Unlocking flow and improving our staff and patient experience

Earlier this week you will have seen a message about how we can all support each other as our hospitals face unprecedented pressures.

I thought it would be helpful to share some of what our executive management team and the wider Dorset health and social care system is doing to support you too.

It's important to say that the current demand on health services isn't just a problem for UHD – all our partners in Dorset are under similar pressures. Regionally and nationally, the NHS is facing high demand for urgent care.

That's why it is vital that we agree solutions as a system, involving every organisation involved in the care and support our patients receive, including community and mental health services provided by Dorset HealthCare, our local authorities and their social care teams, the ambulance service and our GP and primary care colleagues.

At executive-level and with our partners, we are involved in programmes of work including:

• understanding why people present to emergency departments, and why they are admitted
• recruiting further community-based support, like occupational therapy, to promote earlier supported discharges from hospital
• enhancing GP cover in urgent care settings
• establishing 'wraparound' post-acute care support, eg mental health, therapies and district nursing, to support an increase in bed numbers.

I am personally working with my opposite numbers at Bournemouth, Christchurch and Poole and Dorset councils to reduce the increasing numbers of patients we know are ready to leave hospital but cannot do so safely. Improving this single issue will make an enormous difference to the health and wellbeing of every patient unable to be discharged, and to the flow of patients through our hospitals.

As a Trust board, at our most recent meeting we agreed to fund additional posts to promote the flow of patients in our hospitals, and to draw up plans to create additional escalation capacity later in the year, should it be needed.

There are no easy answers to these thorny problems, but we are doing all we can to find solutions with our partners. Where it is within our gift to act, we can and will.

I would also encourage any member of staff with a suggestion to improve flow or efficiency in their area to raise this with their care group lead.

We know the strain that working under these pressures places on every member of staff. 'Thank you' doesn't seem enough at these times, but please know that your commitment and dedication are recognised and truly appreciated.

Debbie Fleming, chief executive

Beales confirmed as location for our new "think big" outpatient clinics

We want to tackle the number of outpatients waiting for a face-to-face appointment and the time that they have to wait. We have been developing plans with our partners across Dorset to run some outpatient appointments and assessments in a completely different way and can now confirm that this will involve us taking over the top floor of Beales department store in the Dolphin Centre in Poole.

This space will be converted into a safe, clinical area for tests and screening and is planned to welcome its first patients in the autumn. The centre is initially planned to cover dermatology, orthopaedics, ophthalmology and breast screening

Mark Mould, our chief operating officer of UHD, said: "Last year our hospitals had to respond to the rise of Covid-19 and completely redesign our services and estate across our hospitals. This meant we had to, very reluctantly, cancel many appointments. With all the social distancing guidelines, our hospitals are not going to be able to tackle the subsequent rise in our waiting lists so we needed to "think big" to deal with the problem, as we know what an effect this can have on the patients waiting and their families. Using this fantastic space in Beales, we can design the area specifically so we can see more patients, more quickly and we hope this will make huge inroads into our lists."

Dr Ruth Williamson, our deputy chief medical officer, said: "Across Dorset we really want to do our best to provide the healthcare that our patients need and this space will be fantastic as one of the many things we are doing to catch up. We look forward to welcoming patients to the new centre in Beales to help progress their treatment as we know how frustrating and challenging these delays can be. As healthcare professionals, we are really excited to be part of this project as we hope it will be of huge benefit to many of our patients."

New LIMS – what you need to know ahead of next week's launch

Pathology and IT teams have been working on a major project across Dorset to implement a new Laboratory Information Management System (LIMS) which will provide a single pathology system for Dorset. The existing LIMS will be replaced by Clinisys WinPath Enterprise and the new system will go live next Tuesday (17 August).

Urgent Requests

• In support of the go live please limit pathology requests to urgent only on Monday 16 August and Tuesday 17 August.

