Useful information for medical staff
Marie Curie Centre Bradford
This is available on the computer system in the centre. Please add to it, or change it if you
have new information, or if something has changed, or if there is anything else it would have
been helpful to know when you started. You can find it on the computers by going to Start –
My Computer – groups on „sbraddc01‟ (L:) – Patient – Useful information for medical staff.
It is multi-purpose, for new SHO‟s and SpR‟s, and for on-call SpR‟s, and for any of us to refer
to, so it will not all be relevant to everyone.
Our number 01274 337000
Our fax number 01274 337094 (fax machine in secretaries‟ office) Direct line to Doctors‟ office 01274 337021/337020 Direct line to any extension is 33+extension number
Dial 9 for an outside line
Ring-Ring means an outside call
Single ring means an internal call
To transfer a call – press Recall and the extension number, wait for the person to answer,
and then tell them you have a call and put the phone down. If the extension you are dialling
doesn‟t answer, press recall twice to be reconnected to the caller.
Internal numbers – see list on pinboard in office. Some useful ones are:-
Medical Director – Rosemary Lennard - 7605
Medical Secretary – Wendy Murphy – 7611
Day Therapy – Chris Matthews, Lydia Lepp, Sakina Iqbal – 7010 Social Workers – Kim Reddyhoff – 7621; Jacqui McGuire/Sandra Gibbons– 7628
Monday Jacquie 9.15 - 16.30 Kim 11.00 - 19.00
Tuesday Jacquie 9.15 – 16.30 Kim 13.00 – 19.00
Wednesday Jacquie 10.00 – 14.00 Sandra 9.15 – 19.00 Kim at school
Thursday Kim 9.00 – 17.00
Friday Kim 9.00 – 17.00 Sandra 9.15 – 19.00
The above is subject to change to accommodate annual leave, sick leave etc.
IT Helpdesk 02075997230 or firstname.lastname@example.org
To bleep someone – dial 7099 – listen to the recorded message – then dial the bleep number of the person you are bleeping, immediately followed by the extension number you are
ringing from. Wait to hear “your paging request has been accepted” before putting the phone down.
Numbers are on the list of internal telephone numbers
If your bleep sounds, the number to ring is displayed on top of it. 7000-7004 are outside calls.
A constant ring is the emergency call, linked to the patient call system (so a lot of false
alarms). Should say in writing on bleep where it is. Usually you will get a message cancelling
Local Specialist Palliative Care Services
Community team – 323511 – secretary and answerphone - use this if non-urgent.
MacMillan Nurses –
? Pat Holford - 07939 525735
? Nadine Donaldson – 07956 173140
? Liz Penny – 07956 173114
? Chris Claughton – 07949 102591
? Richard Dillon – 07947 741022
? D/N on a year‟s secondment (currently Bev Blake) – 07957 211372 Consultant – Belinda Batten – 07985 112597
Social Worker – Linda Hughes – 07957 202537
Psychologist – Jan Helbert – 07949 140864
Ethnic Liaison Workers – Wali Nazar (“Naz”) -07950 260450 – and Rupinder Kaur – 07956
Bradford Hospital team office 364035/6
Janet Munro – 01943 817957 – 07798 637951
Ian Fenwick – 733237/2
Angela Fidgeon – 01535 646094
Hospice at Home – Mary Johnson – 363662
Cancer Support – 776688
Airedale Hospital Team Office – Janet Duerden – 01535 651054 Wheatfields 0113 278 7249
Cookridge 0113 267 3411
St Lukes Hospital 734744
? Office 364054
? Lab 364802
? Dr Marsh 364218 (Consultant Microbiologist – for advice)
? Dr Campbell 364027 (Consultant Microbiologist – for advice)
? For results:- 0113 3927832 or 0113 3926989
? Sputum results:- 0113 3923499
Blood Transfusion 364204
Pathology Supplies 0113 392 6989
? BRI 364498
? SLH 365342
? Central Booking 365105
? Fax Requests to 334470?
? Secretaries (for finding results) 364124/364123/364543/365086/366550 – (or fax
Dr Cheeseman‟s sec. 364095
Dr Bradley‟s sec. 364723
Anne Raine 07768372749
Registration Dept. at BRI (for hospital numbers) 365167 – if you ring them they‟ll give you a hospital number for a patient not known to Bradford Hospitals – you would only need this for
a cross match. If the Patient is known to Bradford Hospitals it‟s probably easier to ring
biochemistry who will look on computer and give you the number.
