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PROactive Management of Integrated

Services & Environments

PROGRESS PROCESS PROMOTE PROTECT

Mulberry 1, Simon Pavling, Charge Nurse


On Mulberry 1 we’ve started to run a ward based cardio exercise group.  There is access to a gym on site but that is off of the ward and we ask people not to go out the first few days that they’re here.  This means that people are stuck inside for three days and although they can go into the garden you don’t really want to just walk round the garden continuously for exercise.  We already had exercise DVDs like the Green Lizzie/celebrity work out type routines but some of the patients didn’t feel these were up to it and they wanted to step things up a bit.  I got together with James and Lesley from the Physio department and we set up a bit more of a cardio work out.  That runs successfully now every Friday.


The group was easy to set up.  We knew that it would be good to introduce something a bit more physical on the ward so we contacted the Physio department and told them what we wanted to do, asked ‘what can we do?’ and ‘when can we do it?’  Once we’d identified it as a possibility we managed to sit down and work out a time and plan and got it up and running quite quickly.  From a health and safety perspective we do need that professional there to make sure people don’t hurt themselves.  Lesley Lewis, who is a Physio Assistant, was already qualified to run the group and James, who is based on the ward, is now going to get some qualifications so he can help run groups too.  It’s a bit more energetic than any of our existing activities and using energy is a good way of avoiding people getting angry.  We do get a lot of younger people come in and they’re often used to going to the gym so the traditional DVDs we had weren’t quite ticking the boxes.  The group is something our patients obviously appreciate.  


Changing attitudes and practice

Jane Poppitt and Mulberry 2 Team


Following the ‘No Force First Conference’ in Merseyside we looked as team at the way we worked and how we could change our practice for the better.

We first looked at our environment to see if there were small changes we could make for the better.


On Mulberry 2 we had a lounge which was not well used and a dining area which was in the main area of the ward. This meant that at mealtimes the food was dished out and patients sat and ate with constant traffic backwards and forwards around them. It was not a pleasant dining experience and mealtimes were a necessity rather than a pleasurable experience.

We made the decision to swap the dining and lounge areas making a designated dining room which we set out in an aesthetically pleasing way. We joined our patients for meals and made it a social occasion.


We looked at the relationship between food and mood and how we could improve on our menus as well as our environment. The main area became a social seating area and the hub of the ward. The feedback from the patients was excellent and they embraced the fact that the staff were joining them for mealtimes and were more accessible in communal areas.

We had a contemplative area added to the garden for people to sit, and a vegetable patch to grow produce for people to cook their own meals on the ward.


We used our Datix to look at peek times of violence and aggression. We identified when these times were and put measures in place to counteract this.


We introduced community meetings in the mornings 3 times a week which everyone is encouraged to join. We also introduced a protected hour in the afternoons which we dedicated solely to our patients.


We looked at our practices and realised that some of our routines were in fact quite archaic and were following an institutional model. We introduced tea in bed in the mornings and changed the way we dispensed medication. We no longer made people queue up and allowed people to take their treatment in private.


We introduced a ‘No Audit’ which we plan to set up formally. This looked at when we said no and got us to think about weather our approach could be more flexible, while still maintaining necessary boundaries.


The ward had done a lot of work on breaking down barriers. We have introduced a ‘know me board’ where, instead of ‘mug shots’ of the staff we have short profiles of each of us so the patients identify with us being ‘real people’. We worked with our patients to produce a set of mutual expectations for staff and patients and looked at truly cohesive care plans, allowing patients to write their own if they wished to do so.


We introduced meaningful groups in the evenings and at weekends and promoted the positive work being done around the hospital, such as the Recovery College and WI. Our ward is now a much more homely and less clinical environment and a far less threatening place to be.

Violence and aggression is often fuelled by fear and our aim is to reduce the fear by instilling hope and changing culture. This has not always been easy and we have a lot of work still to do but we as a staff team and our patients are very happy with the results so far.



Terry Hills, interim ward manager, Mulberry 3


Changing Spaces on Mulberry 3


Medication Room

On Mulberry 3 we’ve made some changes to the medication room to make collecting medication a more dignified experience.  Previously the medication room had a stable type door with a hatch at the top.  The top half of the door would be open for staff to hand out medication to an institutionalised queue of patients.  We’ve changed that by clearing out all the things that didn’t need to be in the medication room and adding a couple of chairs.  Now patients can come in, sit and talk in private to the nurses.  It’s an extra opportunity to have that chat and get a little bit of feedback.  Some of the medications have extremely unpleasant side effects that you really would not want to discuss in a queue of people.  Occasionally I’ve seen the door being used as a hatch so one of the things I’ve done is order a new door without a hatch, so that can’t happen  It makes the ward a more dignified place.


INA Room

On Mulberry 3 our intensive nursing area used to be a dedicated nursing room where we could nurse someone who had become distressed to a point where they couldn’t be nursed elsewhere on the ward.  We are going to be a proactive ward and make sure that we do absolutely everything we can to stop it getting to that point by changing the very little things at the start of that cycle that could lead to someone becoming distressed to the point where they may need an INA.  To highlight this goal we’ve converted the INA into a clinic room.  Although everything in the clinic room is on wheels so it can be turned back into an INA should we need one for safety or everything all else has failed.  However, we’re making a statement as a team that actually we don’t need an INA because we will stop it before it gets to that stage.  As a clinic room the purpose of this space is now for doctors to have 1:1 time with patients.  They can do bloods, any invasive standard physical tasks in there.  We’ve also put chairs in there so nurses can have 1:1s with patients as well.



 Mulberry Wards (Cambridge 333)