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Introduction
The Chedworth Suite is a friendly 12-bed specialist unit providing day surgery services to the population of Cheltenham and the surrounding area. We care for men and women undergoing a variety of surgical procedures as day cases. The types of surgery undertaken include gynaecology, urology, vascular and general surgery. The procedures undertaken are incredibly varied, from hernia repairs, varicose vein surgery, circumcisions and fertility investigations, to minor procedures such as prostate biopsies and the removal of skin lesions. We also care for certain medical patients having liver and lung biopsies, infusions and desensitisation treatment such as bee and wasp allergies.
The unit is staffed by registered nurses who are supported by two nursing auxiliaries. Sister Christine Moon is the unit manager, and the lead nurse for surgery is Sister Lynn Robinson. Student Nurses are valued in the unit and care for patients under the guidance of a qualified nurse.
The unit is open from Monday to Friday, from 8.00am until 8.00pm. The unit is located at the back entrance of the hospital in the Centre Block. It is on the first floor below Prescott Ward.
What to Expect When you are Admitted to our Ward
On arrival to the Chedworth suite, please report to reception. The receptionist will take your name and let the nurses know you have arrived. You will be asked to have a seat in the waiting room until the nursing staff are ready to call you through. Day surgery patients for the morning lists will arrive in the unit at 8.00am, patients for the afternoon lists will arrive at 1.00pm.
Once you have been allocated a trolley, your 'named nurse' will come and introduce themselves and prepare you for theatre. This is the person responsible for your care, who you can ask questions of and who will support you through the day. If your named nurse goes off shift, they will introduce you to the nurse taking over responsibility for your care.
If you have not attended a pre-assessment clinic, the nurse will ask you some questions about your past medical history and take details of your next-of-kin and take details of the person collecting you after surgery. A name band will be put around your wrist so that all staff can identify you. A red allergy band will also be applied if you have any allergies. Any rings and piercings that cannot be removed will be covered by tape. Dentures must also be moved prior to surgery if you are having a general anaesthetic, if you are having a local anaesthetic you may keep your dentures in. You will be given a hospital gown to change in to, and shown where to leave your belongings and clothes.
Things you can do:
• Only bring medication if you need to take it while you are with us. If you have not been to pre-admission clinic-bring a list of your medication.
• Please leave all valuables at home including watches, jewellery, phones and wallets. Facilities are limited for security of these items.
• You will be sent fasting information in the letter asking you to attend for surgery. PLEASE follow this advice. If it is not clear then please phone the ward for advice as failure to fast may lead to a delay or cancellation of your surgery.
• Do bring in comfortable clothes to wear home, a dressing gown and slippers and some magazines or a book to keep you entertained.
• Ensure you have organised someone to pick you up following surgery, and stay with you overnight. We cannot discharge you home on your own following a general anaesthetic (where you go to sleep).
• Remove nail varnish and make-up prior to admission
Please be aware that the Trust is now a smoke free NHS. Smoking is not permitted in any building or within the grounds of any of our sites. Information and support is available to any patients who wish to stop smoking. Nicotine Replacement Therapy is available to help reduce your cravings during your stay.
Clinics
There is a purpose built colposcopy unit called the Landsdowne Suite where colposcopy, hysteroscopy and smear clinics are held, this is situated in Centre Block on the ground floor. The clinics are run by a Consultant or Nurse Specialist, aided by a registered nurse and nursing auxiliary. Occasionally we have student doctors or practice nurses coming to observe clinics. All patients will be told this on arrival, and their permission asked if students or observers wish to be present.
If you have any questions regarding these clinics, there is an advice line- Telephone 08454 22 2583
A message may be left on the voicemail and a nurse will phone you back.
Infusions
We undertake a maximum of two infusions daily. These include infliximab, cosmofer and venofer. The administration of these infusions is nurse led from admission to discharge.
Pre-Assessment Clinic
We run a nurse led pre-admission clinic to ensure a problem free admission and discharge for patients. The nurse can assess the suitability of patients to undergo day surgery. An assessment will be performed which will include past medical history, regular medication, home circumstances and next-of-kin details. We will also check your blood pressure and pulse, and measure your height and weight. This clinic is a good opportunity for patients to get to know staff and to familiarise themselves with the unit. Patients are also encouraged to ask any questions or express any concerns they have.
We can hopefully put your mind at rest and make your surgery day less worrying for you. At the end of your appointment you may be asked by the nurse to go and give a blood sample or ECG (heart trace) done. If you do need either of these done, you will be given clear instructions on when and where to go.
Allergy de-sensitisation
Allergy desensitisation is administered by specially trained nurses in the unit. They provide treatment for allergies such as bee and wasp stings, and grass and tree pollen. Treatment is given over 3 years which enables a good relationship to be built between the patient and the nurses in the unit.
