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Smooth operator: how to set up a hospital ward

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The task of setting up a ward can appear daunting. Sara Morgan offers some advice on getting it right

Setting up a ward from scratch is an enormous task, but with current hospital and service reconfigurations, it will be happening more often in the coming months and years.

In October 2010, the major trauma ward at St Mary’s Hospital, London, opened. Construction of the ward had been underway for almost a year, but the nursing management team had only four months to get everything else in place, from staff and supplies to nursing policies and communication systems.

Trauma is a new specialty so nurses were hired with a range of backgrounds, including surgical, medical and critical care, along with several graduate nurses. The staff learnt from each other, which promoted teamwork.

Induction programmes should be planned for staff to complete together, preferably before the ward opens. Because everyone will be arriving with different backgrounds, it is imperative there is at least a core of common knowledge among staff.

The trust’s policies, procedures and guidelines should be gathered in one place as a resource file. This means all nurses are providing care based on the same standards. It also minimises how often the phrase “This is how we used to do it at my old trust” will be heard.

This also allows for policy gaps to be identified. Wards that have been open for years often work around these gaps with “oral history” protocols, handed from nurse to nurse. If all of your staff is new, there will be no shared oral history to draw from. For example, on realising that our trust did not have a unified policy for the care of head injury patients, an interim protocol was pulled together while a permanent policy was drafted.

Sara Morgan began working in the emergency department of the Johns Hopkins Hospital in Baltimore, US. She moved to London in 2007 and is currently the lead nurse for Trauma at Imperial College Healthcare Trust

The things you must not do when setting up a ward

  • Don’t take too long to react when something isn’t working We attempted to have a paperless patient admission process, using only the trust’s bed state software. But we found that when the ward clerk was not available to enter patients into the system, it did not get done. So we adopted an old-fashioned paper admission book as a quick solution to what could have been a huge problem.
  • Don’t forget about consumables Having staff and policies in place is great, but if syringes are not available to give IV medications, care cannot be delivered. And accept that every day for weeks and months after opening, the staff will notify you of items that you have forgotten to order.
  • Don’t be too hard on yourself or your staff As long as patients are taken care of appropriately, you can cope with the hiccups along the way. Anything that does not go smoothly, you will have the opportunity to fix before it becomes ingrained in the ward culture.
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