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Single rooms pose safety risk, warn nurses

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Increasing the number of single rooms in hospitals will lead to patients being harder to monitor and in some cases at greater risk of dying, nurses are warning.

Placing patients in single rooms instead of traditional wards has led to safety breaches, according to nearly half of nurses surveyed by Nursing Times.

Difficulties in observing patients being treated in single rooms have led to serious incidents including suicides, invasive lines being pulled out and assaults on nurses, the survey of more than 1,200 nurses has revealed.

Single rooms have come under close scrutiny in recent weeks after the Conservatives’ draft health manifesto stated single rooms should be expanded “as resources allow” – a watering down of an earlier pledge to double them. The government also wants to build more single rooms.

While the majority (64 per cent) of nurses surveyed supported the policy, many also had concerns.

More than two thirds said single rooms made it more difficult to observe patients (70 per cent) and healthcare support staff (67 per cent).

One said: “Patients inside rooms are forgotten about. They are isolated, lonely and are not observed as they should be in order to be kept safe.”

Many were aware of patients dying as a result of less frequent checks by nurses.

More than half (53 per cent) of nurses surveyed said certain groups of patients were better off in traditional wards, such as patients who were elderly, anxious, confused and depressed.

Patients who nurses felt benefited most from single rooms included those who had infections or weakened immune systems, were vulnerable, needed palliative care, had gynaecological or embarrassing conditions and those who posed a risk to others.

Nearly two thirds (64 per cent) of nurses said single rooms increased their workload and 70 per cent said they required extra staff or more support from managers.

However, nearly all (91 per cent) agreed single rooms improved levels of privacy and dignity for patients, while 69 per cent said they reduced healthcare associated infection rates.

Shadow health minister Anne Milton told Nursing Times that patient expectations and reducing HCAIs made the move to more single rooms a necessary.

She said: “Nurses may well not like single rooms and I understand why, but what matters is having a structure to hinder the impact of healthcare associated infections.

“Expectations have risen and patients don’t want to be on a ward with lots of other people, even four other people. We have to give the public what they want and be very mindful of the need to consult,” she said.

North Teesand Hartlepool NHS Trust deputy director of nursing Cath Fiddle said areas of her hospital consisting predominantly of single rooms had seen “significant reductions” in rates of MRSA and clostridium difficile.

She said all patients were risk assessed to see whether they were prone to falls, before they were placed in single rooms.

Hillingdon Hospital Trust director of nursing Marie Batey said: “We had some initial concerns about whether some of our confused vulnerable people would wander. But actually it would appear that when they’re in a single room they seem to be more settled.”

Early observations suggested this could be because they were feeling more comfortable and secure, she said.

Just over half of nurses responding to the survey said most adults attending hospital for elective care preferred to be accommodated in single rooms.

But King’s College London National Nursing Research Unit deputy director Jill Maben said there was little evidence to back this up. She said: “Often the idea of being in single rooms is much more appealing when we’re not ill.”

One respondent to the survey agreed, saying: “Many patients prefer the camaraderie of the bay which can boost morale and reduce the length of hospital stays.”

Another said: “Recent experience has show that the majority of patients in single rooms feel isolated, state that they do not see anyone for most of the day and feel more depressed.”

A Department of Health spokeswoman said: “The department’s guidance is that the proportion of single rooms in new hospital developments should aim to be 50 per cent, but should not fall below 20 per cent and must be higher than the facilities they are replacing.”

All mental health patients should be accommodated in single rooms, she said.

She added: “Each trust makes an informed choice regarding the appropriate percentage of single bed provision based on practical considerations such as site restrictions and affordability as well as clinical and operational restrictions.

“In some cases, providing single rooms for all patients may not be clinically appropriate.”

  • 8 Comments

Readers' comments (8)

  • If the shadow minister feels that single rooms are 'necessary' then maybe listening to nurses with more experience than her might be useful for her with regard to are they appropriate or safe (for patients or staff)? Maybe if she was willing to fund more nurses on the floor (not via management boardrooms/pockets/fluffy carpets) these concerns may be more easily addressed. I would also suggest a truer representative perspective may be sought by having clinically orientated people in her advisory team who are in touch with ward reality rather than PR soundbite producers for the next election or special days out visiting hospitals that have been primped beyond measure prior to her arrival. Or maybe going undercover as a bank domestic/HCSW for a fri night on A&E or MAU would be beneficial, or any morning on a stroke rehab ward and experience the reality directly.

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  • I agree totally with the above comment , I work in a clinical area where we have single rooms and (as usual like all other hospitals) due to permanently shortage of staffs , patients in single rooms are not being monitored effectively and efficiently. Especially during the night we regularly have patients falling out of bed or nurses are too busy on the main ward cannot get to them on time. YES , someone should go undercover and experience the reality directly.

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  • Patients in hospital today are more acutely ill than ever before and staffing levels mean that sufficient direct observation by staff trained to spot deteriorating conditions is impossible even in 4 and 6 bedded bays. I am sure we could all list a number of scenarios where even 5 minutes can mean the difference between life and death. Privacy and dignity are so important, but staying alive even more so, and this issue needs to be addressed before we move on.

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  • Single rooms are totally inadequte for elderley patients.I work with orthopaedic patients after major surgery being sent back to the ward which consists of all single rooms.You can monitor their obs till your blue in the face but within 5 minutes of you leaving that room anything can happen, and wont be discovered until you go back 15 minutes later.When patients go confused it is an absolute nightmare as someone has to sit with them to ensure their safety.If they were on an open ward obviously you can see them all the time.This puts a great strain on already reduced nursing staff

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  • NHS Nursing Student

    I work on a Acute Elderly medical ward as part of my placements. Single rooms would be totally useless and dangerous on my ward. Mine is a nightingale and has 8 beds in one massive bay and 4 stable patients in another part and it's still dangerous. If the NHS are trying to americanize our wards I think they will find that if they walked onto an elderly medical ward in the US also they woulden't find a single room setout. It's a poor concept and only targets and narrow number of hospital specialities.

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  • I currently work an Acute stroke Unit, bed capacity is increasing from 33 to 40 beds, this includes 12 side wards . I am absolutely dreading it for all the reasons highlighted above. I have raised my concerns, nevetheless they seem to fall on deaf ears!
    I also fear the side wards will be used inappropriately by bed management, operational policy will go out of the window no doubt.

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  • As a cancer patient at the moment i have to be in a seperate room at times, and yes it is lonley and depressing. You are left on your own most of the day apart from medicine or procedure times even prisoners have more human contact! I have also just come home after a severe infection (was put in single room but didnt need to be) the antibiotics made me feel extremly ill, however i honestly believe that if i had been on a ward with human contact i would not of felt quite so bad, certainly not depressed and dispondent (most of my time was spent crying) So although in certain medical situations single rooms have to be used for our own protection in general i would say ward is best! Patients talk to each other and help each other through, that is even worth constant interuptions in the middle of the night.

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  • I have previously worked in a private hospital facility where single room accomodation is the norm. When on duty one morning I walked in on a white, sweaty and unresponsive patient - by pure luck I was passing and the door was ajar. The patient came to no harm (he had just fainted!) but it just highlights all the points my colleagues of all grades make. Single room nursing on an already stretched to breaking point nursing establishment is just an accident waiting to happen. And it will be the likes of me & you who take the brunt of any kind of retribution for failing to be in at least two places at once and observe our patients.

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