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Common Christmas mishaps and how you can help the NHS help you

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Falling off stepladders while decking the halls, cutting hands while chopping swedes, breaking toes by dropping a frozen turkey on your foot and children getting toy blocks stuck up their nose, are among the common injuries that see people heading to hospital over Christmas.

In fact, more than *80,000 people arrive in the Emergency Department over the festive period due to accidents like these. 

Staff at Swansea Bay University Health Board have put together a list of their most common ‘festive fails’ and advice on how to avoid them and, more importantly, where you should go to get the right help. 

More than 80,000 people in the UK arrive in the Emergency Department for Christmas-related accidents – everything from fairy light burns, children choking on decorations or being poisoned by batteries, falls from step-ladders or chairs, alcohol-related accidents and others. One in 40 people have suffered an electrical shock due to badly wired Christmas lights and 1 in 50 people have fallen from the loft when getting decorations down.

Swansea Bay University Health Board is urging people in the region to ‘help us, help you’ by being careful during their celebrations, but also by knowing where to get the correct help if they do get into difficulties. This can range from visiting the pharmacy, optician or dentist to calling 111 or visiting the Minor Injury Unit at Neath Port Talbot Hospital.

Dr Andrew MacNab, Emergency Department Consultant at Morriston Hospital, said: “We treat people who have fallen from their loft, who have lifted boxes of decorations that are too heavy, who have slipped on spills in the kitchen, or have dropped the turkey on their foot. Seasonal stress, excited children and pets, electrical goods, alcohol and busy kitchens all help to fill the home with Christmas spirit, but they also add extra dangers to our homes. We all like surprises at Christmas, but a trip to the hospital is one we could all do without.

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“One of the most important things we can all consider is making sure that if we do have a health issue over the festive period, that we go to the right place for the appropriate care. Our very clear message this season is please help us, help you by tapping into the appropriate help, by consulting your pharmacy, calling 111 or visiting the Minor Injury Unit (MIU) in Neath Port Talbot Hospital. If you have a minor injury, the MIU can treat you, and they generally have far shorter waiting times.

If you are unwell but it’s not a 999 emergency, you can ring 111 for advice about the right place for the most appropriate care and support. Sometimes, patients will be referred straight to the Emergency Department because of the nature of their illness or injury, so they save a wasted journey and get the right treatment as soon as possible. Sometimes the solution lies on the high street – very often, patients are advised to go to their local pharmacy, optician or dentist.

Dr MacNab adds: “We know some people are nervous about coming to hospital because they are worried about Covid-19 but any delay can make an injury worse. Bear in mind that we all wear appropriate PPE. These are all changed between each patient and all surfaces are thoroughly cleaned down. Don’t delay – if you feel something is wrong, contact us. Remember too that NHS 111 Wales is available, so you can check your symptoms online or give them a call if you need further advice. Let’s all do our bit to stay safe and well this Christmas.”


How to Avoid Becoming a Christmas Statistic 

Swansea Bay University Health Board have put together a guide of the common incidents that occur so you can avoid becoming a Christmas statistic. Follow their guide to keep you and your family safe over the festive season:

Allergies

People with food allergies should take extra care at Christmas, particularly if you are buying special dishes that you aren’t familiar with, or if you are having catering. Check ingredients lists carefully. 

Alcohol

A little sherry whilst cooking is a perk of the chef, but accidents are more likely to happen in the kitchen and the home if you drink too much. Alternate alcoholic drinks with soft drinks and perhaps wait until you sit down with a meal before you pour.  Make sure any residual alcohol is emptied out of glasses, so children and pets can’t get to them. 

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Choking

Keep glass and fragile decorations out of reach of toddlers and pets, and check toy safety standards. Small parts from gadgets or crackers can be a choking hazard for children.

Decorations

More than 1,000 people each year are hurt while decorating their Christmas tree according to RoSPA, usually whilst adding the star or the fairy to the top branch. Don’t use unstable chairs or stools – always opt for a step-ladder.

Fairy Lights

350 people a year are injured by Christmas tree lights, either during falls, by electric shocks and burns, or by swallowing the bulbs – they can look like sweets to young children. Test your lights and wiring before you put them up. RoSPA reports that between 1997-2010, 26 people died as a result of watering their Christmas tree with the lights on. Make sure you unplug them first.

