T SE IS R IS AL NU R CI N OR EA L A M SP IL N M LU AC OS
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Issue 6 September 2013
PATIENT CALL
HEPATITIS C LOOK BACK EXERCISE
STROKE CARE GUIDE THROUGH TREATMENT
JAIL FOR ASSAULT ZERO TOLERANCE AGAINST ABUSE
THAI HONOURS FOR ORTHOPAEDIC SURGON
ALCOHOL DETOX SAFER CANCER SURGERY
e d o c R Q e Scan th f o s e u s s i s u for previo e r a c h t l a e Your H @cwmtaf
CONTENTS page 2
Patients called for testing
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A Passport to guide stroke patients through treatment and beyond
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Could you be a VIP?
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Cancer patients to recieve support of specialist Macmillan nurse
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Jail for man who assulted Cwm Taf staff
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Thailand honours Merthyr Tydfil surgeon
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Prompt cards for prompt treatment of sepsis
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Alcohol detox programme helps make cancer surgery safer
14 - 15
Stop Smoking Wales is a free local NHS service to help people in Wales quit smoking. People who want to quit smoking are 4 times more likely to succeed when they attend our service than if they do it alone.
Click here to request a call bac k Call 0800 085 2219 or go online to request a call back from our call centre team.
USEFUL CONTACTS Royal Glamorgan Hospital: 01443 443 443 Prince Charles Hospital: 01685 721 721 Ysbyty Cwm Cynon: 01443 715 211 Ysbyty Cwm Rhondda: 01443 430 022 Ysbyty Cwm Rhondda Minor Injuries - Phone First: 01443 444 075 Dewi Sant Hospital: 01443 486 222 Ysbyty George Thomas: 01443 430 022 Y Bwthyn: 01443 443 758 Keir Hardie Health Park: 01685 351 021
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Patients called for testing FORMER patients treated during an eight week period between May and July 1984 at the old East Glamorgan General Hospital in Pontypridd are being contacted by Cwm Taf Health Board. page 4
The move comes after a healthcare worker involved in their obstetric and gynaecological treatment almost 30 years ago has been subsequently diagnosed with hepatitis C. The healthcare worker spent most of their career working at Caerphilly District Miners’ Hospital but also briefly worked at East Glamorgan General Hospital between May 28 and July 17 1984 and
at Wrexham Maelor Hospital between May and June 1978. The virus is known to have been transmitted from the healthcare worker to two patients between 1984 and 2002, when the individual stopped clinical practice. Cwm Taf Health Board is identifying and contacting patients who have or may have been treated by the health-
received obstetric and gynaecology treatment at East Glamorgan General Hospital between May and July 1984. However, we want to stress the risk of transmission to patients is small. “But it is important that we get in touch with patients who may have been in contact with this healthcare worker during the course of their treatment, which is why we are writing to some former patients, to ask them to contact the helpline. “We are working closely with colleagues at Aneurin Bevan Health Board to identify all those patients who may have been affected and support them during this difficult time. “Special clinics have been set up to offer hepatitis C testing to former patients and support will be provided by specialist nurses.” Cwm Taf Health Board is working with Aneurin Bevan Health Board and Betsi Cadwaladr University Health Board to ensure a co-ordinat-
care worker at East Glamorgan General Hospital during that eight-week period. Patients will receive an individual letter that will ask them to ring a dedicated helpline to arrange an appointment in a specialist nurse clinic. Nicola John, director of public health at Cwm Taf Health Board, said: “We know this will be a very worrying time for patients who may have
ed response for patients. The appointments helpline will be open from today (11th September 2013) from 8am to 8pm seven days a week. Specialist clinics will start taking place from 13th September 2013 and patients who attend for testing will receive results in approximately two weeks. Hepatitis C is a virus which can lead to inflammation of the liver, causing chronic liver disease and in some rare cases liver cancer. Treatment is available for hepatitis C. In most cases, the virus is asymptomatic – people who are infected do not realise they have the infection and suffer no noticeable symptoms. The virus is transmitted via blood-to-blood contact. It cannot be transmitted by social contact, kissing or sharing food and drink.