Acute kidney injury (AKI) alerts

• Acute kidney injury (AKI) alerts are determined by comparing the current result with a previous result issued within the last year
• The change in the LIMS on 17 August will result in a number of a AKI patients alerts not being released due to a gap in the availability of historic results
• We anticipate that the historic creatinine results will be available by 23 August. As always, correlate biochemical results with the clinical picture
• Please be extra vigilant if a patients is at risk of AKI.

Blood Transfusion

• From Tuesday 17 August the Blood Transfusion Laboratory will not be able to use historic blood group data for the provision of group compatible blood components due to the installation of the new (LIMS) containing a blank database.
• This means any patient requiring any blood component will not have a historic blood group on record. Therefore all patients will require two samples, taken separately, for group compatible blood component issue.
• Emergency group O red cells (and group AB plasma) will still be available if absolutely necessary – as per Major Haemorrhage protocol
• From 09:30am on 17 August BloodTrack will be unavailable across the two hospitals for the majority of the day whilst it is being interfaced to the new LIMS.
• During this downtime all blood components will require collection from the laboratory using the contingency paper based system.

Results look up

• Please be aware that there is an issue with Graphnet EPR where multiple versions of the results may be visible. All of the results are correct. Unfortunately the number of these results will increase with the new system until Graphnet can resolve the issue or when the method of sending the results is replaced later in the year. This does not affect the graphing function, hence this may be the clearest way to view numerical results.
• Please use additional care to ensure you are viewing the most recent update.

There may be some service disruption next week during the implementation and we apologise for any inconvenience. If you have any issues or queries please contact Paul Massey - This email address is being protected from spambots. You need JavaScript enabled to view it. or ext 4780.

Pharmacy reduced service update

Due to a significant level of pharmacist and technician vacancies on all sites we have to reduce the level of services for all areas.

So we will be prioritising admission areas and high risk e.g. Cancer / Aseptic, Critical Care and Paediatrics. We will focus on discharges and new admissions but will not be able to review prescriptions for all patients or on a daily basis.

We are aware that there are low staffing numbers in other areas across the Trust too.

The impact will be seen as;

• Increased time to process TTAs and ability to supply medicines within 4 hours. This may lead to delays in discharges and increased missed or delayed doses.
• Pharmacy time on individual wards throughout the week will reduce as teams will need to cover multiple wards and provide a weekend style / discharge only service.
• The "safety net" that Pharmacy provide will be reduced
• Prescribers will need to interrogate DCR and SCR for drug histories and not rely so heavily on the Pharmacy teams.
• Reduced input to ward areas at weekends.

How to help us and maintain safety;

• Nursing staff to identify any medication needed either for in-patient supply or ward stock and alert pharmacy. Please ensure you check the stock locator to avoid doses being missed when pharmacy is closed.
• Ensure you have the right patient, right drug, right route, right dose.
• Prescribing for same day discharges;
  • Poole - MUST have a reconciled / screened e-discharge before 4.30pm or written prior to 4pm to facilitate safe processing of discharge medication
  • RBCH – 4pm deadline
• Complex TTAs – please prescribe earlier in the day or day before;
  • Controlled Drugs, palliative, compliance aids
• Daily ward rounds – review prescriptions and respond to pharmacy queries
• Prescribe accurately - all medicines can cause harm if not prescribed correctly and reviewed regularly.
  • Recent examples of inaccurate prescribing;
    • Methotrexate 175mg should be 17.5mg
    • Levothyroxine 12.5mcg should be 125mcg
    • Numerous errors with types and doses of insulin, DOACs and prescribing for VTE with no adjustment for weight or renal function and duplication with DOAC and LMWH

We will continually review and will reinstate normal services as soon as new staff are in post and trained.

Jacqui Bowden, Associate Director of Pharmacy. August 2021

Supporting each other - message from chief nursing and chief medical officers

As you will all know, our hospitals remain extremely busy. Our care group leadership teams are doing all they can to support you in providing the care our patients need and expect from us, and it's vital that we do all we can to support each other too.

