Priory Hospital Cheadle Royal - Cedar Unit

There are many people who make up the Cedar team and we are all dedicated to providing you with the best possible care. We understand that meeting with so many new people can be overwhelming, so we have listed a few key team members to hopefully make this easier.

There are also many Registered Mental Health Nurses and Healthcare Assistants whose roles include administering medications, ensuring diet plans are given correctly, having one to one sessions with you, providing day to day support.

You will also be allocated a nurse to act as your key worker and two or three HCA’s for consistent support and help. You can meet your team on a 1:1 bases each week. Your team will get to know you as an individual and help you to set yourself goals, face challenges and help keep you on track.

Below is a daily schedule complied by past patients.

This is a list of various items you may like to bring with you, or ask your family and friends to bring in. These suggestions have been made by past patients. 

• Comfortable clothing, ensuring they are appropriate for the time of year. We also ask that clothing choices are not too revealing as other patients can find this distressing.
• A swimsuit to shower in if you are placed on level 3 or level 4 observations.
• All current medications. This will be given to the nursing staff and they will ensure medications and dosages are given correctly. 
• Laptop/tablets/phones.
• Money for personal use. 
• Personal items to keep you motivated. 
• Bedding. We always provide bedding but some people wish to have their own.
• Hobby and craft items. 
• Books.
• Pens and notebooks.
• A blanket.
• Puzzle books.
• A mug for the dining room (we have spares if not).

Certain items need to be banned or restricted on Cedar Unit to help ensure the safety of all patients and staff.

Below is a list of items BANNED from Cedar. If you have brought any of these items with you, they will be removed and either given to your family or stored until your discharge.

• Any food and drink – this includes chewing gum and water bottles.
• Alcohol
• Explosives of any kind
• Caffeine
• Illicit drugs
• Knives
• Non-prescribed medications
• Psychoactive substances
• Weapons and replica weapons
• Wire coat hangers

The following items are RESTRICTED. This means that you may have access to them – they can either be kept in your room or in your patient locker – but they may have to be removed if there is a risk to yourself or others.

• Adhesive tape of any kind
• Aerosol containers
• Bath oil/bubble bath
• Batteries
• Cable/wire
• Wire bound notebooks
• Cans and tins
• Cigarettes and vapes
• Curling tongs and hair straighteners
• Dental floss
• Devices which can access the internet or recording devices.
• False nails
• Glass items
• Glass or metal nail files
• Hair dryers
• Herbal remedies
• Lighters and matches
• Magnets
• Mirrors
• Mobile phones and sim cards
• Nail clippers
• Nail polish remover
• Plastic bags
• Razor blades
• Scissors
• Sewing and knitting needles
• Sharp items
• Glue
• Wool and string

The following clothing items may also be restricted

• Any clothing with draw strings
• Hoodies
• Shoelaces
• Belts
• Loops in clothing
• Scarves
• Tights
• Dressing gown cords.

Ward round is a weekly review meeting between yourself and key members of the multi-disciplinary team (MDT). This is an opportunity for all professionals involved in your care to review your progress over the previous week and alter the treatment plan if needed. Family members or advocates are welcome to join if you wish for them to be there to support you. Ward rounds are held every week on either a Monday or Wednesday. This is your time to voice your opinions or concerns. You can also request things such as access off the ward during your ward round.

CPA stands for ‘Care Programmed Approach’ and is a meeting held four weeks after your admission and then every 6 weeks after that. This is a meeting to discuss your care and treatment and update your home team with your progress. You are also welcome to invite family or carers. The CPA report has a section for your views and the views of your family. The CPA report will be sent to you and everyone in attendance. If you do not wish the report to be sent to family or carers, please let us know before the meeting.

The Wi-Fi signal is sometimes not very strong so some patients choose to purchase a dongle instead. This is a pay as you go device which will provide your own internet and is more reliable. These devices can be purchased in stores such as Argos which is not far from the hospital.

Family and friends are welcome to visit you as often as they can, however we do ask that you prioritise treatment i.e. therapy and groups, so that you can make the most out of your admission. 

Any children visiting the ward must be accompanied by an adult. Staff may request that if you have children visiting you on the ward, that you have your visit in the quiet lounge. 

Please remind your visitors that any food or drink is not to be brought onto the unit and that their bag may need to be searched by staff to continue the safety of all in our care.

On the first day of your admission, you will meet with either Karen or Dom, our dieticians, who will work with you to develop a meal plan that you are comfortable with and that meets your nutritional requirements. They will also help you learn how to meet your needs and re-establish the internal physiological cues of hunger and satiety.
 
Diet plans move in a way that depends on your physical health and levels of activity. All meals are accurately measured. This is to reduce the risks of re-feeding syndrome. 

Diet is considered a part of your prescription and so any missed/refused diet is replaced with the Fortisip equivalent. Beliefs or fears about certain foods can be discussed with the dietician and staff can be made aware to offer additional support. 

There are six meal times per day – when you first start treatment you will be given an additional snack at 10pm to ensure that you remain physically stable through the night. 