More information More information about hepatitis C, including a factsheet and frequently asked questions, will be available from the Cwm Taf and Aneurin Bevan health board websites at: www.cwmtafhb.wales.nhs.uk and www.aneurinbevanhb.wales.nhs.uk General information about hepatitis C is available from the Hepatitis C Trust at www.hepctrust.org.uk
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A PASSPORT TO GUIDE STROKE PATIENTS THROUGH TREATMENT AND BEYOND A UNIQUE “passport” has been developed by Cwm Taf Health Board to help guide patients and their families through their stroke care journey. The interactive document is designed to help stroke patients feel fully informed and engaged in their recovery and to link information provided by NHS, social and voluntary services, especially after they are discharged from hospital. The passport, developed by a multiagency Life After Stroke Team with the help of stroke patients and their families, includes three booklets which cover the different stages of the stroke journey; early (hospital) treatment, rehabilitation and life after a stroke. Maintained and owned by the patient, the passport helps the individual retain control of their care during their recovery from
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stroke. They are now being piloted on a small number of patients from across Cwm Taf Health Board, following successful focus group work. Dr Kathryn Head, Clinical lead speech and language therapist and Team Lead for Life After Stroke at Cwm Taf Health Board, said: “Previous feedback from stroke patients across Wales has informed us that when they leave hospital they feel as though they have been abandoned; there’s little to no support for carers and that services aren’t joined up. “As part of the 1000 Lives Plus national improvement programme for Life after Stroke, we thought this was an opportunity to develop a resource for patients that covers the whole of their stroke journey, not just life after a stroke.”
information about what happens next and who will be involved in their care. Patients and their families will be able to personalise the booklet with details of their symptoms and the clinicians caring for them. The Rehabilitation booklet is specifically designed to help patients develop and set their own goals, while the Life After Stroke booklet is an ongoing record of their recovery, clinical appointments and quality of life, which can be shared with the various NHS, social and voluntary staff involved in their ongoing rehabilitation. It also contains information and advice about driving, fatigue and money.
Images from the three booklets that together make up the stroke passport.
Kathy McLernon, a specialist speech and language therapist for acute stroke, who designed the passport, said: “We had really good feedback from the focus group – several people said they wished they’d had this when they’d had their stroke. They said they’d have found things easier and would have known what to ask for.
The Early Treatment booklet is used from the day a person is admitted to the stroke ward after suffering a stroke and contains detailed but easy-to-understand
“The stroke survivor focus group further reported having felt that often things are just done to stroke patients because they aren’t aware what to ask for but
these passports will hopefully give the patients confidence to initiate discussions around their care and recovery.” If the pilot work is successful, the passport will be given to everyone who receives stroke care in Cwm Taf Health Board. Dr Head added: “We hope that the passport will guide patients through their stroke journey and that patients will feel better informed and engaged in their recovery from the point of admission to a stroke unit through to returning to their lives when they leave hospital.” It is estimated about 500 people in the Cwm Taf Health Board area suffer a stroke every year. A stroke is a brain attack, commonly caused by a blood clot which restricts the flow of oxygenated and nutrient-rich blood to the brain – these types of strokes are known as ischaemic strokes and are suitable for thrombolysis treatment. Strokes can also be caused by a bleed in the brain – known as a haemorrhagic stroke. Whatever the cause of the stroke, the symptoms are sudden and immediate: •
• • •
The person’s face droops on one side, and they may be weak, numb or paralysed on that side of their body They may not be able to lift both arms They may have slurred speech, not be able to find words or understand speech They may have blurred or loss of vision.
If this happens it is important to ACT FAST and dial 999 as the patient needs emergency treatment.