Pharmacy (Alistair/Os) 363230
Other (mostly Yorkshire) hospitals and hospices – pinboard in doctors‟ office
Shipley H/C (SHO on Fridays) 531153
Coroner‟s officer 373037
Barkerend Health Centre – Avicenna Medical Practice (GP‟s do Part 2 Cremation forms) 637417
Pain Management Team, SJUH, to order refill packs 0113 3924637 (or do we get them from
Acumedic (to order acupuncture needles) 020 7388 6704 (Our customer number is CT2412)
National Blood Service (Tissue donation co-ordinators) 07963 086823 go through them for
cornea donation. They will organise consent from family, and someone to come to the
hospice to remove eyes.
Leeds University (for donation of body) 0113 243 1751 System not entirely clear. They need
consent from family, even if patient has previously consented. They have an informal list of
people who have expressed an interest, but people don‟t need to be on this. Usually will not
take patients with cancer (but may with lung cancer)
PRN Treatment We would usually prescribe prn oral and parenteral opioids in appropriate
doses (eg Oramorph 2.5-10mg and Diamorphine 2.5-5mg if opioid naive), an antiemetic/an
antipsychotic (eg Haloperidol 1.5-5mg), a benzodiazepine orally/ parenterally (eg Lorazepam
0.5-1mg PO/SL and Midazolam 2.5-5mg SC/IM) for all in-patients.
For rationale see induction folder.
Current stock list – prepared by Alastair (pharmacist, based at Lynfield Mount) on the basis of what we have used – kept in blue folder in treatment room, and copy in induction folder. We don‟t have an up-to-date formulary, but would regard the palliative care formulary as what we primarily use.
Ordering drugs – any new non-stock drugs should ideally be ordered before 10 am, and will
then arrive the same day at around 2 pm. Nurses do this by faxing a copy of the drug chart.
After 10am, if the drug is needed the same day, this is more difficult, but can be done – talk
to nurses about the details at the time. The sooner, the better.
TTO’s – ideally order 2 working days ahead. Controlled Drugs on a separate form.
FP10‟s available from day therapy – if insufficient time to get TTO‟s sent – or occasionally we
need to use them for dressings not available from pharmacy.
If you are prescribing drugs that D/N‟s will have to give (e.g. syringe driver or PRN
injectables) use a pink form as well, for their record, to go home with the patient. Kept in top
drawer of our filing cabinet.
Drugs in Community out of hours – a palliative care formulary is available from certain
pharmacies – see blue card on pinboard in office.
Signature lists – there are lists in each of the teams‟ folders of drug charts, with doctors‟
signatures on. Could everyone please sign them.
Off-Licence Prescribing is common in palliative care. When using recognised, common palliative care drugs – e.g. Amitiriptyline for pain, continue as for any prescribing. For unusual ones, record discussion with the patient and the reasons for use.
Drug or prescribing errors – there is a policy of reporting any errors, which are recorded, and in the event of any errors being made, then those involved may receive a letter about
this. The system is intended to be supportive, and not threatening. Any prescribing errors
should be recorded on a drug incident form (filing cabinet under desk in nurses‟ office) and
given to one of the Consultants.
In an effort to minimise drug errors, please try to keep prescription charts as tidy as possible
– no one should have 2 charts unless it‟s unavoidable – don‟t re-write on to the second side
when 2 weeks have expired, use a new chart.
May be for Assessment, Symptom Control, or Terminal Care. Usually referred by Hospital or
Community Specialist Palliative Care teams. If urgently, then sometimes referred by GP. Ward
15 (oncology) do not need to go through the hospital team.
Average length of admission is about 2 weeks. On average about 50% of admissions are
discharged, and around 50% die during the admission. Plans are reviewed weekly at the MDT
meeting (e.g. what the aims of admission are, whether we should be planning discharge)
On weekdays, admissions are generally co-ordinated by Amanda Poppleton (Ward Manager).
If she is not available, then we may be involved in co-ordinating admissions, or it may be
done by Jean Gordon, or one of the team leaders (Liz or Eileen) on the ward.