Keeping our focus on good infection prevention and control (IPC) practices is an extremely important way of doing this. We know this is a familiar message, but as we continue to see high Covid-19 rates in the communities of Bournemouth, Christchurch and Poole at almost twice the national average, it is worth underlining.

The good news is it isn't complicated and we already know what to do. Wearing the facemasks provided properly so they cover both nose and mouth, and ensuring there are good supplies of surface wipes and alcohol hand gel in your area, are straightforward. As is maintaining good hand hygiene and ventilation and adhering to room risk assessments for any face-to-face meetings you may have.

Staying completely bare below the elbows, changing into or out of the uniform or clothes you wear in a clinical setting as you start, finish or take a break off-site, and keeping socially distanced when collecting food or a hot drink, will all help keep us safe.

An increase in levels of Covid-19 in the population was always a risk as the Government relaxed legal restrictions earlier this month. And while we wholeheartedly support using these freedoms to enjoy time away from work, and to catch up with friends and loved ones, please remember that the pandemic has not gone away. Outside of work, use judgment and caution, especially if meeting in larger groups, and try to do this outside where possible.

The restrictions and IPC guidance within our hospitals are still in place and they need to be. Only by observing all of these measures are we doing all we can for ourselves, our colleagues and our patients.

Thank you.

Prof Paula Shobbrook, chief nursing officer and director for infection prevention and control

Dr Alyson O'Donnell, chief medical officer

'Long Covid' – September's Schwartz Round

The next Schwartz Round focuses on 'Long Covid – how it is affecting our staff' and will take place on Friday 3 September, 1-2pm. It is open to all staff and is a great chance to share your experiences.

This Schwartz Round will run face to face and via Teams. All panellists and a small audience will be in the conference room at RBH and there will be an audience and Schwartz Round facilitators in the lecture theatre at Poole.

We encourage you to attend the event in person but please arrive early as seats will be limited. If numbers reach capacity, you will need to log on to the event via Teams instead.

To attend virtually and contribute to the event using the Teams chat box, please go to the Schartz round pages on the RBCH intranet.

Changes to cancer multi-disciplinary team (MDT) referrals

A new electronic process to refer patients to cancer MDT is due to be launched on 23 August. To refer a patient to a cancer MDT please use 'managed bookmarks' via the intranet and select 'clinical systems – electronic forms -cancer MDT referral'.

You will be prompted to answer a number of questions about the patient you are referring, including which cancer MDT you want to refer to and at which hospital site (if applicable).

Once the referral is submitted, the MDT clinical lead / representative will either accept the referral for discussion at the MDT (and will appear on EPR) or decline for a specific reason or if more information is required.

If you require further information, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Further recall of some Clinell Universal wipes

The Medicines and Healthcare products Regulatory Authority (MHRA) has issued a recall notice on some batches of Clinell Universal wipes (green packet), which may be in use in some areas of the trust. This is the second recall of this product.

Five batches were originally affected (LOT UBV1033020A, LOT UBV2033020A, LOT UBV3033020A, LOT UBV4033020A, LOT UBV6032920A), while further investigation by the MHRA has identified four further batches: UBV3032520A and UBV3032520B LOT UBV1032720A, LOT UBV7032720A, produced in June/July 2020.

Action to take:

• Look at above batch details against all your stock
• Keep records of how much stock you have of above batches of wipes
• Throw away packets that have already been opened as these cannot be returned – give details to materials management/logistics
• Let materials management/logistics know how many unopened packs you are looking to return and arrange either collection or return by contacting:
  • Poole site This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Bournemouth/ Christchurch sites This email address is being protected from spambots. You need JavaScript enabled to view it.

Safety message for Tympanic thermometers

Please ensure that Tympanic thermometers are properly cleaned and dried before use.

If the device is used before the cleaning fluid has completely dried the device can overheat. Do not use the device if the ring around the measurement button shows a green blinking light or if the device requires multiple power up's before showing a green solid light.

If you experience an overheating probe tip, or a faulty device do not use it and contact equipment library or clinical engineering to report the fault.