All meals are given in the dining room and under supervision. Once you feel comfortable and confident in the dining room you can move onto the unsupervised table where you will take on more responsibility for your own diet, practice portion size and prepare your own breakfast and snacks.

Diet plans are broken down into four stages – 0,1,2 and 3 – and then each stage is broken down into three again – A, B and C. The stage you start on will be assessed by the dietician and you will then work your way up over a period of time to find the right plan for you that meets your needs. We do this so the ‘jump’ from stage to stage is lessened and easier to manage. If you do not gain enough weight, normally but not always around 0.5kg per week, your diet plan will be increased. Before your plan changes you will have an opportunity to meet with the dietitian so that you can move forward at a pace that you feel comfortable and the rationale for diet increase will be explained to you so that you can understand and agree to it. 

Every day, you will consume the same amount of overall nutrition but in different forms. This can be daunting for some people, as they may feel that a Sunday roast has more calorific value than the sandwich and crisps they have for lunch the previous days. Please try to keep in mind that every lunch is the same overall, just as every evening meal is the same each day. 
If diet is continually refused then the Cedar team will have to look at alternate treatment plans. In some cases, this can result in NGT treatment where a tube is place down the patient’s nose to the stomach and a nurse administers Fortisip. This is always a last resort and is only done if there is no other option. The patient will always be informed of a plan to use NGT. 

Meal plans are structured to help you with the ability to choose a balanced diet in a carefree manner using a variety of foods. This is initially achieved by prescription which will help you learn how to meet nutritional requirements and register internal cues of hunger and satiety. In the longer term, the meal plan will hopefully help you to resolve the fears you may have about food related issues and restore physical well-being. Meal planning also helps to develop life skills such as problem solving and we find that it is helpful to commit to one specific and relevant goal each week.

The menus on Cedar are designed to introduce the concept of a balanced diet where food groups are seen as neither ‘good’ nor ‘bad’. Using the principle of regular meals and snacks, following the REAL food pyramid and the portioning system that we use will help you to re-establish a normalised eating pattern. 

Structured meals and menu planning requires the consideration of the following;

• Each meal plan consists of three meals and three snacks spread out over each day. 
• All meals are based on the ‘REAL Food Pyramid’.
• Dairy food provides a balance of nutrients specific for tissue repair and so are essential. Dairy alternatives can be discussed with the dietitians if necessary (e.g. if you are lactose intolerant).
• Menus can be adjusted around any allergies and food intolerances.
• Fruits and vegetables are included.
• Adequate fluid is necessary however we do not allow carbonated or caffeinated drinks on the unit.
• There are always vegetarian options available.
   

Patients are not permitted to enter the dining room without staff present. All patients are allocated a seat in the dining room with one or two other patients and a member of staff. Seating arrangements change regularly.

The staff are there to offer you support and demonstrate normal eating patterns. They are not there to judge you. Staff are trained on how to notice if someone needs help and how to do this but it is equally important for you to use the staff and ask when you need help.  Let us know what you want your meal support to look like, do you like distraction? Do you prefer silence?

Once you are seated it is important to remain seated until you are finished. If you become upset, please call over the meal co and they will take you out of the dining room and provide support. If at any time you leave the dining room your meal may be documented as a refusal if you don’t return within 10 minutes.

Cedar is rather boundaried with the dining room and we understand that this can be intimidating. Staff try to discourage ‘disordered’ eating behaviours. Disordered eating is very common and a symptom of an eating disorder. For example, you may have a thought along the lines of “if I have to eat it, I will eat it a certain way so I feel in control”. You may receive two gains from this, 1) having a small amount in your mouth may feel easier for you and 2) by creating crumbs or braking part off you may feel you are not having to eat the whole meal. To combat this, staff will ask you to finish your meal, any food left will be replaced with Fortisip.

Wind down takes place after each meal in the lounge. This is a time that patients sit together and utilise staff and activities for distraction. If you need additional support this can be arranged.

Please be aware that if at this time you need to use the bathroom, staff will accompany you.

You will be asked to remain seated during this time.

During this time, we discourage any discussions of diet plans or comments about the meal just eaten to take place. This is because other patients can find this distressing. If staff hear these conversations, they will encourage you to discuss something different. 

There should always be at least one member of staff in the lounge during this time. Staff will also offer activities such as games to help you.

When you are reviewed by the medical staff, they will prescribe you your current medication along with any others you may need. Your medications will be reviewed each week and if you have any concerns a doctor can be called to discuss this with you. Your medication will be prescribed at times which are suitable to you however below are the general times we give out medication.

All medication is administered in the clinic room by the nurse.

• Morning medication – 08:00
• Lunch medication – 13:00
• Evening medication – 17:00
• Night medication – 22:00
• PRN as needed.

When you first come to Cedar, you will be placed on a 7-day algorithm. This is in accordance with the MEED guidelines. This means that staff will take your physical observations every four hours. These consist of blood pressure (both sitting and standing), heart rate, oxygen saturation, and temperature, breathing rate, and blood glucose levels.

Blood tests and ECG’s will be taken daily.