Notes are Multi-disciplinary. Write in the yellow medical section primarily, or in significant
Communications – green sheet near the start of the notes. Each entry should have date and
time; signature, printed name, and grade. Avoid abbreviations, except those on an approved
list in each patient‟s notes.
Admission proforma used for first admissions. Important aspects of history include detailed
background information, including about illness history. Hospital records may be needed to
complete this. Problem orientated history – i.e. break down complex problems in to individual ones which can be addressed. For a subsequent admission if a long time has passed, it may
be worth using a new proforma.
When possible, try to do a joint admission with one of the nursing team, although this
depends on what else you and they need to do.
Green problem sheets for review of that patient‟s care, as well as for audit purposes.
Problems are identified and scored by the patient where possible, or by staff when that‟s not
possible. We as doctors are responsible for scoring problems on admission, then weekly –
usually on Monday, or as soon as possible after. If problems are identified or scores given by
us, rather than the patient, then mark it with a *. Score from 0-3. Aim to include anything
that‟s a problem to the patient – not just physical, and not to include things that are not a problem to the patient.
Orange multi-disciplinary meeting sheet is intended to provide a summary of what is going on, so please complete on admission and update with new information
CPR – Admission proforma has a space to record:- For CPR Yes/No, Discussed with patient
Yes/No, Discussed with family Yes/No. Currently (Sep 03) we would record not for CPR
without needing to discuss, if it is futile – on the grounds that the chance of successful resuscitation in patients with advanced cancer, particularly out-of-hospital, are minimal. We
would aim to discuss with patients who might benefit from CPR (e.g. having active anti-
cancer treatment, non-cancer) what their wishes would be.
The in-patient information leaflet says: - something along the lines of – this is not a hospital
and we have only basic facilities for resuscitation. If you wish to discuss this with your Doctor,
they will be happy to give more information. We do have a box of emergency drugs, and an
Liverpool Integrated Care pathway for the terminal phase is in use. A patient starts
on the pathway after the team agrees they are dying, and certain criteria are met (2/4 of
bedbound, not taking tablets, semi-comatose, only taking sips). When the pathway is in use, make all entries in this rather than in the medical notes.
SystmOne is the electronic record which is in use for all patients. It is also being used by the
hospital and community palliative care teams, and by Manorlands.
If you see an out-patient or day-care patient and are going to write to the GP, or hospital consultant, dictate a letter, and Wendy will copy it in to the SystmOne record. Copies of discharge summaries are also entered. If you are not sending a letter, then enter the Clinical information in to SystmOne yourself. There is no need to separately enter a patient contact if you are doing a letter, as Wendy will do this when putting the letter on the system.
Please update the palliative care template when there is any new information to add. If a diagnosis is incorrect, then remove the old one (ask Andrew, Andy or Wendy H). Otherwise information can be added, leaving the older information in place. Particularly try to update it when someone is discharged from the ward. Try also to keep the current medication list up-to-date.
For a GP to share information to us, ask them to go to Administration in the menu, and below that is Shared Care. Right click on new share. Select any of the palliative care teams in Bradford. Most General Practices in Bradford do not use SystmOne, exceptions are Akram Khan‟s practice at Barkerend/Eccleshill, and Kensington St H/C. Shipley Health Centre, and the Ridge Medical Practice use it specifically to share info with us, but not routinely. Most of Airedale PCT use it.
Borrowing hospital notes
Amanda Poppleton will ask for hospital notes to come with the patient, when someone is being transferred from hospital.
Cookridge and the medical oncologists at BRI are good at having notes on computer, and the secretaries will fax us the whole record of their involvement.
For other specialities, the easiest way is usually to borrow the entire hospital records. If you ask Wendy Murphy (or Rabinder/Wendy Hurcomb if she‟s not here), she will arrange this.
Wendy keeps a track of what notes we have here.
Bloods – bottles and forms in the bottom drawer of our filing cabinet. Needles, vacutainer
holders, tourniquet, cotton wool, sharps bins are all in the Clean Utility room next door. There is a routine collection of specimens at around 9:30-11:00, so we aim to have bloods done as early as possible. If they are taken after collection van has been, then if not urgent, can keep in fridge until the next day (not potassium or clotting). If fairly urgent (i.e. result the same day, but might be in to early evening), ask one of the maintenance men to take sample to Community Trust Reception before 12:00-13:00, Barkerend H/C before 1pm. If after 1pm, or more urgent, request through Amanda, then the Maintenance men can take them to BRI or St Lukes. If very urgent, ask them to take it to BRI.
