Priory Hospital Preston - Bartle Unit

Weekdays 

Monday to Friday the Bartle Unit team politely request that visits do not occur during your loved ones allocated group therapy programme or individual Therapy / Nurse sessions.  The ward asks that meal times and post meal supervisions are not interrupted.

Weekends

Visiting can be flexible over weekends, again, the ward asks that meal times and post meal supervisions are not interrupted.

Visitors are to sign in on arriving and sign out on leaving – the register can be found in the nursing office. A visitors badge is to be worn also.

The ward endeavours to support both yourself and your relatives / carers throughout the course of your admission.  Contact and discussion with your relatives / carers will only take place where your consent has been obtained.  With your consent your loved ones can access the following:

• Receipt of a carers pack at point of your admission
• A weekly update and support conversation with your allocated nurse
• Invitation to monthly Maudsely carers skills evening events
• Attendance at your weekly ward round
• Attendance at your 6 weekly CPA review meeting

We endeavour for all patients to feel settled on the unit. We want you to feel safe and your treatment to be a priority. Our aim is to support you in your recovery 24/7 whilst you are a patient on the unit; to offer you holistic care and treatment that is individualised, allowing you to feel empowered and positive and to gradually gain control of your disorder in a healthy way.

At times it will be challenging, but with the support of the whole team we hope to enable you to become more confident in your own abilities and more at ease with your own emotions.

We want patients to feel at ease whilst on the unit and understand fully that often patients like to bring home comforts. Below are things that we as a Unit allow and also items that may be best left at home, in order to support you to overcome any disordered thoughts or eating behaviours:

Items allowed

• Mobile phones
• Radios/ CD players
• Books/ magazines
• Games consoles
• Familiar bedding
• Interests, e.g. art work, knitting, sewing, puzzles, jigsaws

Banned / Restricted items

For the duration of your inpatient stay, no food should be brought onto the ward and all diet consumed will be provided by the Priory. We will do our best to accommodate dietary needs and preferences. If you have any food or drinks with you from the list below upon admission then please give them to a staff member. Your food/drink items will be returned to you when you are discharged.

• Sweeteners – if you would like to sweeten a beverage then please use sugar
• Carbonated drinks
• Caffeinated beverages – all drinks provided will be caffeine free alternatives
• Chewing gum
• Green tea / herbal tea and mint tea or any diet related fluids
• Cinnamon
• Any diet pills, supplements or products thought aid weight loss/dieting

Using any of the above products to excess will interfere with managing the symptoms of refeeding and will prevent you re-establishing physiological cues of hunger and satiety. The potential for consuming these products when on leave from the unit can be discussed with the dietitian, as well as the rationale behind the above guidelines.

From September 2019 the Priory Hospital Preston has been a non-smoking site.

We are proud to have a Smoking Cessation Representative – Dr Catherine Carney.  She is available to discuss stopping/ reducing smoking if this is something you would like to challenge

On admission you will be given a smoking questionnaire to complete and also nicotine replacement will be offered to you if you do smoke at the time you are admitted

At present, we ask that smoking only take place at the designated area away from the main hospital.

We kindly ask patients to smoke their e-cigarettes outside also

Ward Round will be held weekly with your consultant. Timings will be displayed on the office door, please allow some fluctuations in timings

Patients are encouraged to complete a Ward Round Request Form for any issues/ questions they would like to bring to Ward round (please ask a member of the nursing team). Your thoughts, feelings and comments are very important to us.

During this time patients will be seen by the Consultant Psychiatrist, ward Doctor and ward representative

During this time the following will be discussed –

• Keeping Healthy: meal plans/ physical health/ post meal supervision/ medication
• Keeping Safe: observation levels/ MHA & Section 17 leave/ safety plans
• Keeping Well: self-care/Therapy/ Safeguarding
• Keeping Connected: confidentiality/ leave/ discharge planning/ ward activities
• Weight/ Compliance/ Mood

If you would like to attend church/mosque or an alternative place of worship, please inform staff and this can be discussed in ward round. We feel it is very important that patients keep connected during their admission here and we are encouraging of maintaining beliefs and cultural practices.

