The Rowans Hospice

On this page

• 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

The service provided care and treatment in a way which made patients feel safe, supported, involved and listened to. Safety events were investigated and reported thoroughly and lessons were learned to continually identify and embed good practices. The environment and equipment was clean, tidy and well maintained. The hospice worked with people and partners to establish and main safe systems of care and ensured continuity of care when people moved between different services. Risk assessments about care were person centered, proportionate and regularly reviewed where possible.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff recognised incidents and near misses and reported them appropriately. Staff told us they were encouraged to report concerns and safety events.

Leaders investigated incidents and shared lessons learned with the whole team and the wider service. There were clear open and transparent processes for reporting and learning from incidents. One staff member told us ‘We get an email or its discussed at team meetings, we’re kept informed for our own learning’.

Incidents were discussed at multidisciplinary team (MDT) and clinical incident review meetings. We reviewed the clinical governance minutes which showed evidence of incidents being reviewed and learning from incidents being shared.

Leaders provided feedback, reflection and learning following an incident. Patients and families could provide feedback via the QR codes which were displayed around the hospice.

The hospice followed NHS England’s Patient Safety Incident Response Framework (PSIRF). The PSIRF sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents and issues for the purpose of learning and improving patient safety.

Staff could also refer to the provider’s procedure for reporting accidents and untoward incidents to staff, patients and visitors document which provided staff with information on the procedure and what to expect following an incident.

The hospice held monthly open forums where staff presented case studies and shared learning from these to all staff. Emails were sent out to staff who couldn’t attend.

The hospice 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. This included the Integrated Care Board (ICB), social care, community nursing teams and the local acute trust.

Referrals came from healthcare professionals from within the community or hospital settings and these were received by the clinical hub which was made up of specialty doctors and consultants who triaged it and then allocated it to the relevant service. This included medicines review and assessment of suitability of patients own medicines.

As well as taking referrals the palliative care support hub provided advice and support to those professionals as well as patients and families, known and not known. This service provided a single point of contact providing a streamline service often diverting from acute services for a population of 600,000.

All admissions were discussed on the day of the admission with the Senior doctor covering the ward. Patients were reviewed each patient face to face within 24 hours of admission with the exception of weekends and bank holidays when a ward round was conducted. If clinically indicated, the Consultant or Specialty doctor will review patients face to face on the ward out of hours including weekends and bank holidays.

There were systems to access patients GP records.

The length of admission assessment was tailored to individuals and the hospice involved relatives and other healthcare professionals in their care when needed.

Patients’ needs were thoroughly assessed prior to them using the service to ensure their needs could be safely met. Staff completed an Integrated Palliative Care Outcome Scale (IPOS) form on admission with patients and their families. The IPOS is used to measure patients physical symptoms, psychological, emotional and spiritual, and information and support needs. This was reviewed every week and presented at MDT meetings.

A member of staff told us ‘we work really closely with the medical team, patients and their families and pick up signs of deterioration quickly and have conversations with doctors to discuss any changes’ and ‘ we will look at evidence of deterioration from admission through to discharge.’

The hospice ran a youth group for children and worked together with children’s hospices to help young adults with transitioning from child to adult hospice care.

Patient notes were electronic. We reviewed five patients records and found the assessments to be accurate, joint up with doctors and nurses and up to date with information on people’s needs and preferences. Transfer of care was clearly recorded in notes, with comprehensive discharge summaries including anticipatory medicines and social care plans.

We observed a handover which was attended by members of the MDT team. Staff discussed patients emotional needs, referral to the living well services, physio input and discharge planning.

Clinicians worked with the social team who were based at the hospice with discharge planning.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

Staff received safeguarding adult and children level 1 to 3 training depending on their role and had access to Adult and Children safeguarding policies and procedures. Both of these policies were in date and due for review in 2025. In addition to the policies, the hospice had Safeguarding leaflets available for patients and families.

Data provided to us post inspection showed that the hospice had made no referrals to the local authority in the last three months.

The hospice reported two safeguarding incidents in the last six months and identified learning from this. Feedback and information regarding safeguarding outcomes had been shared with staff at regular meetings and supervisions.

The hospice appointed a safeguarding lead who made sure information on safeguarding was accessible and available throughout the service, they also were a point of contact for people, their relatives and staff who had had any concerns or required further information.

Staff were aware of who the safeguarding lead was, and information was displayed as a poster throughout the hospice.

Patients and their families were involved in managing risks, risk assessments were person-centred, proportionate and reviewed regularly. Patients felt safe, listened to, and supported on the ward, and in the community. Their concerns were dealt with, individual risks were well managed.

Risks to each person's health and well-being had been considered and assessed in the inpatient unit (IPU) and at home. These included risks relating to people's mobility, skin care and nutritional needs. We reviewed patient records and found evidence of bedrails assessment, falls assessment template, repositioning and PURPOSE-T (Pressure Ulcer risk primary or secondary evaluation tool) skin for skin integrity.