Urology Treatments
Our Nurse Practitioner Louise Gittins provides bladder chemotherapy which includes BCG and Mitomycin C treatments, this takes place on a Tuesday afternoon.
Our Staff
A variety of people will be responsible for your care whilst in hospital. Some of the staff you may come in contact with while on Chedworth Suite are: -
General Surgeons
Sister: - Navy blue dress / tunic / trousers.
Staff Nurse: - Blue and white striped dress / tunic with red piping and navy trousers.
Nursing Auxiliaries: - Green striped dress / tunic and navy trousers.
Housekeepeing staff: - Pink and white stripped dress / tunic and trousers.
Domestics staff: - Pale green and white striped dress / tunic and trousers.
Yellow dress with blue tabard.
Consultant Ward Rounds / When will I see a Doctor?
The surgeon, one of their team of doctors, or specialist nurse will come round to see you before surgery. They will explain the procedure to you and ask you to sign a consent form. This is the form you sign to say you are happy to go ahead with the surgery. You may also have an arrow drawn on you to indicate where surgery is to be done. Gynaecological patients will see a doctor prior to discharge, other patients will not routinely see a doctor, but will be discharged by the day unit nurses. If the doctor wants to see you again, the nurses will ensure you are given a follow-up appointment in the correct out-patient clinic.
An anaesthetist will also see you before you go to theatre to make sure you are fit for your anaesthetic. They will also prescribe analgesia and anti-sickness medication if required.
We do understand that coming in to hospital can be a stressful time for both patients and their families. The unit is often busy and we see many patients on the unit in any one day. We believe, as nurses, that it is our role to support patients and their families, to respect their decisions, to keep them informed and act as their advocate while in hospital. If you are unhappy or concerned about any aspect of your care as a patient, or of a relative, please speak to a member of staff who should be able to answer your questions, keep you informed and reassure you.
Medicine Rounds
We do not have medicine rounds on the unit. You will be given pain relief if you require it after surgery. Although some discomfort may be experienced following surgery, our aim is to relieve any pain to a level that is acceptable to you. Please do not be afraid to say if you are in pain, it is our job to make you comfortable and help you recover quickly. Painkillers may also be prescribed for you to take home. It may be useful to purchase some painkillers and keep at home prior to your hospital admission.
Facilities
Facilities on the Ward include: -
One toilet in the day unit with wash basin
Two toilets in the waiting area, both with wash basins, one with walk-in shower.
Waiting room equipped with comfy recliner chairs, books and magazines.
Mealtimes and Catering
We do not serve food on the day unit. You will be offered hot and cold drinks and biscuits when you return to the unit after surgery. If your procedure means you will be on the unit most of the day, we can order a sandwich for you. Please be aware that we cannot offer visitors drinks; there are two restaurants in the hospital that provide facilities to visitors.
Visitors
Due to the nature of day surgery and limited space, patients are not in hospital for very long, we therefore do not encourage too many visitors into the unit. It is advisable for relatives/friends to leave the unit and come back when the patient is ready to be discharged. This gives the patient time to sleep and recover from their anaesthetic. The nurses will telephone you to arrange transport (if not already agreed). We ask that children are left at home where possible. If you do need to bring your children in when picking up a relative, you may be asked to wait in the waiting room with them so that other patients are not disturbed (we are very flexible with this).
How to Contact the Ward
You and your family will be informed of the best time to telephone for news following your surgery.
Telephone numbers: - 08454 22 3588 / 4005
Or Telephone Switchboard on 08454 22 2222 and ask for the Ward.
Going Home
Please be aware that we have different surgeons operating on the same day in different theatres. Patients come to the unit for a variety of procedures and other patients will be having different procedures to you. Therefore please do not worry if you see other patients going to theatre before you, or getting up and going home before you. This is quite normal.
Before you can go home, we will ensue you are comfortable and check your dressings. Most patients will also be required to walk out to the toilet and pass urine before discharge. This is entirely normal so do not worry if a nurse asks you to do so. We will then call the person collecting you to pick you up and give them details of where to park.
A nurse will give you pain killers for you to take home if needed, and tell you how often to take them. They will also give you discharge leaflets and instructions to follow at home. This will vary depending on the type of procedure you have had done. The nurse will be able to answer any questions you have, and give you the details of who to contact if you require further advice or information once home.
You may be asked to take a seat in the waiting room once you have been discharged. This is so we can prepare the unit for other patients coming in after you.
Cleanliness and Infections in Hospital
Infections in the day unit are rare because patients are not in hospital for a long period of time. Nurses also follow strict infection control policies which include hand washing, the use of alcohol gel and the wearing of gloves and aprons.
