our menu of options. Catering have done a frankly brilliant job the last year increasing their services, and new outlets are planned for ED and for BMEC in the year ahead. Certainly by the time the February Heartbeat is issued I hope that it is really clear how we will be supporting wellbeing at work, and the kind of activities that we will endorse within paid work time. The Trust is wholly committed to trying to support each of us to be our best self at work, and just as we have changed mind-sets about what is normal for the NHS with our #smokefree programme, we believe that there are things we can do differently to tackle obesity, to address exhaustion, and to help all of us to give our best at home and at work.

Perhaps inevitably after an election, local announcements are competing with national ones for air-time. The big picture remains the need for a strategy for long term care and social services. That matters to us as communities age, Continuing Healthcare Costs rise by 10%+ per annum, and we work hand in hand with local care home providers. We have had some recent publicity about car parks and parking charges, and will implement guidance from April when that guidance arrives. In the meantime you know that we are investing in car parks, and that we have a balanced system of on-site and off-site parking, as well as our car share app, and other public transport subsidised options. Given in particular the parking pressures at Sandwell, we will look again at the shuttle bus timings and scale to see what more we can do to support inter-site travel.

Policy, newsworthy as it is, is never a substitute for local quality improvement work. We will end 2019 with a whole list of teams rated Gold or Silver for their Quality Improvement Half Day work, and over 70 entries in this year’s poster contest (there will be another poster contest in 2020!). I wanted to congratulate those teams and publish here a roll call of honour for their efforts. It will be taking time within teams to plan improvements that will make the greatest difference of all to both workforce and patient wellbeing and service quality. Well done!

• Children’s therapy (Gold)
• Rapid response and medicine therapy team
• Stroke
• Rheumatology
• General surgery
• Care of the elderly
• Obstetrics and gynaecology
• Health visiting
• Foot health
• Intermediate care therapy team
• Gastroenterology
• Orthoptics/Opthalmic technical team
• Newborn hearing services
• Urology
• Palliative Care

On 1 January I will circulate a brief message about our priorities in the year ahead. With the implementation of Unity and the steps forward with Midland Met, but also our first GP practices and the return of school health nursing to the Trust in 2019, it feels increasingly as if the strategy we have had since 2014 is beginning to become embedded. Of course getting the Care Quality Commission to see the value of what you do, and of what we do together, is really important in the year ahead. There is no good reason we cannot be rated Good, not just in maternity or community inpatients, outpatients or surgery, but across the whole Trust. Ensuring we hit those standards in 2020 is the focus of my latest Heartbeat article which tries to explain why I think that would help us to do what we do even better.

#hellomynameisToby