Could you be a CWM Taf Health Board is searching for VIP patients to help train the next generation of doctors. The ground-breaking scheme will see patients with long-term conditions help to teach firstyear medical students how to take a medical history and interact with patients. The volunteer instructor patients (VIPs) will take part in special teaching sessions to be held in Keir Hardie Health Park, in Merthyr Tydfil. The initiative will support the new C21 curriculum introduced by Cardiff University to revolutionise medical education in Wales. Dr Ruth Alcolado, clinical director of acute medicine and A&E at Cwm Taf Health Board, said: “We believe that real patient contact should be at the heart of learning, particularly as what patients can contribute to the education process is now being given greater consideration. “This unique scheme will give patients a voice in the training of the next generation of doctors – they will play an integral role in teaching medical students how to take a patient’s history and helping to improve their interaction with patients right from the start of their degree. “We’re very excited about bringing patients and medical students together in these sessions at Keir Hardie Health Park.” Volunteer instructor patients need to be over 18, have a long-term health condition and
VIP?
be willing to work with medical students. The changes to the Cardiff University curriculum will see first year medical students take part in training sessions in Keir Hardie Health Park from January 2014. The VIPs will meet with a group of students who will take a medical history and ask questions under the guidance of a tutor at training sessions, which will last two to three hours. All the discussions will be confidential. Cwm Taf Health Board will reimburse volunteers’ travel expenses and will provide a light snack when they attend sessions. Dr Alcolado said: “This is a real opportunity for patients to share their experiences with the doctors of the future, which will improve their overall training experience. “Ultimately we hope this will help medical students become better doctors because patient contact will be at the heart of their learning. “Patients will also benefit in the long-term as students gain experience of interacting with patients and develop sensitivities needed for shared decision-making, which is an increasingly prominent and expected aspect of healthcare.” Induction sessions for the VIPs will be held in November. For more information about becoming a VIP call 01443 443 406 or email kevin.jones3@wales.nhs. uk
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Cancer patients to receive support of specialist Macmillan nurse PATIENTS being treated for colorectal cancer will now have the support of a clinical nurse specialist at Cwm Taf Health Board. Rhoslun Morris, a Macmillan colorectal specialist oncology nurse is based in the Royal Glamorgan Hospital, in Llantrisant. She will play a vital role as a key worker for all patients newly diagnosed with col-
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orectal cancer and follow in her mother Eileen’s footsteps in the process Rhoslun said: “I always had an interest in cancer care. My mother, Eileen Owen, was one of the first Macmillan nurses in Taff Ely. She was one of two nurses who set up the service.” Susan Morris, general manager for Macmillan Cancer Support in Wales, said: “Macmillan is delighted to have worked with Cwm Taf Health Board to fund Rhoslun’s role as a Macmillan colorectal specialist oncology nurse to support bowel cancer patients. “Rhoslun is one of more than 250 Macmillan professionals working in Wales to support people affected by cancer and their loved ones.” Colorectal cancer is the third most common cancer in the UK – after breast and lung. 75% cases occurring in people aged 65 or over. It is the second most common cause of cancer death in the UK. According to statistics published by Bowel Screening Wales in February 2013, the number of new cases diagnosed in Wales was 2000 and affects one in 20 people over 50 (the risk increases with age).
