QE Facilities Patient Transport

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had developed a patient safety incident response plan to ‘…define actions, responsibilities, and standards that … patients require and have an expectation of when receiving care, treatment, and transportation.’ The plan identified how staff and the service were expected to respond to an incident encouraging learning and improvement.

The service had established a monthly policy review group to ensure group policies were effective in meeting the needs of patients and enabling input to policy development within the host trust processes.

Although staff were encouraged to report all incidents and understood the process, the service had no patient safety incidents reported in the last twelve months. The patient safety response framework detailed an investigation must be started as soon as possible after the patient safety event and completed within three months. The stated outcomes from the process was to allow the circumstances of an event to be understood and identify individual learning and required actions.

A comprehensive duty of candour policy had been developed and staff were aware of their responsibilities. Although duty of candour had not been formally applied, we saw the principles had been applied. For example, we saw that an unexpected delay meant a patient would arrive late for their appointment and the crew informed the receiving department, explaining the cause of the delay. The crew also communicated openly with the patient, keeping them updated and offering an apology for the inconvenience, taking ownership. The receiving department was able to rearrange the appointment, preventing further disruption for the patient. This showed transparency and accountability, leading to safe patient care.

The service had adopted the host trust’s earning and development policy and confirmed overall compliance with mandatory training was 98.16%. This included, for example, adult and paediatric life resuscitation training, mental health and learning disabilities, autism, conflict resolution and dementia awareness.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service provided transport for patients discharged from the local trust hospital after receiving treatment. Arrangements for the transport of patients were organiszed at the local hospital and followed the service’s referral processes. All essential information about the patient was recorded and communicated to crews on site. This meant all the needs of patients were safely met.

Staff involved all necessary healthcare services to ensure patients had continuity of safe care. Procedures were in place to ensure there were pathways in place for requesting local NHS ambulance assistance when crews identified a higher category on attendance than initially reported.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

All staff had received safeguarding adults and children training during their induction and through annual refreshers. Staff knew how to make a safeguarding referral when necessary.

We spoke to staff who were able to discuss situations where they had identified potential safeguarding issues and reported these to the designated safeguarding lead. The training staff had received included how to protect patients from harassment and discrimination, and how to identify adults and children at risk of significant harm. This included working in partnership with other agencies.

The service accessed guidance from the named nurse safeguarding children and also the strategic lead for safeguarding adults qualified to level 5, at the host trust when needed.

No safeguarding incidents had been reported within the last twelve months.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Crews received booking forms on site, completed in the discharge lounge at the local hospital. Details from booking forms were input to the patient transport service database the day after transfer. The needs of the individual patients determine the need for single or double crews and equipment needed, such as a stretcher and adapted chair as well as oxygen. Observations and comments by crews regarding the patient transfer were recorded as necessary, such as access issues.

Although crews were trained in restraint techniques and the prevention of management and aggression (PMVA), crews did not transport patients where restraint may be needed. Where the need for a security escort was identified, transfers were referred to the local NHS ambulance service, directly from the hospital discharge lounge. However, internal compliance audits of patient record forms identified, crews had occasionally transported patients living with dementia who had required security escorts, only after a risk assessment by senior managers within the service.

Do not attempt resuscitation (DNAR) decisions and also when a DNAR was not in place were recorded on patient transfer records. Further patient information was recorded by the discharge lounge and wards for handover to crews. This included the need for pressure relief and appropriate equipment, oxygen, and whether a deprivation of liberties safeguard authorisation (DoLS) was in place,

Further information was gathered was gathered for handover to crews where a patient lacked capacity to determine if any additional requirements were needed. Patients who did not have capacity or required oxygen were assigned a two-man crew.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service used fully equipped ambulances providing transport services to the local acute hospital, within their catchment area and with easy access to other local hospitals and care services.

All ambulances were kept within a secure and monitored compound. Daily ambulance checks were carried out confirming the road worthiness and maintenance of the vehicles. Checks were completed on the physical condition of ambulances, all onboard equipment, and gases such as oxygen. We saw all equipment was within date and well maintained; vehicles had been serviced regularly and all had current MoT certificates.

Schedules for deep cleaning of ambulances were in place, and the rota ensured each vehicle was deep cleaned routinely every month, and also when needed. Staff carried out a full deep clean of vehicles after transporting infectious patients consistent with personal protective equipment and infection prevention and control guidance.

Ambulances were cleaned daily by the driver at the beginning of the first shift and before any transfers. The service recently introduced further documented end-of-day vehicle cleaning, using a comprehensive checklist ensuring consistency and traceability. The vehicle cleaning standard operating procedure had been updated. Station cleaning was carried out by the domestic services team, responsible for maintaining cleanliness and hygiene throughout the building.

We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service was staffed by teams of qualified responders located at the main site. There was a comprehensive induction and training programme for all staff and refresher training for staff already employed. Staff competencies, such as manual handling, basic life support, dementia awareness and safeguarding were recorded and kept up to date through a training matrix overseen by the registered manager.

The service had a structured process in place to ensure staffing levels and skill mix were safe and met service demand. We saw staff rotas were organised in advance to ensure appropriate cover across all shifts. Rotas were then reviewed weekly to maintain safe staffing levels and to match crew skill mix. Supervisors monitored staffing levels at the start of each shift and provided cover when required; unplanned absences were risk assessed, and contingency actions implemented, such as allocating staff or adjusting schedules. Further, staffing concerns may also result in additional staff being called in, where necessary.

Regular manager and supervisor meetings were in place to review service demand, plan staffing requirements and anticipate contingencies.

We reviewed staff files which confirmed all recruitment processes, including references and Disclosure and Barring Service checks had been carried out.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had a decontamination policy in place which identified infection prevention and control processes and training available for all staff to undertake at induction and on a regular basis. Training and awareness was available to identify direct and indirect methods of spreading infection and ways to manage and minimise its impact.

An infection control risk assessment had been completed and quality checks and audits were carried out on vehicles following infection prevention and control cleaning by staff.

The deep cleaning checklist identified a series of tasks to structure the measures to reduce infection and prevention control. Specific tasks for example were clean window and door frames and ceilings, mop and driver’s cab, check and replace out of date consumables, remove and correctly dispose of soiled linen and clinical waste bags.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The service had adopted the host trust medical gases policy, this applied to the use of oxygen, the only medication carried in vehicles. The policy described the systems and processes required to ensure the transportation of oxygen in pressurised cylinders was maintained, inspected and tested to provide a safe and suitable environment.

The policy specified management responsibilities for ensuring compliance with NHS technical memoranda by introducing safe systems of work, reducing hazards in the patient environment and clarifying day-to-day management of medical gases. Specific requirements had been developed for medical gas cylinder management, storage of cylinders, and the safe handling of portable cylinders.

Following training, staff operated, maintained and developed medical gas systems. A permit to work system was in place to ensure patient safety was maintained. Regular training was undertaken to ensure all key staff had an understanding of the principles, design and function of gas systems. All clinical staff were trained in how to connect devices, isolate the supply locally, and how to implement emergency procedures.

Crews were able to transport patients on oxygen if that patient had already been prescribed, continuation of care already being administered. All administration of oxygen was documented on the patient report form. Any administration was recorded, and documented method of administration and dosage.