Ooh. Now, this is something I'm 'qualified' to comment on! I work in the NHS, on an elderly care ward. As a health care assistant I am close to the nub of the problem. I'm also relatively new to the NHS so see things perhaps more clearly than those who have worked there for aeons. Dear Gordon claims that targets have no bearing on infection rates for C Diff. However, I would beg to differ. We are told that the infection can be stopped in its tracks (from spreading) by good hygiene.
OK. What happens then, when bed managers are chasing government targets for 'patient throughput'? Each patient that leaves the ward leaves a bed that needs to be stripped, washed down thoroughly, including pillows, air dried, and remade, plus a locker, table, chair, nurse call buzzer and bed control unit - oh, and Tone's 'TV for every patient', also all needing to be cleaned. These all fall to the lot of the nurses on the ward (well, generally the HCAs) If the patient is in a side room that has to be thoroughly cleaned and curtains changed, which falls to the lot of the ward cleaner, as does cleaning the bed space area and changing the curtains in a bay on the main ward. Now all this has to be fitted in on top of normal daily routine work, but the bed managers want it done immediately, so they can move the next patient(s) in.
Fine, but how do the numbers work out? Early shift (heavy, when all patients need to be washed, most need help and several will need bedbaths) 6 untrained workers, 3 trained workers and 32 patients. 2 of the 3 trained will be busy with drugs rounds at 8am and 12noon, and Doctor's/consultants rounds in between times and paperwork, so now it's 7 staff to 32 patients. Could work, as long as no-one needs feeding at breakfast/lunch times, to go to Xray or other clinics, wants a bedpan or commode and staff don't have breaks, and certainly no patients are discharged from the ward - or die!
Late Shift: Not so heavy, hopefully washes have been completed by early staff, still numbers are down, reflecting the 'reduced' workload. 3 trained and 2, sometimes 3 untrained. However, this is the shift when the visitors are in and expect to see the nurses actively nursing the patients. They also want to ask questions of the nurses about their relative/friend. Clinics are still on so patients may need to be escorted off the ward to ray etc. (Ours are generally in a bed and need a nurse/HCA with them)There are drugs rounds, more paperwork and suppers to be distributed, then assisting the patients to bed - some of whom will need to be hoisted (2 person job) back into bed. It is also the shift when most discharges actually leave the ward, after the doctor's rounds in the morning and the ward cleaner will now have moved on to another one of her wards. Beds, lockers etc cannot be cleaned till patients have left, in case they get back onto a cleaned bed, likewise curtains cannot be changed, in case the patient being discharged touches them. Nor can side rooms or bed spaces be cleaned down by the cleaner until the occupants have left. Lastly the staff have to have their breaks!
Finally the night shift. Generally 3 trained, 2 untrained. Most of the patients will be in bed, but still need checking on, turning to prevent pressure sores, and bed changes for the incontinent ones. Thre is more time to catch up on tasks on this shift, but a lot of general routine tasks are scheduled for this shift. Filling and tidying linen trolleys; cleaning and replenishing the drinks trolleys; checking of drugs; deep cleaning commodes and a myriad of similar tasks. Of course, most of the patients are asleep, so it is not convenient or appropriate to try and work on the ward cleaning beds and bays. And again the staff have to fit their breaks in.
One can see from this how busy the staff are on the ward - and that's without answering the buzzers and phones. Yes we have a ward receptionist - but only for half a day. We try our utmost to give the patients the care they deserve, but as we are continually understaffed it is impossible to meet all the targets set us by politicians. Many visitors comment on this fact. They can see we are doing our very best, but we are facing an uphill struggle. Add to that the pressure to use less of everything to save money (most of which is then wasted employing someone to check whether we have met our targets - and they are usually employed on a higher salary than those who do the real work of the NHS - caring for patients). To top the mix off ask us to do MORE cleaning to prevent the spread of infection, whilst using FEWER supplies and with LESS staff, which equals LESS time. Last year most NHS trusts were obliged to cut back on staffing levels to prevent a massive overspend. of course the jobs that went were nurses and HCAs, not some of the increasing heavy bureaucratic layer that has been spawned AS A DIRECT RESULT OF THE GOVERNMENT'S OBSESSION WITH TARGETS (Brilliant tactic! NOT!!)
C Diff CAN be beaten, but not if the government insists on treating the NHS as it currently does. Targets should not be the over-riding factor in a patient's treatment. Money should be found and put where it is needed, paying for extra nursing and cleaning staff to ensure high standards of patient care and hygiene. Some of the bureacrats (perhaps 50% - most hospitals have more office staff than nursing staff) should be weeded out - the saving on their salaries would easily pay for more HCAs and cleaners. Patients need time to recover, and nurses and HCAs need time to aid a person to recover. People are not like packets of peas whizzing through a supermarket checkout. They are individuals and should be treated as such. It's fine to have a general target, but if it is not always met then the reasons why should be looked at closely. It will probably be a patient being human and taking longer to respond to treatment. As for C diff, well better hygiene will beat this -give nursing staff and cleaners the time and tools and they will do the job. However, visitors also need to ensure their hygiene is tip top. It is amazing how many people don't wash their hands after using the toilet - stand in any public loo (motorway services are good) and check it out
