What does quality look like? 
Part 2: Fundamental Care

Following on from last month’s blog about how communication and the interface between departments and organisations can impact on the quality of our services, I’d like to delve a little bit further into the subject of quality and the things that can affect it. 

In my organisation we have launched a programme called ‘Fundamentals of Care’. This is something that I think is both fantastic and sad. It’s fantastic because it is successfully improving how we care for our patients by taking things back to basics, but sad at the same time that it’s necessary and because it started out with some distressing feedback from patients about their poor experiences in hospital. Patients at end of life whose relatives were poorly communicated with. Stories from relatives whose loved ones did not have their basic hygiene needs met and who were greeted with soiled bedding when they came to visit. Patients who weren’t eating because no-one was giving them the sort of food they could eat. Whilst advances in the technical aspects of care are wonderful, it is important not to forget the fundamental principles of how to look after our patients. 

The fundamental care principles identified are: 
• Harm Free Care
• Promoting independence
• Nutrition and Hydration
• Communication
• Symptom Management
• Sleep and Rest
• Personalised care 

At first glance, much of this does feel very ward-based, and it is easy when you work in Imaging to think this doesn’t apply to us. But as I said in last month’s blog, it’s often not until you have an experience yourself that you start to consider the sort of seemingly small things that can make a huge difference. I remember visiting my dad in hospital the week before he passed away and he was sat in a chair with no trousers on. My dad was the type of man who wore a shirt and tie (and trousers!) every day of his life. Apart from warm days on holiday when the shirt and tie were exchanged for a polo shirt. Never anything without a collar. He had other visitors that day and they had put a blanket over his legs, but this kept falling off. He was a big man, and I think the staff had just given up trying to get the trousers on him, but to this day, this is one of my stand-out memories of his final days in hospital. Making sure someone is properly dressed and retains their dignity is pretty damn fundamental. And yes, I’m still mad about it. 

You may be reading this and thinking that’s all very interesting, Jilly, but what does it have to do with Nuclear Medicine? But we do have in-patients in our departments, who may well be in their nightwear. Do we make sure their dignity is preserved at all times? And are they warm enough, for example? 
Many of our patients are only with us for a short while, and a lot are out-patients. However, some people can be with us for quite extended periods. Sometimes planned, and sometime unplanned – for example, waiting for transport. Do we make sure they have enough food and water? Maybe they are diabetic – do we make sure they eat when they should? Do we check they are able to take any medication they may be on if their transport is delayed? You may feel this is going beyond our remit, but I feel that every single department in the hospital should be actively thinking about how this applies to them. 

You’ll see there’s reference to ‘Harm Free Care’ on the list. So what does Harm Free Care mean for Nuclear Medicine? My thoughts are that for us this means ensuring the patient has the right test and gets the report at the right time. The GIRFT (Get It Right First time) principle is particularly apt here. And certainly, no-one could argue this is beyond our remit. 

Again, my experience of Nuclear Medicine departments is that we do look after our patients well, but it never does any harm to look beyond the doors to the Nuclear Medicine department and have a think how initiatives within your organisation can be applied to your area. Have a think about how someone’s dignity is being preserved, whether they have enough food and water and what happens when transport doesn’t turn up before the department closes, for example. And have a think about how we can assure ourselves that we are providing Harm Free Care 100% of the time. 

I hope you’ve found this interesting! Find me on X (formerly known as Twitter) @PresBnms

Please look out for our Autumn meeting, coming up on 31st October in London – it would be great to see you there if you can make it!