Based on the ground floor of the hospital we have a room dedicated as a multi-faith room, of which patients can use. If you would like to use this space please ask a staff member. We can also support you with religious items such as prayer mats if needed. 

We can also provide a translation service if there is a preferred first language or BSL need; to ensure clear communication at key meetings. This should be identified at point of admission to support yourself with translation services throughout your inpatient stay.

As the unit has two lounge spaces, the larger lounge is a mixed (male and female lounge) and the smaller lounge is a female only lounge. We acknowledge that all individuals have a right to privacy and dignity and we endeavour to respect that

The Priory group recognises that all persons have the right to live their lives free from violence and abuse. This right is underpinned by the duty on public agencies under the Human Rights Act (1998) to intervene proportionately to protect the rights of citizens.

The Children’s Act 1989 states that the welfare of children and young people is paramount. This includes their right to be safeguarded against all forms of abuse. Our Safeguarding duties towards adults are set out in the Care Act 2014.

We take the safeguarding of our inpatients and outpatients seriously. Our legal duties extend to responding to any concerns about the neglect, physical, sexual or emotional abuse of any children (under the age of 18) connected to our inpatients and outpatients.

The Priory Group recognise that confidentially is an important part of your therapeutic relationship; however, where there is a risk of abuse or neglect the Data Protection Act 2018 enables the lawful sharing of information:

• Emergency or life-threatening situations may warrant the sharing of relevant information with the relevant emergency services without consent.
• The law does not prevent the sharing of sensitive, personal information within organisations. If the information is confidential, but there is a safeguarding concern, sharing it may be justified.

If you disclose a risk of abuse (current or historic) to staff either:

• during your stay as a patient,
• as a day-patient,
• in a therapy group,
• in 1:1 therapy,
• in an outpatients appointment
• or if you are a relative visiting, attending a meeting or family group

… a record will be made and the information will be shared with the safeguarding team and the patient’s multi-disciplinary team to ensure that proportionate action is taken as a response to the risk disclosed.

Where abuse is seen as ‘historical’ the Priory group recognises that the alleged perpetrator may still pose a risk to others. Staff will encourage you to provide details of those at risk and the alleged perpetrators, however it is important to note that unless we are provided with information that enables us to identify the perpetrators staff may not be able to initiate a safeguarding response. We hope that you feel able to provide the details to allow staff to use the information with an aim of preventing further abuse, to yourself or to others.

The Hospital Director is responsible for safeguarding practices at Priory Preston and our local safeguarding lead is:

Steve Wallace / Danielle Pritchard     -  DESIGNATED SAFEGUARDING OFFICERS

Main meals are 45 minutes in duration and snacks 30 minutes, all of which will be held in the dining room

• Breakfast: 8.30am-9.15am
• Morning Snack: 10.30am-11.00am
• Lunch: 12noon-12.45pm
• Afternoon snack: 2.30pm-3.00pm
• Tea: 5.00pm-5.45pm
• Supper: 8.30pm-9.00pm

We ask patients to be prompt to the dining room to facilitate the safe running of the unit.  Late arrivals will be discussed with patients individually regarding potential outcomes

• PMS will take place in the large lounge following each meal and will be supervised by staff, patients are not to return to their bedrooms prior to going to the lounge
• PMS is compulsory unless decided otherwise by the Multidisciplinary-Team in your weekly ward round
• During this time we ask that patients remain seated and rest. If you need to use the bathroom this can be done with the supervision of a staff member
• No drinks are to be consumed during PMS

PMS following main meals – 30 mins

PMS following snacks – 30 minutes

PMS will start from when diet has been completed in the dining room. 