Fires

People are 50 percent more likely to die in a house fire at Christmas than at any other time of the year. It is important to keep Christmas cards, paper decorations and the Christmas tree away from candles, fires or heaters, make sure your smoke alarms and your Carbon Monoxide detectors are working, and don’t borrow batteries from your smoke alarm to power a Christmas toy.

Food poisoning

There are around one million cases of food poisoning every year – make sure you defrost and cook your turkey thoroughly. Salmonella poisoning can be life-threatening for some people. Never risk taking short cuts as it takes hours to cook the bird properly.

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Kitchen Hazards 

Hot oven trays, boiling water, knives and spills can make the kitchen hazardous, and accidents while preparing Christmas food are common. Burns from hot fat are common, too. Make the kitchen a no-go area for pets and children, wipe up spills swiftly, treat small burns by holding them under tepid running water for 20 minutes, and don’t dig into the wine until you are at the table.

Stairs 

Falls can be very serious, particularly for the elderly, and strewn toys and wrapping can make stairs and cramped hallways accident hotspots at Christmas. Keep stairs, entrances, exit and hallways clutter-free. 

Plants

Holly and mistletoe might add festive romance, but their berries are toxic. Choose non-toxic Christmas foliage, or keep them away from children and pets. 

Batteries and magnets

Many Christmas novelty items will have small button batteries that are easily accessible to children. They can cause internal bleeding or perforation. Small magnets can also cause bowel perforation. Check that all batteries and magnets are secured inside toys, remote controls and novelty cards and gadgets. 

*Data from RoSPA (Royal Society for the Prevention of Accidents)

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Health

From a girl who dreamt of being a nurse to retiring aged 75

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A nursing career that dates back to 1964 has finally come to a close for Swansea’s Hazel Eastman.

Hazel has decided to retire at the aged of 75, to spend more time with her family – including her soon-to-be eight grandchildren.

“I would have kept going if I could but it’s a very tough, demanding job – more now than ever – and I have had some health issues.

“It’s been a part of my life for so long and it’s hard to break that routine,” said Hazel.

“You really get to know your patients and I enjoyed working with my colleagues. You could share problems and have a laugh too. I will miss it terribly but I have a lot of good memories.”

In 2016, Hazel, then aged 70, featured in a health board media release about her long career. She recalled how nursing was something she had wanted to do ever since she had her tonsils out as a little girl.

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“I wanted to nurse and look after people. I remember having all the teddies and dolls on my bed and sticking needles into them.

“I had a shock when I went nursing and found out it’s not just sticking needles in people!”

Hazel in her SEN days.
The photo was taken in the late 1970s
(Image: Swansea Bay NHS)

Hazel first donned the student nursing uniform in 1964 at the age of 18 in Morriston Hospital.

She was involved in elderly care for most of her career.

In the mid-1960s she transferred from Morriston to Swansea’s Mount Pleasant Hospital where she trained to become an SEN – State Enrolled Nurse.

Every Christmas Day, Hazel and her colleagues would wear fancy dress to make it a special occasion for their patients.

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Hazel remained in Mount Pleasant for 23 years, during which time she converted to an SRN (State Registered Nurse).

During her time there, she also gave birth to identical twin daughters, in 1967, and later to her third child, a son.

Over subsequent years Hazel worked in Hill House and Fairwood Hospital until it closed in 2010, when she was redeployed to Gorseinon Hospital.

In later years she nursed part time and now, finally, has called it a day. But with seven grandchildren, and with an eighth on the way, even in retirement she will still be kept very busy.

She’s also the first person her family calls on when there is an injury, illness or when any medical attention is required. 

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Hazel, aged 70, pictured in Gorseinon Hospital in 2016 (Image: Swansea Bay NHS)

Deb McNeil, unit matron at Gorseinon Hospital said: “I have had the pleasure of working alongside and getting to know Hazel very well for the last four years.

“Hazel makes me smile when I think of her, on a personal level I think of her very witty humour and professionally I am in awe of her achievements and dedication to our health board and ultimately our patients.

“Hazel has a generous nature and will always go above and beyond for both staff and patients alike.

“I remember times when she would volunteer to work every Christmas to give staff time off with their young children.