and Mr Woodward, who all specialise in bowel surgery. And also with Dr Yim who is a consultant oncologist. She has seen 190 patients since starting the role in June 2012. Rhoslun started her career in the NHS in 1990 joining as a student nurse in East Glamorgan Hospital. Following her training she then went to the Royal Glamorgan Hospital as a staff nurse and became a deputy ward manager in December 2001. She was offered a secondment in June 2012 and jumped at the chance saying: When patients are diagnosed with bowel cancer, Rhoslun is brought in to provide support through their care pathway. She undertakes a comprehensive assessment of the patient’s needs, providing information and advice, and acting as the patient’s advocate. “Good communication is essential in this role. By making sure the patient understands every part of their treatment they can be empowered to making fully informed decisions regarding their treatment plan, says Rhoslun. “Every patient has different needs and by devel-
oping good relationships, I can ensure that the patient feels confident to contact me whenever they feel it necessary.” Cancer Research UK statistics published in January 2013 showed that 90% of people diagnosed at the earliest stage survive more than five years. Rhoslun said: “Macmillan offers excellent support and training for staff. The organisation’s website is very informative and I know patients have found the support line free-phone number to be very useful”. As well as providing support at clinic appointments, she also visits patients when they are on the ward, making sure they understand their surgery pre-operatively and also explaining the next stage of the process post-operatively and co-ordinating and planning care when further treatment is required. Rhoslun said: “The role is absolutely rewarding. I have met the most wonderful people and it is a privilege to be in a position to help patients through what is a very traumatic time in their lives”.
Clinics are held in the Royal Glamorgan Hospital, Ysbyty Cwm Rhondda and Velindre where she works alongside consultant general surgeons – Mr Foster, Miss Clements page 9
Jail for man who assaulted Cwm Taf staff A MAN who spat at two receptionists working at Royal Glamorgan Hospital’s A&E department has been jailed for four months.
In response to violence or abuse against staff, in 2012-13, Cwm Taf Health Board: • Made 79 anti-social behaviour referrals to Rhondda Cynon Taf and Merthyr Tydfil Community Safety Partnerships • Placed 102 warning markers on patients’ electronic records to warn staff about the potential risk of abuse or violence from the patient The patients also received letters informing them about this and advising them any further incidents would be reported to the police • Sent 28 code of conduct letters to perpetrators of unacceptable behaviour towards NHS staff advising them their behaviour was unacceptable and any further incidents would be reported to the police • Prosecuted 25 people for abusive or violent behaviour towards staff. hospitals run by Cwm Taf Health Board. Other recent prosecutions include:
Pontypridd Magistrates’ Court imposed the prison sentence on Andrew Lewis, 45, (pictured, above) from Cymmer Road in Porth, on Friday, after he admitted the offences and a further charge of spitting at a police custody officer. The prosecution is the latest to be brought against violent and abusive patients and visitors to
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Louis Bird, 18, of the Waterton Hotel, in Tonyrefail, was sentenced to 12 weeks’ imprisonment, suspended for 12 months, for assaulting three members of staff at the Royal Glamorgan Hospital, including pushing and assaulting two members of staff as he fled from the mental health unit in June and grabbing a nurse by the throat. He admitted the offences and was also made the subject of a supervision order and ordered to pay the three victims £50 each. Emma Louise Anthony (pictured, lef), 37, from Pentre, was fined £37 and ordered to pay
a victim surcharge of £20 after admitting a public order offence. She became abusive towards staff and refused to leave the Emergency Care Centre at Prince Charles Hospital, in Merthyr Tydfil, on August 23. Dave Lewis, Cwm Taf Health Board’s violence and aggression case manager, said: “These three successful recent prosecutions once again demonstrate that we will take action against people who are verbally or physically abusive against our staff. “Our staff come to work to help people who are hurt and sick; not to be shouted, sworn, spat at or even attacked. We will not tolerate such behaviour.”
Thailand honours Merthyr Tydfil surgeon ORTHOPAEDIC surgeon Kodali Prasad has received a clutch of prestigious awards from the former deputy Prime Minister of Thailand at a ceremony in Bangkok. The honours are the latest to be bestowed on the staff grade doctor, who is based at Prince Charles Hospital, in Merthyr Tydfil. Making the long journey to Thailand this summer to collect the awards, Dr Prasad was presented with the Sri Rama International Award and the International Ac h i e v -
ers Award from His Excellency Korn Dabbransi, the former deputy Prime Minister of Thailand. In the ceremony organised by the India International Friendship Society, he was also given the Navrattan Award and the Best Citizens of India Award 2013, in conjunction with International Publishing House. He once again dedicated the awards to the memory of his mother Kodali Jagadamba and father Kodali Venkateswara Rao.
