https://kingstonhospital.nhs.uk/information/this-is-about-your-carer-agreement
 | This is a written agreement between you and the nursing staff which talks about the ways you would like to keep your role as a carer while the person you care for is in Kingston Hospital. |
 | The agreement talks about the ways we can work together for the person you care for. It talks about the care the hospital staff will provide as well as the care you will give. |
 | Agreeing or wanting to provide care for someone in hospital does not remove any responsibility* from the hospital and the staff. * Responsibility means taking care of the things that are yours and doing the things you’re supposed to do. |
 | Where more than one person is a carer for the same patient, they should also sign the agreement. If this applies, please choose a main carer to plan a carers rota also including the nursing staff. The agreement of the patient should be recorded if they are able to say their wishes. The agreement and its contents may be looked at and changed at any time. |
| Patient’s name | MRN (Medical Record Number) |
| …. | |
| …. | |
| Date of agreement | Review date(s) (minimum weekly review) |
| …. |
| Arrangements for visiting and / or staying on the ward (for example what days / times, overnights) |
 | Personal care: what carers will do (for example washes / baths / showers / dressing etc) |
 | Personal care: what hospital staff will do |
 | Mealtimes / feeding: how carers will be involved |
 | Medications: how carers can help with giving medication |
 | Examination, treatment and talks: how carers can be involved (for example ward round, aids, communication, provides assistance etc.) |
 | Useful information for staff about patient’s condition and choices |
 | Discharge arrangements: how carers will be involved in decision-making |
 | Who carers should speak to if worried about the patient or their own role as carer |
| Signature of patient (if able) |
| … |
| Name of main carer (PRINT) | Signature |
| 1 | 1 |
| … | |
| Date of agreement | Review date(s) (minimum weekly review) |
| 2 | 2 |
| … | |
| 3 | 3 |
| … | |
| 4 | 4 |
| … | |
| Name/designation of staff member | Signature |
| … |
Translate
Please talk to a member of staff before or during your visit to the hospital if you require translation support to access Patient Information. Please ring the phone number on your appointment letter, if you have one.
Accessibility
Please talk to the Patient Experience Team on 020 893 3850 if you need this information in a different format.
Patient Advice and Liaison Services (PALS)
PALS provides information, advice and support to patients and relatives.
Email: khft.pals@nhs.net
Phone: 020 8934 3993 (Monday to Friday 9am to 5pm)
Pastoral and Spiritual Support Service
We offer all backgrounds serving people of all faiths.
Phone the hospital switchboard: 020 8546 7711 and ask for the Duty Chaplain, we are available 24 hours a day 7 days a week
Learning Disability Liaison Service
We support patients and carers to plan a visit, helping to organise changes.
Email: khft.learningdisabilityteam@nhs.net
Phone: 020 8934 6895 (Monday to Friday 9am to 5pm)
| Translate | Please speak to a member of staff before or during your visit to the hospital if you require translation. |
| Accessibility | Please contact the Patient Experience Team on 020 8934 3850 if you need this information in a different format. For information accessibility please visit Kingston Hospital AccessAble www.accessable.co.uk/kingston-hospital-nhs-foundation-trust |
| Support services
www.kingstonhospital.nhs.uk Switchboard 020 8546 7711 |
|
Please speak to a member of staff before or during your visit to the hospital if you require translation support to access Patient Information. Please ring the phone number on your appointment letter, if you have one.
Please contact the Patient Experience Team on 020 893 3850 if you need this information in a different format.
For detailed information on accessibility at Kingston Hospital visit Kingston Hospital AccessAble (https://www.accessable.co.uk/kingston-hospital-nhs-foundation-trust).
Visit the hospital website, ask a member of staff, or ring us for details.