“Hazel is very much a go-to person, with her trustworthy way and her wealth of life experience that we all as a team learned from and cherished.

“Both personally and on behalf of the whole team I want to say a huge thank you all of your years of service, your dedication and commitment to your role and for your support over the years.

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“You really are an inspiration to us all. Congratulations on your retirement, love and best wishes.”

Lead Image: Hazel outside Gorseinon Hospital, where she worked after redeploying there in 2010 until her retirement (Image: Swansea Bay NHS)

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Neath Port Talbot

Digital solution saves nurses hours filling in essential paperwork

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Countless hours spent completing essential paperwork for patients is fast becoming a distant memory for nurses and other healthcare staff in Neath Port Talbot Hospital.

The nursing documentation required for a single admission to hospital can run to more than 70 pages.

This is not only time-consuming, but frustrating for patients and carers, who may have been asked the same questions several times by healthcare staff elsewhere before they came into hospital.

Now a digital solution known as the Welsh Nursing Care Record (WNCR), is being rolled out across Wales. It means much of this work can be done electronically – saving time and improving patient safety.

The WNCR has involved developing standardised e-documents, allowing the same patient information to be recorded across the whole of Wales.

To begin with, the admission assessment, along with six core patient risk assessments including nutrition, falls and pain, were standardised, with work ongoing to add more.

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WNCR went live in Neath Port Talbot Hospital earlier this year following a pilot in March 2020. Staff now record and access patient information using computer devices.

Feedback has been really positive, with many nurses reporting it has freed them up to spend more time with patients.

Clinical nurse specialist Tracy Jones said: “It takes about an hour to complete a comprehensive nursing admission.

“There are about 70 pages to admission documents which the nurses or healthcare support workers have to complete for every single patient that comes in.

“On every one of those pages they have to put a sticker with the patient’s ID on.

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“Handwriting can be illegible. Pieces of paper don’t stay in the same order, there’s no spellcheck, there are lines crossed through. It becomes messy.”

Staff nurse Zoe Evans is one of the many nursing and healthcare staff at Neath Port Talbot Hospital to use the system (Image: Swansea Bay NHS)

As well as having to fill in all the forms when patients are admitted, risk assessments have to be updated daily and weekly. Yet more paperwork has to be completed when the patient is discharged.

Senior matron Liz Williams said: “The aim of WNCR is to release nurses from the administrative burden of completing essential paper nursing documents, allowing them to spend more time on direct patient care.

“Digitisation of the nursing documentation has enabled more remote working. For example, dietitians and physiotherapists can access patient notes without having to come to the ward.”

The information is also instantly available when the patient is discharged, and is fed into the Welsh Clinical Portal, the national digital patient record.

This means the information is available to NHS healthcare staff wherever in Wales the patient receives care.

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Swansea Bay developed an electronic nursing assessment that was piloted in NPTH Ward A in 2018. It was shown to save around 10 minutes per admission for nurses and 20 minutes for healthcare support workers.

The WNCR was subsequently developed in Swansea Bay on behalf of Digital Health and Care Wales, which selected it as the basis of an all-Wales solution.

WNCR went live in five wards in Neath Port Talbot Hospital in April this year, with a sixth ward added in August.

The hospital was chosen because it was already using another digital solution, HEPMA – Hospital e-Prescribing and Medicines Administration – so the nursing teams were familiar with the technology involved.

HEPMA automates the prescribing and administering of medicines for patients in hospital, again saving time and reducing the risk of errors.

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Neuro-Rehab Ward Manager Christine Evans using WNCR  (Image: Swansea Bay NHS)

Swansea Bay’s Digital Programme Manager, Marc Thomas, said: “Nurses and healthcare support workers have embraced the technology and the new digital ways of working.

“Implementing WNCR after HEPMA contributed to its success, though that wasn’t the only reason – we had vast support from our brilliant team of corporate nursing colleagues.

“But it really made it easier because, while the type and amount of information going into WNCR is wide and varied, the staff were already confident with the devices.”

Nursing staff are proud of what they have achieved, especially as Neath Port Talbot is the first hospital in Wales to have both HEPMA and WNCR.

For example, ward sisters receive regular reports showing when the last risk assessments were completed.

Tracy said: “Some display them on the wall so the nursing teams can see them.