“These award ceremonies are an opportunity to contribute to the progress of trauma and orthopaedic surgery worldwide and create momentum for future achievement.” Dr Prasad’s trip to Thailand in June rounds off a busy 12 months, which has seen him receive awards and honours in numerous ceremonies in India, Thailand and London.
Dr Prasad said: “I consider it a great honour to play a small part in re-emergence of the image of India and I get great pleasure in contributing to the positive image of Prince Charles Hospital, Merthyr Tydfil.
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Prompt cards for prompt treatment of sepsis ALL maternity staff working in Cwm Taf Health Board have been trained to recognise the signs of the life-threatening condition sepsis in pregnant women and new mothers. The training is part of an organisation-wide drive to identify patients with sepsis and ensure they receive speedy treatment. Other measures include the development and introduction of the sepsis response bag, which ensures all the equipment and medicines needed to start treatment of sepsis are available in one place. Staff on the maternity wards at Prince Charles and Royal Glamorgan hospitals wear information cards, which list the symptoms of sepsis, on lanyards around their necks. The cards are part of the 1,000 Lives Plus maternity collaborative work. Sepsis is the most common cause of maternal death. Senior midwife Ruth Friel said: “Sepsis can happen at any time during pregnancy and childbirth and it’s not just the mother who is at risk of developing the infection – the baby is too. If a baby is born with sepsis, it will need antibiotic treatment and to be admitted to the special care baby unit. “Sepsis can be difficult to diagnose, which is why we have these prompt cards which the midwives use to highlight the symptoms they need to be lookpage 12
ing for. This means that sepsis is much more at the forefront of their minds, which means that it’s more likely to be diagnosed early and women start the essential and life-saving treatment early.” Sepsis is caused when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognised early and treated promptly. Between a third and half of all sepsis patients die. It causes more deaths than prostate and breast cancer and HIV/Aids combined every year and, statistically, someone dies from sepsis every three to four seconds. Sepsis is classed as a medical emergency but quickly identifying the often subtle symptoms and treating the patient with antibiotics and fluids can halve the risk of death. The symptoms of sepsis include a raised temperature, increased pulse and breathing rate. Measures to identify and treat sepsis have been introduced across Cwm Taf Health Board and include: The assessment of all patients for signs of sepsis on admission to intensive care units at Prince Charles and Royal Glamorgan hospitals and throughout their stays The introduction of sepsis re-
sponse bags on wards, which ensure all the medicines and equipment needed to start treatment of sepsis are readily available in one place. “Sepsis kills 2,000 people a year in Wales and harms a lot more. In Cwm Taf we are constantly improving our care for these patients - by recognising sepsis early and treating it early with simple measures we can make a real difference to survival.” Dr Richard Jones, a consultant anaesthetist Cwm Taf Health Board will be raising awareness of sepsis as it marks the second annual World Sepsis Day with information stands at Prince Charles and Royal Glamorgan hospitals. World Sepsis Day, on September 13, is an international awareness day to raise the profile of sepsis and its treatment. The stands, which will be manned by members of the critical care outreach team and midwives, will provide information about sepsis and its treatment – the Sepsis Six – within Cwm Taf to quickly identify and treat patients with sepsis.