• Morning: 7.30am-8.00am
• Lunch: 11.30am-12noon
• Tea: 4.30pm-5.00pm
• Evening: 8.30pm-9.30pm

• Patients are requested to attend the clinic for all medications within these time slots
• Patients are requested attend the clinic in a timely manner as not to interfere with meal times

No discussions about weight, diet, care plans are to be discussed at meal times. If a staff member suggests the conversation is inappropriate it must cease immediately

1. Patients are to sit still whilst seated at the dining table
2. All plates, bowls and yogurt pots must be clean when finished with, staff will check this prior to supervision
3. No more than 2 glasses of fluids at meal / snack time
4. All meals are portioned out by the kitchen and are checked by the meal coordinator – these should not be questioned
5. Maximum of 1 sachet of salt and 2 sachets of pepper per hot meal
6. Maximum of 2 sauce sachets per meal (vinegar is classed as a sachet). Appropriateness of the sauce is at the discretion of the meal coordinator/ unit staff.
7. Meals cannot be reheated
8. Cordial can be added to water and Nesquik added to milk – to be prepared by staff as per product instructions
9. Patients may have warm milk on porridge and Weetabix if desired. Staff are to heat the milk and this is not to be scalding hot
10. Cereal must not be eaten dry; milk (not water) must be added
11. Finger foods must be handled appropriately e.g. toast/ sandwiches/ buffet items must be picked up and eaten and not be ripped up or picked apart
12. Cutlery is not permitted with finger foods e.g. sandwiches/toast/fruit/buffet items (except a fork with melon and for the salad accompanying sandwiches)
13. A dessert spoon must be used for cereal and puddings. A teaspoon may be used for yogurts if desired

Items we ask not to be brought in the dining room:

• Non clear cups
• Tissues/paper towels
• Hats
• Gloves
• Scarves
• Bags
• Mobile Phones/laptops/newspapers
• Electric cigarettes
• Clingfilm/ tissues

There are 2 supervised tables (Red & Amber) in the dining room and 1 unsupervised (Green)

Patients will be allocated a seat on admission – this will be dependent on the level of support that person requires

• The Red table is for patients who require more support around their eating and who may display more eating disorder behaviors
• The Amber table is for patients who require less support and supervision 

Seating arrangements within the Red/Amber tables will be changed sporadically and patients will be moved amongst the tables at the discretion of the MDT.  This will be discussed at your weekly ward round.

These are in place to facilitate dietary variety, normalisation of the eating process and challenging of eating disordered behaviours.  We aim to enhance your dietary coping strategies and skills throughout your admission here.

The team recognise that adhering to such guidelines will be very challenging and we are here to support you.  Please remember, you are not alone.

All menus will be handed out to patients on Fridays and should be returned to the red file in the ADL by Monday lunchtime. If menus are returned after this time and changes are needed, these are unable to be discussed with you. If menus are not in by Wednesday lunchtime, the Dietician will have to make choices for you. If you require help with your menu, please ask Meal Co or speak to the Dietitian, they will be more than happy to help you.

We appreciate that you may find some of these guidelines difficult and value your cooperation. The guidelines are in place to help normalise your eating, introduce variety and balance into your diet and to challenge and re-educate you in your attitudes and beliefs towards food, eating and general health.

Breakfast

• There must be 3 types of cereal each week (between breakfast & supper) and the frequency of each must be reasonably equal. Cereal choices available are Weetabix, Cornflakes, Fruit and Fibre, Branflakes, Shreddies and Porridge. The same applies for supper.
• Toast may be swapped for crumpets twice a week ( 1 slice = 1 crumpet)
• Porridge is made with milk. Toast will be made with butter/margarine in addition to the topping that is chosen – nutella/ jam/ peanut butter/ marmalade.

Hot meals

• One swap can be made each week.
• The hot swap is not to be made on a Friday or Sunday.
• All Sunday dinners should include roast potato and new potato as a carbohydrate source.
• Every Friday dinner is a challenge meal of pie/ battered fish/ sausages/ pizza/ burger or lasagna served with appropriate accompaniments.
• A red meat/ iron rich hot meal must be chosen at least once per week.
• All jacket potatoes will be served with margarine or butter (whichever you prefer).
• One dessert swap per week will be allowed – the alternative is ice cream/ cake & custard/ fruit & cream or custard.
• At least one hot pudding from the menu must be chosen per week.