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“When they were first printed out, there were lots of red on the reports which showed what was out of date or overdue. Now it’s all green on some wards.

“The nurses are really proud of that. They can see how they’ve improved their practice and they’ve improved patient safety and patient care.

“We had a visit from another health board and they were so impressed by how our reports were being used to improve care and how the nurses were taking ownership of them.

“It’s a much more professional way of completing nursing documentation, and safer for the patient and for the staff.”

Liz said the implementation had been successful because the system was intuitive and had been designed with nurses in mind.

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“We’re fortunate because it was originally designed in this health board, which we should be really proud of,” she added.

“We’re now planning our next roll-out, at Singleton Hospital this November.”

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Swansea

State-of-the-art stroke unit proposed for Morriston Hospital

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A state-of-the-art stroke unit offering 24-7 emergency care could be developed at Swansea’s Morriston Hospital.

The health board is developing a proposal for what’s known as a hyper-acute stroke unit, expanding on the existing facility based in Ward F.

It would bring together experts and equipment under one roof to provide world-class treatment whenever patients need it.

Another proposal is the creation of an Acute Hub for patients requiring urgent unplanned medical care but who will not need to stay there for more than 72 hours.

These form part of wider proposals to reconfigure services across Swansea Bay, creating a series of different Centres of Excellence in each main hospital to avoid delays and rapidly work through sometimes lengthy waiting lists.

If the proposals – contained in a document called Changing for the Future, which is currently out to engagement until Friday 1st October – are approved, all urgent and emergency medical and surgical cases would be brought to Morriston.

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The hospital would then become Swansea Bay’s Centre of Excellence for urgent and emergency care.

As part of these proposals, acute medical wards at Singleton would transfer to Morriston, with the space created allowing Singleton to become the centre of excellence for planned care (operations/treatments by appointment.)

An important part of the Morriston proposals is the development of the Acute Hub, which would be centred on Enfys Ward.

This is the former outpatient waiting area that was temporarily converted into an additional intensive care facility during the pandemic. The proposal is to continue to use it for clinical care in the future.

The Acute Hub would bring together existing services from several sites, and some new ones.

It would ease the pressure on the hospital’s ED by diverting many urgent, but not 999, patients its way. For many people it would provide alternatives to hospital admission.

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Developing the Morriston Acute Hub would ensure staff with the right expertise could work together in one place, rather than be spread across various sites. The service would be more joined up and effective.

It would also mean patients who need to be seen urgently, but don’t have life-threatening illnesses, would no longer have to wait behind very sick people in the ED for diagnosis and treatment.

Instead, they would be seen on the same day by new or expanded multidisciplinary clinical teams and receive diagnostic tests and treatments.

One of the services proposed to relocate there is the very successful Acute GP Unit (AGPU), currently based in Singleton.

Dr Stephen Greenfield

AGPU is staffed by experienced GPs and other healthcare professionals. Dr Stephen Greenfield, who leads the service, explained: “Any GP wanting to admit a patient into hospital comes through us.

“We have a discussion with the GP. The outcome could be advice and discharge, so the patient does not come anywhere near a hospital, or referral to a community team.

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“Some patients will come to AGPU and have ambulatory care – tests and investigation but they are not admitted. Others may have to be admitted.

“Currently, between 50 and 60 percent of the patients we deal with do not end up coming into hospital.

“Some are advised or referred to community services, some are seen in AGPU and then discharged.

“This is better for the patients because there are unintended consequences of coming into hospital such as the risk of picking up infection or losing muscle strength through inactivity.”

AGPU also works with the Welsh Ambulance Service, redirecting some patients who have not yet had a paramedic review to more appropriate services rather than be brought into Morriston ED by ambulance.

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The unit will move to Morriston on a temporary basis as part of the health board’s ongoing response to the pandemic.

This has been agreed with patient watchdog Swansea Bay Community Health Council, ahead of the conclusion of the engagement which proposes making these and other changes permanent.

The Acute Hub would also bring together other services, some of which are well-established while others are new.

For example, GP Out of Hours, which was temporarily moved during the pandemic, has now relocated back to Morriston, into Enfys.

The hub would also incorporate Morriston’s existing Older Person’s Assessment Service, which assesses clinically appropriate elderly patients who might otherwise have gone to ED.