Results take 2-3 working days to come back in writing. Ring if you need them sooner, Haem 364206; Biochem 364195.
Transfusion – D/W lab on 12/5/04 – there is a policy of limiting the availability of blood if
Hb is above 8-9 g/dl, but this is aimed at post-operative patients. They have no intention of limiting our use of blood transfusion.
X-Rays – most straightforward XRays do not need an appointment, but can go between 9-4
to Main XRay at St Lukes or BRI with a form – top drawer of filing cabinet. Write on form if
you want the result within a certain timescale, but it may also help to ring secretaries to
speed it up.
Scans – Either liase with Hospital Consultant/team, or arrange directly with XRay dept. They
usually want to see a form first, before giving us a date. Forms kept in top drawer of filing
If urgent, D/W US/CT/MR dept. and they‟ll probably also ask you to speak to a radiologist.
Locally agreed standard for suspected cord compression is to do MR scan within 24 hours,
although the same day is preferable. BRI does not offer an out-of-hours MRI service. Some
greyness about how to arrange MRI at weekends – probably best to D/W Cookridge as a first
On-call requests for scans at BRI should only be made via radiologist on call, via BRI
switchboard – not through radiography team.
Consider sedation for MR/CT scans – eg Lorazepam 0.5-1mg
Obtaining test results after discharge – If there are outstanding test results (eg scan
results) at the time of discharge, it is the doctors‟ responsibility to chase these up. Put a note
in the diary to chase up the result and carry this forward until the results have been seen and
acted upon. It should also be noted in the discharge letter that there are outstanding results.
We are generally able to perform paracentesis where appropriate. Pleural Aspiration where it
is part of complex palliative care, but we would probably not admit routinely simply for
pleural aspiration. This is probably better done in hospital.
IV drugs can be used occasionally where it is clearly appropriate, and hospital transfer would
not be appropriate. Should only be considered after team discussion. Some, but not all nurses
can give IV antibiotics, so if this is being done, it may involve on-call Dr coming in.
Arrangements when someone dies
Wendy will phone the patient‟s GP, and Community team. Remember to inform Hospital
Consultants by phone if they have been closely involved recently, and by letter in any case.
Coroner – ring Coroner‟s Officer Tel 373037 if someone dies within 24h of admission (not
necessary if from hospital as they are in “continuous care”), if recent surgery (less than 24h,
or not recovered from anaesthetic), if recent injury, or if Mesothelioma, or any other reason
to be concerned.
If you have referred a patient to the coroner, please write a “C” on the death certificate stub,
so Wendy can track this. If a patient is referred to Coroner, and they are holding an inquest,
so we don‟t issue a certificate, pleae leave a note in with the death certificate stubs, again so
Wendy can track this.
Certificates – usually, families are asked to return the following working day, unless
someone is here at the time who can issue certificate.
For Muslim patients, the body is allowed to leave the hospice after a nurse has confirmed death – if the death is expected, and there would have been no reason to inform the coroner
otherwise (i.e. been an in-patient for over 24 hours, not industrial related/Mesothelioma).
This has been agreed in discussion between Dr Lennard and the Coroner‟s officer, September
If we will need to discuss with Coroner‟s Officer in the morning, for example if someone has been an in-patient for less than 24 hours, then there is no mechanism for releasing the body
from the hospice before this has been done.
D/W Barbara Mitchell, Registrar, 1/4/04, there is no need to see a body after death, as long
as we have seen the patient alive within 2 weeks – so we can issue a certificate at the
hospice to be collected by family first thing in the morning if necessary, but it seems
preferable to see the body if at all possible.
The family can register the death out of hours – Registry Office open until 4pm on Saturdays,
and on call 9-11 on Sundays – family would need to meet the registrar at BRI office with –
patient‟s medical card if possible; patients‟ occupation, date and place of birth, and date and
place of death; spouse‟s DOB and occupation. Undertaker can contact coroner‟s office on call
at weekends 9-5 if an “out of England” order is required. The funeral directors will arrange all
this. All we need to do is issue a certificate.