Sandwiches /cold meals

• Cold meals will include pasta/ cous cous or sandwiches (sliced bread, pitta bread, barm cakes or wraps). Patients can make one cold meal swap per week.
• There is a choice for white or wholemeal bread for the sandwiches (also breakfast and supper).
• If mayonnaise is a dislike then the sandwich filling will be made with salad cream
• Please state fillings fully and clearly eg ‘tuna mayo’ not just ‘tuna’. If this is incomplete it will be added when checked
• All toast and sandwiches (except for when stated on the menu) are served with flora
• If salad is not included in the sandwich it will come as a side salad
• Turkey and chicken are similar in nutritional content and count as the same type of filling. If chicken is not available the kitchen may have to replace this with turkey

Snacks and supper

• Portion sizes of snacks and supper are dependent on re-feeding stage and meal plan as agreed by the Dietitian.
• All snacks vary between fresh fruit, biscuits, cereal bars, cake bars, chocolate, nuts/dried fruit and crackers with topping/ houmous & vegetable sticks.
• The same fruit should not be chosen more than 3 times per week.
• Nesquik, Hot chocolate and Horlicks can be added to milk. Please mark on your meal plan if you would like these.

Dislikes

• Three genuine dislikes can be stated on admission. Please think carefully about what they are.
• Unfortunately, you cannot request meals to be altered e.g. Chinese vegetables with cashew nuts cannot be requested without the nuts (unless you have a confirmed allergy).
• Patients may only choose a dislike between:
• Butter or margarine- there must be one used where appropriate.
• Salad cream or mayonnaise- there must be one used where appropriate.
• If cheese is a dislike the type of cheese must be specified e.g. blue or soft or hard or cooked/uncooked cheese.
• Vegans & vegetarians are not able to choose cheese as a dislike (due to its nutritional value).
• If onions are a dislike please be aware that most vegetarian meals/ hotpots/ stir fry’s will contain onions and if ordered you will be expected to complete the meals containing onions.
• If red meat or fish is a dislike it must be stated on the meal plan and a different meat dish will need to be chosen instead.
• You can choose to dislike a flavour e.g. Vanilla flavour, however this would mean that you do not have any of these flavoured items e.g. Yoghurts, ice cream, milk shake etc  and an alternative flavour will be given e.g. strawberry.
• For any snacks that are a dislike a suitable replacement will be determined by the Dietitian.

• If you have progressed to the stage where you are permitted to prepare your own breakfast or supper, for health and safety reasons, this will be done as per discussion with the Dietitian and timetabled in the ADL.

Fortisip Replacement

• Any diet left will be replaced with the nutritional supplement Fortisip. If half a plate of food is left, 50% of the meal calories will be replaced with Fortisip

Allergies                                                                                                 

• You will be asked on admission if you have any food allergies, please inform staff who will inform the kitchen. The dietitian will also ask about any food allergies you may have which will then be documented on your meal and care plan & inform the kitchen.
• The 14 allergens are: celery, cereals containing gluten (such as barley and oats), crustaceans (such as prawns, crabs and lobsters), eggs, fish, lupin, milk, molluscs (such as mussels and oysters), mustard, peanuts, sesame, soybeans, sulphur dioxide and sulphites (at a concentration of more than ten parts per million) and tree nuts (such as almonds, hazelnuts, walnuts, brazil nuts, cashews, pecans, pistachios and macadamia nuts).

Halal/Kosher Meals

• If you require halal/kosher meals please let us know.