Click here for a guide on how to clean the device.

Tributes paid to Elaine

It is with great sadness that we announce the death of Elaine Wall who was a member of the catering team at RBH. Elaine died peacefully at home on Tuesday 3 August surrounded by her family.

The funeral is being held on Thursday (19 August) at Poole Crematorium, followed at The Tap and Grape in Broadstone.

Elaine joined the Trust in November 2001. She retired and re-joined as a chef on 2 July 2018. Elaine was a valued and popular member of the team.

Donations in Elaine's memory can be made to the Margaret Green Animal Rescue.

The donations can be sent online to https://www.margaretgreenanimalrescue.org.uk.

Putting safety first

Building on a safety checklist culture has been identified as a top quality improvement (QI) project for this year and we want your views on checklists - why you use them, what stops you from using them, what would you want changed?

The QI team has produced a short survey to find out your views.

Improving care for deteriorating patients

The deteriorating patient QI programme team filmed an insightful video of their launch event, which identified eight areas to support improvements to the care deteriorating patients receive in our hospitals. Click here to watch the short version, and here for the long version.

These videos show an overview of the event and those involved and how we reached our initial eight sub-projects which are:

• treatment escalation planning
• sepsis
• communication/referral pathways between wards and ITU
• "soft signs" patient and carer self-referral
• safe medical staffing
• training
• useful data and platform integration
• standard proforma for high NEWS.

If you would like to be involved in any of the 8 sub-projects please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Social media use by patients and visitors

It's important that when patients and visitors are in our hospitals they are respectful of their surroundings and the privacy and dignity of others.

No one is permitted to make pictures, videos or audio recordings in healthcare settings that show other service users, visitors or staff without the knowledge and consent of those individuals.

All instances of pictures/videos/recordings being taken inappropriately in clinical areas must be reported via the Trust's Learning Event and Reporting Notification (LERN) procedure.

For our full social media policy, see the policies pages on the intranet.

New interactive tool to detect malnutrition in older people

Find out how an interactive tool is helping to detect malnutrition at an early stage in older people at the next meeting of the Dorset ICS Innovation Hub Programme Group on 28 September at 1pm.

Jane Murphy, professor in nutrition and registered dietitian, from Bournemouth University will be discussing 'Nutrition wheels in motion: an interactive tool to detect malnutrition at an early stage in older people, with signposting to support'.

If you are interested in learning more from Jane and the team, you can join the Teams event here or for more information contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Understanding if your NHS Pension is affected by changes to public sector pensions

You will be affected by the changes if you joined a public service pension scheme on or before 31 March 2012 and:

• you were a member of the scheme on or after 1 April 2015
• or you left service after 31 March 2012 but returned within five years.

You will be asked to decide which pension scheme benefits you'd like to receive for the remedy period. The remedy period refers to the timeframe the discrimination could have applied, which is between 1 April 2015 and 31 March 2022.

If you have any questions, you'll find more information on our NHS pensions knowledge base.

www.nhsbsa.nhs.uk/changes-public-service-pensions.

More dates for the Leading Teams Through Change workshops

The virtual leadership development workshops are designed to build the skills needed to help lead teams through times of uncertainty. They are also a great opportunity to network with other leaders.

The new dates available are 19 August, 7 and 28 October and 17 November. If you would like to book, please email This email address is being protected from spambots. You need JavaScript enabled to view it..

Job of the week PA to consultant paediatricians at Poole

This role provides a comprehensive secretarial and administrative service to the consultant paediatricians and the oncology service. The successful applicant will have previous personal assistant experience, good organisational skills and the ability to work unsupervised.

This post is 22.5 hours per week on Wednesdays, Thursdays, and Fridays.

Click here for more information, the deadline is 20 August.

Weekly Wellbeing offers

This week, sign up for the Strengthen Your Resillience programme, Care First sessions, Nurse Lifeline listening service and much more...

Please check the intranet A-Z under W for the wellbeing pages.