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Introduction
The Endoscopy Unit is a friendly 8 bedded specialist unit providing a service to the population of Gloucestershire and beyond. The Endoscopy Unit at Cheltenham General Hospital can be found on the first floor of the centre block at the back of the hospital. We are essentially a day time unit and are open between 0730 hrs and 1930 hrs Monday to Friday but provide emergency out of hours cover as needed. We pride ourselves on providing a service that is timely, informative, efficient and friendly. Our aim is to provide the very highest standards of care to patients and relatives alike ensuring privacy and dignity are maintained at all times.
In the Endoscopy Unit we care for adult men and women both inpatients and outpatients undergoing a variety of Endoscopic procedures. The main types of procedures undertaken are: gastroscopy, sigmoidoscopy, colonoscopy, bronchoscopy, percutaneous endoscopic gastroscopy (PEG) insertion, PEG changes, oesophageal and colonical stenting and ERCP (endoscopic retrograde cholangio-pancreatography).
A pain clinic also runs twice a week on a Monday and Thursday Morning.
What to Expect When you are Admitted to our Ward
On arrival to the Endoscopy Unit please report to the reception desk. The receptionist will take your name and ask you to take a seat in the waiting room. You will be called through to an admission cubicle by a trained nurse who will go over the documentation that needs to completed prior to the test, ensure you know why you are here and what is going to happen during the procedure and afterwards. Your blood pressure, pulse rate, oxygen levels and respiratory rate will be checked. If you are a diabetic you will also have your blood sugar level checked before the procedure is carried out. You will have a chance to ask the trained nurse any questions you may have thought of. You will also be asked to sign a consent form to show that you are willing to go ahead with the test.
When you have been seen by the trained nurse and the paperwork completed you will be asked either to return to the waiting room or will be shown to the patient recovery area within the unit. This will depend on which procedure you are having done. Some procedures such as a sigmoidoscopy or a colonoscopy require patients to remove their clothes and change into a hospital gown. If you are having either of these procedures you may like to bring a pair of slippers and a dressing gown with you.
When you are bought through to the recovery area to change prior to your test we ask that your relatives/friends who have accompanied you wait in the designated waiting area. This is to maintain the privacy and dignity of the other patients within the unit who are in various states of undress and recovery post procedure.
Things you can do: -
• Please leave all valuables at home as facilities are limited for storage of these items. You may, however, wear watches and jewellery as these are not removed during Endoscopic procedures.
• Bring something with you to read. Although we endeavor to ensure that lists run to time there are occasions where procedures take longer than expected or emergency inpatients have to take priority. You will always be informed if this is the case.
• Ensure that you have organised for someone to pick you up if you are having a sedative and for someone to stay with you overnight. We cannot discharge you home on your own following sedation and if you have not arranged for someone to pick you up the doctor may refuse to carry out the procedure.
• Please removed all nail varnish prior to admission
• Your relatives may wait for you in the waiting room during your procedure but they are encouraged to return home if it is not too far away. When you have had your procedure done we will ring your relative/person collecting you and give them a definite time when you will be ready for discharge.
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.
Our Staff
Nursing Staff
The Endoscopy Unit is managed by the Senior Sister Jo Robbins. She is supported by Sister Michelle Bullock and Sister Hilary Dowling. The team further consists of 10 Registered nurses and 2 Endoscopy Healthcare Assistants. The unit is overseen and supported by the Lead Nurse Jane Evans. As Endoscopy is a specialised area we also have regular bank staff working in the unit to cover additional lists, study and annual leave.
You will see staff within the unit wearing different types of uniforms. Set out below is the Trust uniform guide for identification.
Sister: - Navy blue dress / tunic / trousers.
Staff Nurse: - Blue and white striped dress / tunic with white piping and navy trousers.
Male Staff Nurse: - White tunic with striped epaulets and navy trousers.
Nursing Auxiliaries: - Green striped dress / tunic and navy trousers.
Domestics staff: - Green tunic and navy trousers.
Due to the nature of the work carried out in the unit you will meet members of staff both medical and nursing wearing ‘theatre blues’. This consists of a pale blue tunic and trousers. All staff can be identified by their name badges.
Clerical Staff
There is an administrative team based in the unit and this is led by Heather Spurway the Waiting List Manager. The team will work very hard to ensure that you have an appointment date and time that is suitable for you. They will try to answer any queries you may have about your appointment and ensure you have the correct information and preparatory materials necessary.
Medical Staffing
Gastroenterology Consultants
• Dr Anthony Kerry
G.P Endoscopists
• Dr Chris Hutchinson
• Dr Tim Healy
Nurse Endoscopists
• Karen Holbook
• Alison Ward
For more information on the Consultants please click on their name.
Other members of staff who may be involved in your care are the specialist nurses, medical and surgical registrars, dieticians, nutrition nurses, GI physiology and x-ray staff.
When will I see a Doctor and what happens next?
You will meet the doctor prior to the investigation being carried out. The doctor will confirm with you the type of procedure that is planned and answer any last minute questions you may have. If you have not already signed a consent form you will be asked to do so. Your signature on this form gives your permission for the procedure to be performed. The completed consent form is an integral part of the overall procedure but this does not waive your right to have the procedure stopped at any time. After this you will be shown into the procedure room by one the Endoscopy nursing team.
Following the procedure
When you return to the recovery area after your endoscopy you will be allowed to rest for an appropriate period of time. Following this you will be given a hot/cold drink and a biscuit. When you are ready to leave the department a trained nurse will go over the report that is generated during your procedure and give you your discharge advice.
Facilities
The Endoscopy Unit has a reception area/waiting room. We ask that all relatives wait in the waiting room and do not come through to the Endoscopy unit once the admission process has been completed. This is due to limited space within the actual recovery area. There are two toilets in the waiting area including a disabled toilet. There is also a pay phone and some reading material. Relatives are encouraged to bring their own reading material with them though. Unfortunately, we do not have any facilities within the unit where relatives can purchase refreshments. However, there are several WRVS shops and a café situated within the hospital. Please ask staff for directions.
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
Or Telephone Switchboard on 08454 22 2222 and ask for the Ward.
Going Home
If you have not had sedation you will be informed of the result of your procedure and you may go home straight away.
If you have had some sedation and/or analgesia during the procedure you will require a responsible adult to come to the unit to accompany you home as explained in the information booklet which is sent to you with your appointment letter. Assuming you have given your permission at the time of admission, you and your relative will be informed of the result of your procedure. After this you may go home.
At the outset, it is very difficult to give a time for you to be collected following your procedure. We are very aware that the parking at Cheltenham General is limited and that relative’s get very anxious if they are worried about parking meters. We therefore recommend that on admission we take the telephone number of the person collecting you and call them after your procedure. This will allow the nurse to give the approximate time that you will be ready for discharge.
Cleanliness and Infections in Hospital
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.
We ask that visitors suffering from minor infections such as a cold avoid visiting if possible, for their sake as well as the patients. We do not recommend babies being brought in to visit, again for their own protection.
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.
If English is not your first language, and you may require the services of an interpreter, please let the ward know before your admission, if at all possible.
If you are hearing impaired and need to sign, we may also be able to provide someone to help with this.
Any Questions?
You will be advised on discharge if any follow up or further investigations are required. You will also be given a discharge information leaflet.
If you have any concerns at all during your stay with us or have any suggestions on how we can improve our service please do not hesitate to talk to one of the Endoscopy unit sisters or any other member of staff at the time of your visit.
