AfPP RESIDENTIAL CONFERENCE 2019
symptoms. I visited the doctor, who didn’t seem to know what was wrong, so I was sent to have some blood tests.” On 19 April 2017 Jules had her first blood test and thought no more of it. Later that day she had dozens of missed calls, so she phoned the number. “My GP told me: ‘You have to get to hospital now, or you may die’,” she recalled. “I was in shock. However, I walked to the hospital and joked: ‘I believe I have a reservation!’ I was then hooked to a drip, still with no idea what was going on. “The next day, I had some scans and the consultant showed me an X-ray that revealed a fibroid - a benign tumour of muscular and fibrous tissues – which was the size of a baby’s head. It was blocking both my urethra and my kidney, which was only functioning at 11%. “To suddenly receive all this information was a shock, and it filled me with worry and fear.”
The patient’s perspective
Jules praised the medical staff, who talked to her, regularly checked on her, and always took a few moments to chat. “It helped me through my hospital stays,” she said. “From a patient’s perspective, I want to personally thank all the medical staff in this conference hall. You have no idea of the impact that you have.
“In April 2018 I was admitted to York
Teaching Hospital, in a ward with several other patients. Sleep was not great, and no matter how hard I tried to get comfortable, it was impossible. I was desperate for sleep and, when I managed a couple of hours, I was woken up by a newly admitted patient who was screaming. The next day, staff woke me and I couldn’t move. I was tired and hungry, but was nil by mouth. The new patient was still extremely loud and I put headphones on to calm myself.” After a while, Jules noticed that the screaming woman, who she overheard was in her 60s, wasn’t speaking as one would
AGM and awards
Following the 55th annual AfPP AGM, a range of awards were presented: l Novice Writer Award: Kristy Stanley l Volunteer Award: Paula Louise Holland and Georgina Berry
l Perioperative Team of the year Award: Walton Centre for Neurology & Neurosurgery NHS Foundation Trust
l Trustee Special Recognition Awards: Kathy Nabbie, Ben Barber and Efua Hagan
expect a woman in her 60s to speak. “It became clear that she had special needs,” observed Jules. “With special needs, routine is important. This routine had been broken and she was becoming extremely stressed. “I said hello to her and talked to her, asking what she needed in a bid to calm her down. I explained to her the routine of the nurses, and this calmed her down. Then another patient began chatting to her, and the whole tone changed. She even began laughing. When she eventually left, she handed out chocolates, gave me a hug and said thank you.”
Jules added that this experience has had a major impact on her life. “It made me realise, it’s about three things,” she said, “having patience, understanding and being resourceful. Everyone has a choice, to be stressed or calm – rather than letting stress take over your life.
“It was around this time that I noticed some of the phrases that consultants would use, such as ‘a painful procedure’ – so you need to remember the impact words have on your patients.”
In 2018 Jules had her first outpatient meeting with a consultant she referred to as ‘Mr Pessimistic’. “Once again, he was using words such as ‘pain’ and ‘sinister’,” she said.
“When my kidney function improved from 11% functionality to 26% functionality, rather than focusing on the positives, he described what three things I could die of. The impact of his poorly chosen words was huge, and I wept.”
By contrast, Jules’ experience with her doctor was completely different. “I had no clarity, and information was confused,” she explained. “When I first met the doctor, he introduced himself, asked if it was convenient to talk, and then asked if he could sit next to me. For the first time, I had a conversation with medical staff eye-to-eye. “He sat with me for 45 minutes, answering my questions and when I explained that the surgery wasn’t due for at least seven months, he arranged for the operation to take place the following week. “My first experience was negative, but the second experience was focused on calm, and talking from a positive point of view. Again, for medical staff, think about patience, understanding and being resourceful.” Jules’ powerful talk was met with a standing ovation and highlighted the theme of this year’s conference.
Below 10,000 feet
Rob Tomlinson, RGN, East Lancashire Hospitals NHS Trust, shared an initiative that has demonstrated how treating staff with respect after a never event creates an open culture that encourages problem solving and service improvement.
This approach has allowed the Trust to be the first in the UK to launch the aviation influenced language tool, “Below 10,000 feet.” The concept was introduced after several never events, and went on to be identified as outstanding practice by the CQC, and win a national patient safety award. Rob, who has been a registered nurse and theatre practitioner since 2008, described how the Trust was involved in a never event in 2017. “In the space of six months, there was a total of five never events, so we took a proactive approach to address this,” he explained. “Theatre staff met in a library and made a presentation which described how we failed and how we could learn from these mistakes. East Lancashire Hospitals NHS Trust’s reaction was fantastic and this paved the way for the ‘Below 10,000 feet’ concept. This was built on the aviation rule that below 10,000 feet is the most dangerous part of an aircraft’s flight – it will be taking off, landing, or crashing. I wrote a paper and presented it to the AfPP.” Rob’s presentation started with a never event involving bilateral avulsion surgery. An issue was picked up with a scanner and there was a 20 minute delay between the patient coming into theatre and the first skin incision. “The National Safety Standards for
Invasive Procedures (NatSSIPs) says theatre staff need to standardise and work in
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