Know the s igns and sympto ms
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Alcohol detox programme helps make cancer surgery safer BEING diagnosed and treated for mouth cancer has become a truly life-changing experience for Maureen Parish and Brian Toogood. They were the first two patients to undergo a pre-op alcohol detox at the Royal Glamorgan Hospital, in Llantrisant, before they had surgery to remove cancerous tumours in their mouths. As a result of the detox, and with ongoing support from drug and alcohol charity TEDS, 55-yearold Maureen, from Porth, has stopped drinking and smoking altogether. Brian (pictured below), 63, who lives near Treharris, has cut his alcohol consumption by two-thirds. Both are also in remission from cancer. However, the alcohol detox pro-
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gramme wasn’t introduced to help alcohol-dependent patients with head or neck cancer give up or cut down their drinking habit; it was introduced earlier this year to help them get through surgery safely without experiencing potentially life-threatening withdrawal symptoms. Sandeep Berry, a consultant ear nose and throat (ENT) surgeon, who works at the Royal Glamorgan Hospital and at University Hospital of Wales, in Cardiff, said: “Most patients diagnosed with mouth cancer will require surgery but for someone who is dependent on alcohol, that can mean that they suffer withdrawal symptoms while they are in hospital. “That in turn means they need
to spend more time in intensive care after surgery and on the ward recovering. There’s also a risk they may pull their lines out and their healing may take longer. It may also delay the start of any subsequent radiotherapy or chemotherapy treatment they need. “We recently treated one very heavy drinker – he was drinking upwards of 97 units a week. He was brought in for his detox three days before he was due to have surgery for the cancer. “He had the detox at the Royal Glamorgan Hospital and was then transferred to the University Hospital of Wales, in Cardiff, for the surgery. He left intensive care the following day and at the end of the week he came back to the Royal Glamorgan and could
begin radiotherapy.” Brian Toogood became the first patient to undergo a pre-surgical detox when he was diagnosed with mouth cancer earlier this year. He had been suffering with eye problems when he sought help at A&E – a nurse asked to see his tongue and a subsequent biopsy diagnosed mouth cancer. “The first thing I did was to go to the pub and tell the boys that I had cancer,” said heavy-drinker Brian. Since the detox and complex surgery to remove the tumour from his tongue, which was followed by radiotherapy, Brian has cut back on the amount he drinks and he now stays away from strong white cider. He has also stopped smoking. Steve Hamer, alcohol liaison nurse for Cwm Taf Health Board, said: “Brian was always very open that alcohol was a part of his life and that this was only going to be a temporary stop. This was about making surgery as safe as possible for him.” Maureen Parish, however, has not had another drink after un-
dergoing her detox and surgery in April but, like Brian, she has also stopped smoking. The first sign she had mouth cancer was a blister in her mouth, which she initially thought was the result of heating too-hot stew. But when it didn’t heal she saw her GP and when she was told she was being referred to “someone who knew more about mouths”, Maureen said she knew it was cancer. “My husband wouldn’t let me say the words because if I didn’t name it, I wouldn’t claim it. But I knew. When I was told it was cancer it was a shock but it wasn’t a massive shock because it had been in the back of my mind to expect the worst and the worst was confirmed,” she said. Jane Wall, Cwm Taf Health Board’s Macmillan head and neck clinical nurse specialist, met Maureen at home after she was diagnosed and identified that she would benefit from a detox before her surgery. At the time she was drinking four large glasses of wine and vodka about five nights a week. Maureen said: “I haven’t looked back since the surgery – I haven’t thought about having a drink. I gave up two things – my drinking and smoking. I haven’t got a bad word to say about anyone who treated me; everyone was totally awesome; they were absolutely marvellous.” Almost 6,000 new cases of mouth cancer are diagnosed every year in the UK; most are linked to tobacco and alcohol use. Mouth cancers are more common in people over 40, par-
ticularly men. However, research has shown that mouth cancer is becoming more common in younger patients and in women. The prevalence of head and neck cancers, which include mouth cancers, is particularly high in deprived areas and highest in Wales in Merthyr Tydfil. The UK recommended alcohol limits are three to four units a day for men and two to three units a day for women with two alcohol free days a week. It is estimated that one in 20 adults in the UK drinks to problematic levels, rising to one in 12 in the Cwm Taf area. Jane said: “We have always treated patients with alcohol dependencies but we have never done anything for them but we now have a screening tool which helps us to identify those who drink to excess or harmful levels. “We can help prevent them going into alcohol withdrawal while they are in hospital, which can affect their treatment, their recovery and may ultimately be life-threatening.”
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