Visitors and relatives should not sit on patient trolleys and should wash their hands before coming into the unit.
If you have been in contact with chickenpox, measles or mumps within 3 weeks of your admittance to hospital, please inform a member of staff.
Hand washing. The most common means by which infection is transmitted is by hand, therefore handwashing is a very basic, yet vital infection control measure. Alcohol hand gel is kept at the entrance of the ward and at each bedside for all the visitors to use before and after visiting. For hygienic hand disinfection apply 3ml (3 shots) to physically clean hands for 30 seconds ensuring all areas are covered, until dry.
What is clostridium difficile? Also called c diff
It is a bacteria that normally lives in the intestine. Up to 5% of the population are thought to carry this without any problems. It is usually kept in check by other bacteria in the intestines, which are normally present in our gut.
What problems does clostridium difficile cause?
Some strains of c.diff produce toxins, these toxins (poisons) cause diarrhoea. It can only do this when the balance of the normal gut bacteria has been disturbed. This can happen when antibiotics are given for infections. This enables the c-diff bacteria to multiply and produce more toxins that damage the cells in the intestines causing diarrhoea.
How is it Diagnosed?
A sample of diarrhoea is sent to the microbiology lab within the hospital. The laboratory looks for c-diff the toxins produced by some strains of the bacteria
How can it be treated?
If it is possible the antibiotics that have contributed to the disease will be stopped. Sometimes other antibiotics will be given, which are effective against the c-diff bacteria
What should happen if someone has diarrheoa?
Whenever possible you will be moved into a side room, before the microbiology result of the diarrhoea specimen is known This is to help prevent the spread of this bacteria. Not all patients can be placed in side rooms. it will depend on the condition of the patient and the availability.
Personal hygiene must be very strict. Everyone must wash their hands with soap and water after going to the toilet and before eating. If diagnosed as c-diff you may be transferred to the Cohort Ward (6A). this is a 16 bedded infection control ward dedicated to the management of patients who have or are suspected to have c-diff.
What is MRSA?
The organism Staphylococcus aureus is found on many individuals skin and seems to cause no major problems. However if it gets inside the body, for instance under the skin or into the lungs, it can cause important infections such as boils or pneumonia. Individuals who carry this organism are usually totally healthy, have no problems whatever and are considered simply to be carriers of the organism.
The term MRSA or methicillin resistant Staphylococcus aureus is used to describe those examples of this organism that are resistant to commonly used antibiotics. Methicillin was an antibiotic used many years ago to treat patients with Staphylococcus aureus infections. It is now no longer used except as a means of identifying this particular type of antibiotic resistance.
Individuals can become carriers of MRSA in the same way that they can become a carrier of ordinary Staphylococcus aureus which is by physical contact with the organism. If the organism is on the skin then it can be passed around by physical contact. If the organism is in the nose or is associated with the lungs rather than the skin then it may be passed around by droplet spread from the mouth and nose. We can find out if and where Staphylococcus aureus is located on a patient by taking various samples, sending them to the laboratory and growing the organism. Tests done on any Staphylococcus aureus grown from such specimens can then decide how sensitive the organism is to antibiotics and if it is a methicillin resistant (MRSA) organism. These tests usually take 2-3 days.
Why bother with MRSA?
MRSA organisms are often associated with patients in hospitals but can also be found on patients not in a hospital. Usually it is not necessary to do anything about MRSA organisms. However if MRSA organisms are passed on to someone who is already ill, then a more serious infection may occur in that individual. When patients with MRSA are discovered in a hospital, the hospital will try to prevent it from passing around to other patients. This is known as infection control.
How do we prevent the spread of MRSA?
Measures to prevent the spread of organisms from one person to another are called isolation or infection control. The type of infection control or isolation required for any patient depends on the organism, where the organism is found on an individual and the patient.
The most important type of isolation required for MRSA is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.
What do visitors need to do?
Provided relatives and friends of patients with MRSA are healthy there is no restriction on visiting and it carries no risk. Visitors are not required to wear special clothing BUT we would ask you to help us prevent this organism spreading around our hospital by keeping the patients' door closed at all times and always washing your hands whenever you leave the room.
What about MRSA at home?
In patients who are otherwise well the organisms often disappear once the patient leaves the hospital. Sometimes they do not however, and this may mean that when a patient has to go back into hospital the isolation precautions need to be used again. Provided everyone at home is healthy special precautions are not required at home.
What can be done about MRSA?
In certain situations it may be a good idea to try to get rid of the organism from a patient and this can be done with various creams and shampoos or on occasions combinations of antibiotics taken by mouth or by injection depending on the health of the patient.