Cremation forms – Usually, GP‟s from Barkerend H/C do Part 2. Wendy will notify them. If
we need to speak to them:- Tel 637417. Mobile for Dr Akram Khan:- 07778 879848. For
patients who were their patients, Dr Peter Dickson will usually do Part 2. Tel – 07967 688928. Fees can be collected from Finance office. Please keep a track of patients‟ names when you
have completed cremation form, and record your name in the book in the mortuary.
Pacemakers – if we remove a pacemaker, it can be sent to the mortuary at BRI for safe
disposal – they are happy to accept them, no need to ring first
On Call Arrangements
First on call – SpR/Staff Grade/SHO/sometimes Consultant on week nights – Expect to answer questions from the ward, and review patients when necessary in the evening/night.
Prescribing by phone – there is a procedure involving saying prescription to one nurse – another nurse will then repeat it back to you to check for accuracy – there is then a form to sign the following morning.
At weekends, usually see the patients who have on-going problems Sat and Sun am.
All calls for advice from the hospitals or community out of hours should be passed on to the
consultant on call. For advice given during working hours, there is a file to record what advice
was given on the shelf in the doctors office.
We‟d expect you to be within 40 minutes travelling time under normal (not rush hour) traffic
Admissions out of hours happen occasionally. Usually referral from GP is necessary, unless we
already know the patient very well.
Second on call – One of the Consultants from Bradford or Airedale are always second on
call. Community or Hospital advice should go to them. Contact them if you are uncertain
about in-patient management. If you have calls about admissions, and are uncertain whether
they are appropriate, contact the consultant for advice.
Rota – The working copy of the rota is kept on the ward office. Any swaps can be agreed
between yourselves, but please make sure it‟s recorded on the ward copy. Phone numbers –
usually a home and a mobile number – please update the ward of any changes. A mobile is
available to borrow when you are on call if you wish – please sign it out on the sheet in the
drawer where it‟s kept in doctors office.
There is a weekend handover form with brief patient details, and issues to be aware of for
the weekend, which we will fill in on the Friday and leave for the on call Dr at weekend
(when it‟s someone not working at the hospice day-to-day)
Discharges + letters
Standard is to have them posted within 48h of discharge. Unless someone is fairly stable,
probably best to fax it if it‟s a Friday.
For all patients, as part of the discharge pathway being introduced from 1st December 2003,
complete an out of hours handover form. Kept on the doctors office noticeboard – fax to GP
and their out of hours service – you‟ll probably need to ring GP practice to find which service
When someone is going home to die, or there is a risk of sudden deterioration during transfer
by ambulance, then we need to complete an ambulance DNAR form, to fax or give to the
ambulance service. These are in the top drawer of filing cabinet in Doctors‟ office. Patient
transport 2 man crews can now transport patients with a DNAR form, providing they are not
thought to have a prognosis of <48 hours. If prognosis is less than 48 hours, a Paramedic
crew is needed. We can‟t send a DNAR form if the patient is being transported by 1 man
sitting ambulance. Under review - ? gone back to only paramedic crews (11/04)
For complex/difficult discharges, it is best to ring the GP personally. GP surgery is always
informed of discharge by phone anyway.
Discharge Summary Format:-
? Name (Wendy will add biographical details)
? Admitted –
? Discharged –
? Diagnosis –
? Problems during admission - 1, 2, 3, etc. Management - in note form after the
relevant problem. As an example: -
1. Chest wall pain. Responded well to Rofecoxib
2. Nausea. No response to……
? Investigations (if needed)
? Drugs on discharge
You might occasionally need to add some free text to this format, or extra paragraphs for eg
Information given, Future care wishes.
Out-patient/day-care letters – dictate a letter which will be entered on Generations, as well as
sent to GP/copies if necessary.
Franking letters – ask Wendy
Photocopying – get someone to go through it first time. Our code is 1914.
Fax – in secretaries‟ office. Dial 9 then the number. Put paper face down in the feed tray on
top. Press start. Record the fax number on the clipboard next to the machine, then if it hasn‟t
gone through, someone will tell you.
