Archived: Hazelwood Ward

Updated 27 March 2014

The services on Hazelwood Ward in Isebrook Hospital were provided by Northampton General Hospital NHS Trust (NGH). The inpatient ward had 34 beds and provided a programme of rehabilitation from a specialist therapy team for people with clinical needs requiring 24-hour nursing and medical care. In addition, the ward provided nursing and medical care for patients with subacute medical conditions. There were six beds dedicated to stroke rehabilitation.

The ward provided continuing support and care closer to home, offering help with rehabilitation and recovery from stroke. The aim was to provide care closer to home for patients fit for discharge from the acute hospital, with a clinical need for medical rehabilitation, offering a ‘step-down’ facility or had subacute medical needs. The ward also offered care to patients referred directly from the community with the aim of providing care and treatment, in order to prevent the need for admission to the acute hospital, so providing a ‘step-up’ facility.

The ward was supported by a multidisciplinary team including nursing, medical and therapy staff.

Updated 27 March 2014

Hazelwood Ward in Isebrook Hospital is one of three community hospital sites where Northampton General Hospital NHS Trust provides services on an inpatient basis. Hazelwood Ward is a 34-bedded ward providing 24-hour nursing and medical support for patients with subacute medical conditions or with rehabilitation needs.

Northampton General Hospital NHS Trust is an acute trust with 800 consultant-led beds, and provides general acute services for a population of 380,000. It also provides hyper-acute stroke, vascular and renal services to people living throughout the whole of Northamptonshire, which has a population of 691,952. The trust is an accredited cancer centre and provides cancer services to a wider population of 880,000 who live in Northamptonshire and parts of Buckinghamshire.

Northampton General Hospital NHS Trust also provides services at Danetre Hospital and Corby Community Hospital.

We found the medical service on Hazelwood Ward to be generally safe because there were assessment and reporting systems in place to identify risk, take action and learn lessons from incidents and complaints. Staff felt informed about incidents and able to report concerns. However, not all assessment tools were completed correctly and audit data demonstrated poor performance on some aspects. Staff felt that this was due in part to the new documentation that had been introduced, which was designed for an acute hospital setting rather than a community hospital.

Nurse staffing and patient dependency levels were assessed using a recognised tool. However, not all shifts were meeting the ratio of one registered nurse to eight beds and bank and agency staff bridge the gap. There remained vacancies, particularly for healthcare assistants and this was having an impact on some shifts and the ability to provide one-to-one supervision of patients. The trust was in the process of recruiting more staff.

There were arrangements in place for the safe administration and handling, storage and recording of medication. However, there had not been an allocated pharmacist to the ward since May 2011 to oversee and review medicine and prescribing arrangements. This meant that patients were at risk of not receiving appropriate treatment, possible medication errors occurring and necessary reviews of medication not taking place. The trust had employed a locum pharmacist who was due to start by the end of January 2014.

Analysis of infection rates in the trust showed them to be within expected limits. The ward was clean and there were arrangements in place for ward cleaning and decontamination of equipment. We found gels, aprons and gloves were in good supply and waste appropriately dealt with. There were assurance mechanisms in place to identify when standards for cleanliness and infection prevention needed improving.

We sought the views of the public at a listening event prior to the inspection and also checked on a range of patient feedback and survey information. We spoke with patients during the inspections who reported that they were happy with the care and treatment on the ward and staff were kind. There was an effective multidisciplinary team supporting patients with their rehabilitation needs and patients reported that they were highly satisfied with their care and treatment.

There were clear clinical, organisational, governance and risk management structures in operation. Staff had confidence in the ward managers and felt well supported. However, not all staff had completed their mandatory training or had an appraisal. This meant that the trust could not be assured that staff were up to date with their skills and knowledge to appropriately meet patients’ needs. Issues over the lack of a pharmacist for the ward and non-completion of training and appraisals had been known to the trust for a significant time, with insufficient action taken to address the issues.

We found that the trust had breached Regulation 9 (care and welfare), Regulation 13 (medication) and Regulation 23 (staff support and training) for the regulated activity treatment of disease, disorder or injury.

Updated 27 March 2014

We found the medical service was generally safe because there were systems in place to identify risk, take appropriate action and learn lessons from any areas of poor performance or incidents. Staff were confident about how to report incidents and felt well informed. Nurse staffing levels and patient dependency levels were assessed using a recognised nurse staffing tool. Some shifts were not always meeting the ratio of one registered nurse to eight beds. Agency nurses were used to bridge the gap. We found the medication arrangements had not had pharmacist oversight since May 2012. This was because there had been no allocated pharmacist for the ward during this time. A locum pharmacist was expected to commence by the end of January 2014.

We found that not all assessment tools were completed correctly. The trust had recently introduced new documentation that was designed for acute services. Not all of this was adapted to a community ward setting and staff were experiencing difficulties in interpreting what was needed. Audit data demonstrated poor performance on some aspects, which staff felt was in part due to the use of the new documentation. We found there was good multidisciplinary team working throughout the ward and with trust specialist teams. Outcomes for patients were good.

We found the ward clean. Arrangements were in place for cleaning the ward and individual items of equipment. Staff knew how to decontaminate medical equipment. Hand gels, aprons and gloves were in good supply. There were effective systems in place for the classification, segregation, storage and handling of waste. Assurance systems ensured ward cleanliness and equipment met appropriate guidelines and standards.

Patients were positive about their experience and found staff kind and caring. We saw good examples of compassionate care. Patients reported they liked the food and we saw positive interactions between patients and staff. The local ward results from the Friends and Family Test were 83 in October 2013 and 50 in November 2013.

The services on the ward responded to the needs of the local population by providing a ‘step-up’ facility with enhanced care to patients from the community, with the aim of preventing the need for admission to the acute hospital. In addition, a ‘step-down’ facility provided rehabilitation services for patients needing nursing and medical support after discharge from Northampton General Hospital and Kettering General Hospital. We found that there were no formal arrangements in place for spiritual or multifaith provision. Local ministers supported the ward but their support was not always appropriate and staff had to ask individual patients and their families where to obtain help for their particular faith.

There were clear clinical, organisational, governance and risk management structures in operation. There was an open culture of reporting incidents and learning from incident investigation and complaints. Staff had confidence in the ward managers and felt well supported. The lack of dedicated pharmacy support, poor levels of attendance at mandatory training and completion of appraisals had been known to the trust a significant time but insufficient action had been taken to address these issues