The in-patient units in the Harbour consist of
- 4 x 18 bedded adult functional wards (2 male & 2 female) There is a design solution to allow for flexibility in use of beds between the male and female wards (swing beds)
- 2 x 18 bedded advanced care wards (1 male & 1 female)
- 2 x 15 bedded dementia wards (1 male & 1 female)
- 2 x 8 bedded psychiatric intensive care unit (PICU) (1 male & 1 female)
All the wards will be in operation 24 hours a day 7 days of the week
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Physical Ward Environment
Each ward unit consists of bedrooms with en-suite facilities. The design of the rooms reflects the balance between the need for privacy for the individual and observation by nursing staff. Bedrooms have been designed to promote a relaxing environment and fitted out with appropriate fixtures including facilities for TVs and computers and a lockable mediation locker (other than in PICU units). Rooms are lockable by service users but can be opened outwards if needed. All en-suite facilities are anti-ligature and accessible to staff if required.
Each ward has a lounge dining area with direct access to an internal courtyard. It is designed to feel light and airy and combine both a living and dining space. A beverage bay is provided to ensure service users have access to drinks 24 hours a day and the dining area is located next to the unit kitchen with food being service from a hatch or trolley. Furniture within this area includes sofas, easy chairs, lockable and open shelving units with space for TV/stereo/ games in the living areas and dining room tables and chairs in the dining areas.
There are also a number of quiet rooms where service users can relax and have some ‘quiet time’ along with rooms for use by multidisciplinary team meetings, for group work, interviewing and ward administration.
In addition to the en-suite facilities each unit has several domestic style bathrooms and access to a larger bathroom in which additional assistance can be provided. The dementia and advanced care wards are fitted with bespoke assisted baths to facilitate safe moves of service users with physical disabilities, and can be raised or lowered to minimize any risk of injury to staff, i.e. back injury through bending.
Significant attention has been given to fixtures, fittings and aids to everyday living – to both facilitate independence and ensure the ongoing delivery of harm-free care. For example all communal comfy chairs fitted with pressure relieving memory foam, lightweight cutlery, and wheelchair accessible dining facilities.
Role & Function of the Ward
The wards provide multi-disciplinary team (MDT) care for people who require assessment and treatment for mental illness within an in-patient facility.
The admission pathway to these wards will ensure a holistic and thorough approach to identify the strengths and needs of each service user, ensuring the service user, and when applicable, their carer or family, are involved throughout this process.
The MDT identified for each of these wards, will carry out a daily review of the ward population to ensure the individualised care plans are meeting current need and that this plan of care reflects the needs and services required for a successful and supported discharge.
Interventions will be sufficiently flexible to meet a wide range of need and offer opportunities to provide meaningful activities and social inclusion with each service user having an individual therapy programme as agreed with the care team.
Within the first week of admission, each service user will have an individualised nursing assessment commenced to address their health and social care needs and an individualised occupational therapy assessment commenced to address their occupational needs.
A wide range of treatment options will be available dependent on the individual’s care plan at each phase of their mental health recovery. These will include some or all of the following:
- Mental health assessment and intervention which may include the use of pharmacology;
- Psychological assessment and intervention;
- Occupational assessment and intervention;
- Pharmacological assessment and advice including reconciliation of medication on admission and discharge.
- Ongoing assessment and intervention by other members of the team;
- Ward community meetings
- 1:1 sessions with clinical practitioners
- Physical health checks/ promotion (including physiotherapy)
- Health promotion and information on medication and treatments
- Service user/ carer involvement in care planning
- Group and diversional activities
- Specialist assessment
- Complementary therapies
- Other specialist services.
On admission, and regularly throughout the admission, physical health monitoring and health promotion will be implemented. According to individual need this will include:
- Full blood count, ECG and screening
- Pulse, respiration, blood pressure, temperature, and oxygen saturation
- BMI monitoring
- Physical examination
- Gender specific screening
Any issues identified will be monitored further as required.
The wards have facilities to accommodate service users with physical disabilities. Although if the disability is not manageable on one of the functional wards, or the MDT do not have the skills and knowledge to manage and cater for identified needs, alternative care arrangements and transfer will be carried out.
Principles of Care
Service users will have individual care plans tailored to meet their needs. However there are certain elements of care that every service user will receive. These will include:
- Appointment times for their activities. (In order to aid therapeutic recovery it is important that service users, carers and staff know when activity is planned).
- 1:1 time with a professionally qualified member of staff on a daily basis, which will be identified in the care plan.
- To be allocated a named worker who is responsible for their care and discharge planning.
- Access to a doctor when appropriate.
- To meet with a mental health pharmacist during admission.
- To have their care discussed in a multidisciplinary meeting daily.
- Access to OT, social worker, physiotherapy, advocacy, psychology and pharmacy when needs are identified.
Philosophy of admission to in-patient services
- All referrals for admission will be accessed through the Crisis Resolution/Home Treatment Teams (CRHT)/ Intermediate Support Team (IST).
- In-patient admissions should be used only when all other potential services and settings have been explored. The in-patient resource is used as a support to community services.
- Service users should be admitted for the shortest possible time and treated in a way, which creates least disruption to their lives with access to most appropriate therapeutic, medication and treatment programmes.
- In-patients will remain linked, as previously, to their community services and returned to their care as soon as possible.
- Some staff should be able to work flexibly across wards and community settings according to clinical need.
Services will engage clients in appropriate meaningful therapeutic activities.
Ward Information Booklets
Each ward provides written information for services users detailing the facilities available, meal times, visiting times, identification of staff and what to expect on admission and during the stay etc.
Primary Health Care
Most service users will have reason to also attend to their physical health needs. Mental health admission prevents service users from receiving usual community care for the normal range of primary care physical health presentations and that care may already be suboptimal because of mental health problems. The Trust is therefore committed to providing a high standard of primary care management for those subject to an in-patient stay that will reduce physical health complications and inappropriate reliance on acute hospital provision.
Across the Trust, therapy and care is supported wherever possible, by the use of the best technology. For the Harbour this includes the use of electronic care records, ‘patient status at a glance’ boards, nurse assist system and the planned introduction of an electronic prescribing system and full task allocation system. Technology will also be mobilised to allow service users and their families to stay in touch, including WIFI hotspots on wards to allow access to Skype/FaceTime or other virtual communication opportunities.
The aim of medicines management within the Harbour is to ensure high quality safe dispensing and
administration of medicines which respects the individual’s privacy and dignity while supporting and enhancing skills and confidence in relation to their control of their own medications.
Pharmacists will be available on each unit to advice on medication therapies and all service users will be assessed in relation to their competence, understanding and risk with regards to their medications. Administration of medications will take place in the most appropriate venue to meet the needs of that individual and where possible respect service user choice.
Service users will be empowered to retain responsibility for their medication by encouraging self-medication wherever possible
The building is designed in such a way, that once the main reception have opened the 'street' door leading to in-patient areas, most visitors can walk freely along the main street until they arrive at the entrance reception to the in-patient ward they are visiting. Anyone requiring physical assistance to walk to the ward areas may request an escort at the main reception, who will make the necessary arrangements.
New people being admitted as in-patients, may either be admitted via the main entrance or section 136 suite, or will be escorted by the staff accompanying them to the ward to which they are being admitted.
Those individuals staying on the in-patient wards will be assessed as to whether they require escorting or not to use facilities such as the Patient affairs/general office, contemplation room, sports facilities or cafe etc., as per current Trust policy.