Most patients attend weekly, for a variety of reasons. As a routine, people are assessed
medically on their first attendance, jointly with one of the nursing team. Usually write a letter
on first attendance to GP, relevant hospital specialists, and community palliative care team.
Mostly, the community palliative care team become less involved when someone is attending
Patients are then seen if they wish to, or if the nurses feel it is necessary.
Write again about any significant changes, and if we initiate a new drug, we should
communicate with GP by letter or phone. If we change a dose, the practice needs to be
notified, which the nurses do routinely by fax.
Some patients attend specifically for medical review by prior arrangement. You are unlikely to
be asked to see someone unexpectedly.
Mostly patients are seen without medical input. You may be asked to see patients
occasionally. Usually this is either when patients have an acute inflammatory/infective
episode, or when they are developing more complex palliative care problems.
Each week, we each write a timetable of planned activities, and give it to Wendy on the
Monday Morning, to type and distribute to the ward, day care, and reception, as well as a
copy in our office. The other Consultants in Bradford are on the timetable as well (Lynne
Russon works with Hospital Palliative care team, Belinda Batten works with Community
Palliative Care team). Remember that at least one of the 4 Consultants is always available
during the week. Contact numbers on the timetable.
A standard week is as follows: -
Monday Tuesday Wednesday Thursday Friday Andrew Marie Curie Off Flexible half Marie Curie Off Daley day for
Rosemary Off Marie Curie Flexible half Off Marie Curie Lennard day for
Andy Tinker 8:30-2:30 8:30-4 8:30-2:30 8:30-4 9:30-2:30 Specialist 9-5 9-5 Study at St 9-5 9-5 registrar Gemma‟s/
SHO (GP 9-5 9-12:30 then 9-5 9-1 then Shipley H/C Registrar) GP training private study Belinda Work Off Work Work off Batten
Lynne Work Work Work Off work Russon morning
Staff are expected to arrive punctually, so that ward work can begin promptly.
Aim to do bloods, certificates, and see patients about very urgent problems by 9:15. Bloods
may not be possible, depending on whether patients are awake, and if they are eating, but
try to do them early when possible.
9:15 ward handover on Monday; Red team consultant round Tuesday; brief discussion
Wednesday; Blue team Consultant round Thursday; brief patient discussion Friday.
Aim to see in-patients, and new admissions during the morning as far as possible.
11-12:30 and 1:30-3 is the best time to see day therapy patients. For continuity, they should
be seen by: -
? Monday Andrew Daley and SHO
? Tuesday Andy Tinker and SpR
? Wednesday Ian Fenwick (GP with an interest in Palliative care who covers day therapy on
Wednesdays). Andy Tinker if he is on leave
? Thusday Andrew Daley and Andy Tinker
? Friday No routine day therapy, but some patients attend heart failure support group –
Rosemary Lennard and SpR available if necessary
12:30 Brief medical handover, so that we all know what is happening, and for supervision,
particularly of SHO‟s patients 2-2:45 Tuesday Red team MDT meeting
2-2:45 Monday Blue team MDT meeting
afternoons – patient and other admin. Seeing relatives (ideally not in morning unless urgent) – tutorials – meetings (Clinical Governance or Journal Club Wednesday, Day Therapy
Monday/Tuesday, Management Thursday / Friday)
Currently on Thursdays at 12:45 pm. Agenda is on the noticeboard in doctors‟ office. Purpose
is to discuss and/or update us on any changes which affect our work.
Diary in the office is ruled for each bed, to allow us to write reminders re: individual patients,
bloods to do, or things to remember, and for the nurses to write update messages or things
to be reviewed each day. There is also a section for general messages.
Staff to see during the induction period include: -
? Centre Director Jane Edgeley (including re: contract, health and
? Principal Social Worker Kim Reddyhoff
? Day Therapy Leader Chris Matthews
? Lymphoedema team Allyson Burrows or Sandra Buckley
? Physiotherapist Sarah Craven
? Clinical nurse specialist Janet Munro
? Librarian (Sarah Lewis-Newton from Liverpool Hospice is
covering at the moment) re: - IT, Library
? Medical Secretary Wendy Murphy
? General Secretary Frances Glover – at least to meet
? SystmOne Co-ordinator Wendy Hurcomb
Please make sure you have at least met all the above as soon as possible after the start of
post (doesn‟t apply to people only doing on-call)