Comment

OPEL alert allowed me to see up close the impact service pressures have on patients and nurses

The urgent need to free up beds takes a toll even on patients deemed fit for discharge

The urgent need to free up beds takes a toll even on patients deemed fit for discharge


The NHS and its staff are under sustained strain – so we need to see action if
OPEL alerts are not to become commonplace. Picture: Mercury Press Agency

I was working a bank shift recently as a healthcare assistant and was halfway through a 13-hour shift when we were notified there was an OPEL alert at the main county hospital.

The OPEL (operational pressures escalation levels) framework was introduced in 2016 in the NHS as a national standard for registering emergency pressures, replacing the previous system of black and red alerts. The levels range from one to four, with four being the most serious.

The main hospital was on an OPEL four alert, with patients waiting outside in ambulances because no hospital beds were available.

The OPEL alert was quickly reduced to a level three during the day and continued to go down over the next few days, but the increased pressure meant staff were over-worked in the main hospital and all the local community hospitals.

Urgency of the discharge process made the patient anxious

One of our main tasks during the alert was to discharge patients deemed medically fit so that we could free up beds and help take the pressure off the main hospital.

I had been working in a female bay that morning, assisting patients with personal care. One patient I was caring for was a woman in her 70s who was recovering from a bowel operation that left her needing to use a stoma. She had been with us for about two weeks and was due to be discharged home in a couple of days.

‘As I reflected on the OPEL alert, I realised the effect it has on the patients we have to discharge earlier than planned because their bed is required’

She was happy about going home but apprehensive about her care package and regaining her independence. She knew she needed to be more independent and having 48 hours’ notice of discharge was helping her to prepare mentally.


Rushing the discharge of a patient – even though they are medically fit – can cause
them stress. Picture: iStock

But as this patient was classed as medically fit, she had to leave the hospital that day because of the OPEL alert. As soon as she was told this, she broke down. We reassured her and altered the timings of her care package so that her discharge was safe and effective, but she was still extremely anxious.

When she left the ward, she held my hand and thanked me and my colleagues for our help and support, but I could see the fear in her eyes.

The teamwork from hospital staff was exceptional, but that shift broke my heart and left me feeling numb.

As I reflected on the impact of the OPEL alert, I realised the effect it has on everybody – as well as the patients who cannot get a bed and the overstretched healthcare staff, there are the patients we have to discharge earlier than planned because their bed is required by somebody with a greater need. This can leave patients’ friends and family feeling anxious and uncertain.

Pressures on staff and services are getting worse, and they’re not confined to winter

As a nursing student, as well as a healthcare assistant of seven years, I love the NHS. I am proud to work for the health service but am hugely concerned about the increasing pressures placed on staff and services, which show no signs of abating.

In a survey by Nursing Standard in January 2018, more than 90% of respondents said winter pressures were worse than in the previous year, with more than two thirds believing it was the worst winter crisis in history.


Picture: Charles Milligan

Latest NHS Digital figures, published last week in partnership with NHS England and NHS Improvement, show 4% more emergency department (ED) attendances in 2018-19 than in 2017-18.

This could mean frontline NHS staff facing another difficult winter period, but the summer months can place just as much pressure on the NHS.

This was highlighted by a report from the RCN, published in November 2018 that found the number of patients waiting more than four hours in the ED for a hospital bed during the summer months has risen by 137% since 2014.

The report revealed that trolley waits in the NHS in England have more than doubled in five years, with RCN members who contributed to the report saying they had seen an increase in the numbers of patients attending EDs and GP surgeries with heat-related problems.


Picture: Daniel Mitchell

NHS staff are feeling under pressure, regardless of the time of year

Everyone who works in the NHS knows there is no such thing as ‘winter pressures’ these days, with the increased strain felt by staff and patients all year round.

Unless more is done to tackle these pressures, I am worried OPEL alerts such as the one I experienced will become increasingly common. Not only does this put staff under more and more strain, it has a negative effect on the patient experience and has the potential to compromise patient safety.

As a nursing student, I remain hopeful that change will come. But with around 40,000 nurse vacancies in England alone, a significant lack of NHS resources and increasing patient acuity, change can’t come soon enough.


Stacie May is a second-year nursing student in Plymouth

 

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