• On Bartle we have an area for patients to wash and dry their clothing and bedding. This space is located next to the ward office. Laundry powder is provided but you are welcome to use your own
• Located at the bottom of the main corridor is the Nook, this is where patients can make hot/cold drinks and also has an additional sensory room.   
• We have 2 communal lounges and a therapy room for individual therapy sessions
• Located on the ground floor is a conservatory where group sessions take place and art therapy. This space can be used by patients’ ad-hoc also
• Each bedroom has an ensuite bathroom. Clean towels will be provided daily by housekeeping
• We have a ward garden based at the rear of the hospital, which can be found by going through the conservatory. This outside space is for Bartle patients only

With the big help of our ward Occupational Therapists, Occupational Therapy Assistant and Dietitian groups and sessions are put on each week for patients to attend. These groups are optional, however, we really do recommend that patients attend, as these times are great for learning new skills, challenging yourself, and also, it gives patients the chance to listen and learn from others. The weekly planners can be found on the notice board by the clinic.

We have groups such as:

• Anxiety Management 
• Mindfulness 
• Relaxation sessions 
• Textiles 
• Creative Class
• Sandwich Making
• Leisure Group
• Discharge Preparation 
• Social Snack
• Nutrition education
• Medical Consequences 
• Gardening classes 
• 1:1 OT sessions 
• Art Therapy classes
   

All patients will have CPA meetings these are scheduled every 6 weeks, or prior to discharge, whichever is earliest. Carers and Families are encouraged to attend with patient consent.

The purpose of CPA meetings is information sharing amongst all agencies to ensure the best support is in place for patients both on the unit and on discharge.

With patient consent an invitation will be sent to carers/family members along with a feedback questionnaire to assist the Multi Disciplinary Team to work towards appropriate outcome.

Patients will also be provided with a feedback questionnaire to complete, which will form part of the CPA report.  The team welcome your thoughts and contribution and will aim at all times to work collaboratively with yourself throughout your admission.

You will be provided with a copy of your CPA report prior to your meeting, from which staff will welcome your comments.

Each patient on admission will be allocated a Named Nurse. The Named Nurse alongside the patient will construct individual care plans and help the individual make goals for what they wish to gain and change during their admission.

Sessions will happen once every 2 weeks (Named nurses can be approached outside of these sessions). A Key Worker will also be assigned (a Healthcare Assistant) of who can also be approached if you wish to speak to someone.

Patients are encouraged to prepare themselves for the sessions; if they wish to discuss specific topics. Making notes may be beneficial, as it is a prime time to discuss progress and areas for development.

Patient Forum

Patient Forum is held on the Bartle Unit weekly.  This is chaired by the Ward/Deputy Manager and the attendance of all patients is welcomed.  This is an opportunity for the Ward/Deputy Manager to discuss and explain any ward changes, issues etc that may be occurring.  It is also an opportunity for you to provide ward feedback and voice ideas and suggestions. 

Nutrition Forum

Nutrition forum is held monthly, chaired by the dietitian and head chef. This is an opportunity to discuss catering based issues and offer suggestions.

Most people with mental health problems are able to get treatment and support at home, sometimes with the help of their GP. But there may be times when you need to go to hospital to get treatment.

You are a voluntary patient (sometimes called an informal patient) if you are having in-patient treatment in a psychiatric hospital of your own free will. You should have capacity to understand that you are going into hospital and agree to treatment for your mental health problem.  To have mental capacity means being able to make your own decisions. You and/or your family can talk to staff if you have any questions about mental capacity.

Being a voluntary patient is different to being sectioned under the Mental Health Act. Being sectioned means you are kept in hospital even if you do not want to go or do not want treatment. 

Hospitals have guidelines about what you can and can’t do that apply to everyone, whether you are a voluntary patient or you are sectioned – for example, meal times and acceptable behaviour. Policies about searching should include the rights of voluntary patients.

However, blanket restrictions – rules that restrict the freedom of all patients without individual risk assessments – should not be used such as limiting your:

• access to the outside world
• access to the internet
• access to (or banning) your mobile phone and charger
• incoming or outgoing mail
• visiting hours
• access to money or the ability to make personal purchases
• taking part in preferred activities.

Your rights

• You have the right to leave the ward
• You have the right to refuse treatment, including medication
• If you do plan to leave the ward or refuse medication, staff would like it if you would talk with them about your decision.

