Nursing Notes

October 6, 2010

Hospital bed transfers put thousands of patients at risk of infection

Here is an article I found on Nursing Times that comes from across the ocean.  It seems that our sisters over in the British Isles struggle with many, if not all, of the same issues we struggle with daily.  This particular article caught my attention because it seems that JCAHO or TJC, whichever you are familiar with, is always looking for a new issue to deal with and I think this should be one.

At my facility, patients are moved from one unit to another, from one floor to another, etc. with little concern for what is best for the patient.  I have always felt that we should look at the needs of the patient and place them in the correct unit from the very first minute.  This article is talking about infection control issues in medical hospitals, but in a psych hospital there are many other issues involved as well.  Mixing depressed people with actively psychotic people or bringing active detoxing patients into a unit with 30 or more patients should be contraindicated.  When we transfer patients to the correct units, staff are tied up, patient belongings get lost or left behind, and the patient experiences increased anxiety about the unknown on a new unit.  This cannot be good customer service and I know is detrimental to good patient care.

It was interesting to see that other nurses are also having these worries.  I also worry about the infection control issue of moving my patients around.  In today’s hospital settings, you have to be concerned about this.

Anyway, I hope you enjoy the article.  Won’t you leave me a comment to tell me what you think?

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Hundreds of thousands of hospital patients are being moved from one hospital ward to another with no clinical justification and risking the spread of infection, evidence collected by Nursing Times suggests.

The bed moves often happen because wards are too full and so patients are admitted into inappropriate wards and then moved.  If you are transferring patients lots of times you are moving bugs around the hospital

Patient transfers between wards are a well known cause of infection outbreaks as they reduce the ability of hospitals to contain infections. The transfers can also result in a disruption in patient care as notes are misplaced and observations missed.

Despite the risks only a small number of hospitals monitor their non-clinical patient transfers.

Nursing Times has analysed the data from those hospitals. It suggests that nationally there are around 1.3 million patient bed moves made each year for non-clinical reasons.

The figures suggest nearly one in 10 hospital patients could be affected, although a proportion of patients will have been moved more than once during their hospital stay so the precise number affected is not clear.

Eighty-eight trusts responded to a Nursing Times freedom of information request asking for data about patient transfers. Among the 42 that collected information about the number of patients being transferred from one ward to another, monthly transfers ranged from 9 per cent of inpatients in one trust to 88 per cent in another.

It is impossible to compare the trusts and judge which have the biggest problem as they measure performance in different ways.

Only six trusts were able to distinguish between transfers that were clinically justified – such as when a patient needed to be moved to a lower dependency unit or a different specialty – and those that were not.

Their rates ranged from 0.4 per cent of inpatients transferred without clinical justification at Frimley Park Hospital Foundation Trust to 15 per cent at Imperial College Healthcare Trust in London.

At Southampton for example, an average 5,922 patients were admitted each month between July 2008 and July 2010, and there were 703 non-clinically justified transfers – 12 per cent of admissions.

At Taunton and Somerset Foundation Trust, another which collects detailed information, there were an average of 6,301 inpatients a month and 735 non-clinical transfers in the same period -11.7 per cent of admissions.

Across the six trusts the average monthly rate of non-clinical transfers was 8.8 per cent of total inpatients.

Scaled up across the 13.6 million hospital admissions in England last year, the data suggests there are around 1.3 million clinically unjustified patient transfers each year.

Royal College of Nursing emergency care adviser Alan Dobson told Nursing Times hospitals were struggling to admit patients to the appropriate ward as the bed occupancy rate in hospitals was higher than ever, meaning fewer beds were left vacant to cope with surges in demand.

Mr Dobson said: “Bed occupancy should be about 85 per cent to enable good patient care. Most hospitals are running at about 95 per cent and sometimes it is at over 100 per cent.

“Patients are often moved around the hospital for non-clinical reasons and it’s unacceptable. If you are transferring patients lots of times you are moving bugs around the hospital.”

Frimley Park Hospital Foundation Trust nursing director Mary Dunne said the trust had changed its arrangement of wards to reduce non-clinical transfers.

She told Nursing Times that senior nurses frequently intervened to prevent patients being moved several times.

She said: “We began looking at it as a patient safety issue, but being moved can also be upsetting. Patients like to get to know their team, and just as they are settling they can be moved to another new team.”

However, she said increasing beds and staff would not help because more patients would be admitted to fill them, rather than the flexibility used to reduce transfers. She said: “The more beds you open the more beds are filled. We should be looking to supporting patients back into their own homes.”

Earlier this year a Nursing Times investigation revealed that patients were regularly being placed in areas not designed for care – including wards that were already full, store rooms and mop cupboards – because appropriate wards were full.

The National Audit Office’s report on hospital infection in 2000 highlighted transfers as a risk factor. Accommodating patients in the wrong area – away from the team that is meant to be caring for them – also means they get less attention and are less likely to get the treatment they need, and more likely to deteriorate.

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