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In a new development, the hub will support the all-Wales 111 First initiative, due to launch in Swansea Bay later this year.

An expansion of the existing 111 service, it will use expertise within the hub to offer alternatives to patients who might otherwise end up in ED.

These alternatives could include appointment slots in the Minor Injury Unit at Neath Port Talbot Hospital or a direct referral to one of a range of services, such as respiratory or mental health.

Morriston is also home to a new, Welsh Government-funded Urgent Primary Care Centre (UPCC) which is strictly by referral from ED only.

“It is not a walk-in service and there is no direct public access,” said Dr Greenfield. “People cannot just turn up if, for example, they cannot get an appointment in their own GP practice.

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“Instead they are triaged and, if it is felt they need to be seen on the same day, they are referred to the UPCC.

“If it is not urgent and they can be seen by their own GP another time, that can be facilitated for them.”

Bringing these key services together, as outlined in the Changing for the Better proposals, would help take pressure off ED.

But, just as importantly, the new hub is intended to ensure all patients get the best care for their needs, in the best place to receive it, and without delay.

“It’s about ensuring that, whatever patients present with and wherever they have come from, they are going to the right place and are treated by the right person,” said Dr Greenfield.

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Another part of the proposals to centralise all urgent care and emergency services at Morriston involves the creation of a hyper acute stroke Unit (HASU).

There is evidence that having a single specialist centre is the best way to provide excellent care and deliver best outcomes for patients.

HASUs have been developed in parts of England, resulting in fewer deaths, improved recoveries and greater cost-effectiveness.

Swansea Bay’s Deputy Chief Operating Officer, Craige Wilson, said: “We are doing reasonably and consistently well, compared to other health boards, against the performance indicators in Wales.

“However, like all of the health boards in Wales, we are not hitting the UK standards and our aspiration is to do that.

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“We already have a stroke unit based on Ward F in Morriston so it would not be about moving services from different locations to create a hyper-acute stroke unit.

“Our major limitation is staffing. We don’t have the medical or nursing staff we need to provide a 24-7 service so a hyper-acute unit would involve a considerable investment in staff.”

People with suspected strokes should have a brain scan, ideally within one hour, so doctors can decide on the right treatment.

Most strokes – around 85 per cent – are known as ischaemic strokes, caused by a blockage in the artery leading to the brain.

The treatment for this is thrombolysis, using medication to break up the clot blocking the blood supply. This should be given within four-and-a-half hours of the stroke symptoms starting.

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It’s essential that the CT scan is carried out beforehand as these clot-busting drugs can exacerbate the other, less common, type of stroke, haemorrhagic stroke, which is bleeding in or around the brain.

Mr Wilson said: “The vision for the future is to have the hyper-acute stroke unit with rapid access to CT and sufficient medical and nursing workforce to thrombolyse patients, where appropriate, in a timely manner, 24 hours a day, 7 days a week.

“That’s the crux of the matter because the quicker we can do that, the better the outcomes are for the patients.

“The issue is, the level of investment that is required to actually achieve that, and a realistic timescale to recruit all the required staff.

“It’s not something that can happen overnight. So we have put together a proposal to do this in three phases over a couple of years.

“This will allow us to incrementally increase our staffing numbers to get us to where we want to be.”

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As part of Changing for the Future, the health board is proposing a rehabilitation centre of excellence at Neath Port Talbot Hospital, which would support patients who have received urgent care in the Hyper Acute Stroke Unit.

This rehabilitation centre of excellence would include specialist rehab services such as neuro-rehabilitation and stroke rehabilitation – instead of the current service which is split between both Neath Port Talbot and Singleton hospitals.

In early 2020, Swansea Bay introduced an early supported discharge team for patients who are medically ready to leave hospital following a stroke but still require rehabilitation.

Mr Wilson said this had led to a reduction in the number of patients having stroke rehabilitation in the two hospitals.

“If we have the opportunity to bring all the rehabilitation staff into one location, we would have better outcomes for patients. That’s also part of our overall stroke pathway.”

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Lead image: Dr Steve Greenfield in Enfys ward with Dr Helen Dean, who works in the GP Out of Hours and Urgent Primary Care centres (Image: Swansea Bay NHS)

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