Your responsibilities

• Being Involved in your care and treatment plan
• Being involved in activities on the ward
• Telling ward staff if you have any concerns

• If staff are worried about you leaving they will explain this to you.
• You have the right to leave the ward unless staff have serious concerns about you.
• Doctors and nurses can stop you leaving if they are concerned about harm that may happen to you and others.
• If staff do stop you leaving the ward they will carry out a Mental Health Act Assessment.

• The doctor will discharge you when your inpatient treatment is complete or you can discharge yourself at any time.
• If you decide to leave before your doctor thinks you are well enough you will be asked to sign a ‘Discharge against medical advice form’, you do not have to sign it.
• After you have left the ward you may be seen by a community team.
• Your family and carers may also need to be told so they can support you.
• You may need to take medication home with you and staff.

If you would ever like to access a second opinion regarding any aspects of your care and treatment, the Bartle Unit team will support you with this request.  Please initially highlight this in your weekly Ward round and with the Ward Manager.

You are a detained patient (sometimes called a sectioned patient) if you are having inpatient treatment in a psychiatric hospital against your will.  In this case your admission will be under a section of the Mental Health Act 1983.

For detained patients your appropriate rights (based upon your allocated section) will be provided to you both verbally and in writing by Nursing staff upon admission.  This process will be guided by the hospital Mental Health Act Administrator.

If you would ever like to access a second opinion regarding any aspects of your care and treatment, the Bartle Unit team will support you with this request.  Please initially highlight this in your weekly Ward round and with the Ward Manager.

Your comments

• We would like to get your comments about the service you receive, both good and bad.   You will be asked to kindly complete a healthcare satisfaction survey sporadically during your inpatient ward stay.  These are completed anonymously.  This feedback helps us improve the service and care that we deliver. Please complete a Priory questionnaire at the end of your stay.

The Bartle Unit team aim to support you holistically throughout your admission Journey with ourselves.  If there are things we are doing well please let us know, so that we can further develop our service.  Compliments can be fed back via ward staff and the ward manager.  They can be discussed in the weekly patient forum.

We pride ourselves on providing service users with quality care and treatment. However, there may be occasions when an individual’s expectations are not met. Everyone has a right to report their concerns, including patients, relatives and friends.

Our complaints process has 3 stages:

1. Local Resolution – the complaint / concern will be investigated by the service manager

2. Internal Review – if unhappy with stage 1, the complaint will be coordinated by a Group Complaints Manager

3. Independent External Review – if unhappy with stage 2, the complaint will be reviewed by an external adjudication.

• Please address your concerns with a member of staff; if you do not wish to speak to a member of staff, you are able to take your complaint directly to the manager of the service.
• You can make your complaint either verbally or in writing – including via email
• Please request a ‘Making a complaint’ booklet from the nurse’s office
• We endeavour to help your and your families through your admission recovery journey

We have a responsibility to protect your personal information and uphold confidentiality. Personal information could include your name and address, or information about your care and treatment. We want you to know that any personal information you give to us in confidence will only be used for the purpose for which it was given (ie: shared between professionals involved in your care) and will not be shared with others without your permission. This means that if someone who is not directly involved in your care (ie: family/friends) contacts the ward asking for information about you, we will ask for your consent to share your information. It is up to you how much information, if any, is shared.

Upon your admission staff will ask if you give consent at that point for information to be shared with specific family / carers.  Your decision regarding confidentiality will be documented in your “Keeping connected care plan”.  Your named nurse will review this with you weekly.

If at any point during and after your inpatient stay on the Bartle Unit, you would like to access your Clinical notes – please request this in writing and give your request to the hospital director / your ward consultant or the ward manager.  Your request will be processed and you will be provided with feedback.

If you would like the support of an advocate, information on advocacy and how to contact them is on the notice board located across from the nursing office , please inform staff if you would like them to contact the advocacy service upon your request.  An advocate is someone who puts forward a case on someone else’s behalf and enables a person to see all options from a non-biased view point.

When a patient requires the aid of an interpreter we are able to access such support from Stockport Metropolitan Borough Council. Please ask a member of staff if you would like help with this.