The above gives the doctors a better understanding of your physical health and any areas of concern. It also allows us to make sure that you are not developing any signs of ‘re-feeding syndrome’. This is a serious and potentially fatal condition that can occur when food is reintroduced after periods of fasting.

If you would like further information on this, please speak to a member of the team.

Every patient on Cedar is placed, by medical staff, on an observation level. This is to help staff to both monitor your health and reduce physical risk levels.

We understand that observations can be very intrusive and try to be as discrete as possible.

Depending on your needs, you will either be with a member of staff at all times (including when using the bathroom and when you’re asleep) or staff will come to check on you every 15 or 30 minutes. Observation levels can be increased by nurses if they feel you need the support. Observations levels are reviewed daily to ensure they remain necessary and are discussed each week in ward round.

Enhanced observations:

• Within arm’s reach: staff will be with you at all times at an arm’s length distance.
• Within eyesight: staff will be with you at all times, and must be able to see you.

Intermittent observations:

• Staff will check on you a certain number of times throughout the hour. This can either be: 12, 4, 2 or 1.

The ward hosts a community meeting each week. All patients and staff working that day are encouraged to attend. Please contribute in any way you can.

This is a space for you to raise any concerns or issues. It is also a place to reflect on what has gone well and provide mutual support and encouragement.

Everyone has a chance to voice their own thoughts openly.

The meeting is recorded and meeting minutes will be printed out and kept on the ward in communal areas.

After evening meal each night, the staff will offer to host an evening activity. It is your choice what you would like to do in this time. We can watch a film, play a game, do a quiz or play cards. Anything you feel like. Let us know.

We also have an OT assistant that will facilitate an evening activity a couple of times a week.

• Free parking is available to all visitors. Patients are discouraged from bringing their own cars. Please be aware that patient cars are not covered by hospital insurance.
•  ​​​​​​​Across the road there is a John Lewis, Argos, ATM, Coffee shop and Sainsbury’s.
• On either side of the hospital there are eating establishments.
• Next door to the hospital there is a Premier Inn.
• There is a bus stop outside the main entrance of the hospital and bus times can be found on the ward.
• The nearest train stations are Heald Green and Cheadle Hulme.
• We use a local taxi service whose information can be found on the ward.

We offer a wide range of groups to help you get everything you need out of your time on Cedar. There is a weekly group timetable opposite the nursing office which is updated weekly. Below are some of the groups on offer.

Attendance at groups is not mandatory however these provide you with a number of skills to support your recovery.

• Activity management
• Make and bake
• Jewellery making
• Dietetic forum
• Art therapy
• Needle felting
• Occupation matter
• Physical health group
• Psychology groups MANTRA – emotions, relationships, identity, thinking styles, compassion
• Bodywise group – Body Image

1:1 psychology

Someone from the therapy team will be allocated as your therapist (usually in the first week of admission) and attend ward rounds (to help think about your care in a psychological way). They will meet you for check-ins and to consider the option of one-to-one therapy. An assistant psychologist will meet with you in the first two weeks to talk through the psychology groups and explain what they focus on and how they could help.

A part of your therapy sessions will be around making sense of what has made you vulnerable to developing an eating disorder and what keeps it going.

Family therapy work

This brings together a person’s support systems and creates a space for conversations to take place. This often involves the immediate family members. It enables ways for people who care about each to express and explore difficult topics and understand each other better.

OT Team

We have an OT team who will approach you a few days after you admission. They will provide information about what they can offer to support you and your needs throughout your time here. They will also help you re-integrate back into your home setting.

IMHA

You are entailed to receive independent support from an advocate who will help you to express your views, access information and services, exercise your rights and explore choices and options.

• Every patient is given an individual bedroom with en-suite, TV and Lockable draw for personal items. The bathroom doors cannot be locked by patients so that staff can enter in emergency situations. Depending on your needs, staff may lock your bathroom at certain times of the day (such as after meal times). This will be discussed and agreed between yourself and staff, and we will always work with you to find the best way to support you. We also discourage patients from locking their bedroom doors for the same reason.
• The clinic room is where you will receive all your medications and have your bloods and ECG taken. This is also the room where we record your weight.
• A laundry room complete with washing machine, dryer and ironing board is available for you to use. The iron is kept in the nursing office to ensure safety and is available on request. We also provide laundry detergent and softener.
• There is a kitchenette in the upstairs hallway for patients and visitors to use, however you may be restricted using this if your fluid balance needs to be monitored for your physical health.
• The communal lounge has a TV, DVD player, DVD’s, games, jigsaws and various other activities to help provide you with distraction and entertainment.
• The quiet lounge is located next to the lounge and is used for 1:1 sessions, groups, pet therapy and any visitors with children. You are free to use this room whenever it is not in use.
• There is an OT room available on request.
• There is a family room and a multipurpose room for you to use during visits if you wish. It is also used for 1:1 sessions. There is a multi-faith area in the family room which patients and visitors are welcome to use to pray.
• There is a bathroom on the ward with a bath tub which you can use on request.
• There is also a sensory room available upstairs on the landing.