There were processes to ensure patients risks were assessed, monitored, and managed on a daily basis. The hospice used a risk management system to record risks and individual patient risks were discussed in patient safety meetings, and multi-disciplinary team reviews.

Staff demonstrated a good understanding of people’s needs and how to positively support them with their known risks. A member of staff told us ‘We have high and low beds for people at risk of falls. Rooms also have sensor alarms, bed rails and mattresses on the floor for patients.’ Staff told us they provided one to one care overnight for confused patients and sat with them until their family arrived.

People's risk management plans were reviewed daily by the Multi- Disciplinary Team (MDT), with all significant risks and decisions discussed at the formal weekly MDT meeting. Staff were kept informed of people's risk management plans in the IPU at each shift handover meeting. These included signs of deteriorating health, medical emergencies or behaviours that may challenge.

Staff told us patients were reviewed regularly through daily handover meetings with doctors present. Staff had access to senior doctors and consultants if deemed required. The hospice had terms of reference to reflect this and assessment guidelines which indicated when to raise any risk aspects.

Access to the building was through the main reception of which was manned 7 days a week. There was also an outside access control system to get in and out during out of hours along with a with a sign in and out system.

The ward and environment were clean, tidy and well-maintained. All rooms were single occupancy with ensuite bathroom. The doors opened into the garden which patients had access to. All rooms had a hoist system, air mattress and chairs.

The waiting environment was described as quiet, private and clean by service users and their families. There were several areas where patients could enjoy time with their families and also take part in activities.

Families were allowed to stay overnight and had access to a shower room.

The design of the environment followed national guidance. The service had enough suitable equipment to help them to safely care for patients. Call bells were available in patients bedrooms to support their safety.

Monthly audits and daily checks were carried out by nominated staff to ensure that the environment and equipment used was safe and fit for purpose. Staff made sure areas were clean and updated cleaning records. We saw complete cleaning records which were dated and signed.

The hospice carried out health, safety and welfare risk assessments on patient rooms. Staff told us an action plan was created if any potential areas of concern had been identified.

The hospice had recently faced funding issues which meant some areas within the hospice faced staff redundancies. Staff commented that staffing wasn’t as good as it used to be, watching colleagues lose their jobs was horrible.’ Another commented ‘overall we could do with a few more nurses’. In conjunction with the redundancy programme 2024, a review had taken place of staffing on the inpatient unit using work produced by Hospice UK addressing skill mix, staffing ratio and numbers which led to an increase of staff to patients by increasing headroom from 6% to 20%.

Leaders told us they kept communication open since undergoing cost efficiencies and commented that majority of staff who were made redundant were still on their bank.

A member of staff told us ‘Staffing is getting better, but we definitely need more volunteers and a good amount of bank staff.’

Patients and their relatives told us sometimes there wasn’t enough staff available to meet people's needs. A patient told us ‘It takes a while for staff to respond and sometimes they forget so I have to ring again’. Another commented that ‘they had to wait a while for their pain relief and by the time the staff arrived, the pain had started to pass’

All staff received support, supervision and development opportunities. They worked together well to provide safe care that met people’s individual needs. Clinical staff had skills passports, identifying specialist skills and knowledge gaps.

Staff completed mandatory training via e-learning, and these included mental health awareness training and safeguarding. Managers were able to monitor compliance for their teams and individuals. Staff told us they were up to date with their mandatory training and managers reminded staff to complete these. Data provided to us following the inspection did not show a 100% completion.

New starters in the hospice received a new starter induction checklist. All staff including volunteers had a renewed disclosure and barring service (DBS) check every 3 years and the hospice kept a spreadsheet to track this. Staff received checks of their competency to ensure they carried out their roles safely.

The provider had recently purchased a training mannequin which allowed the training team to offer on the spot refresher training for PEG, tracheostomy and catheterisation.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

The service had wall mounted personal protective equipment (PPE) in place, and we observed consistent hand hygiene practice by several staff during inspection.

Staff adhered to the 'bare below the elbows' policy when providing care and treatment. Disposable aprons and gloves were readily available. Staff used them when delivering care and treatment to patients to reduce the risk of cross infection.

A patient told us ‘The staff always wear gloves and change them in between. They always wear an apron.’ Another patient told us ‘Staff here are very hot on using gloves and they do wash their hands, I have a sink in my bathroom, so they always wash their hands there.’

Infection prevention and control audits of the environment on the ward area were carried out on a rolling programme over the year. The hospice carried out a further clinical waste audit alongside the suite of audits. Results from these were shared with the rest of the staff and appropriate directors.

Hand hygiene audits were carried out as part of the infection control audit program. The hospice reported a compliance of 100% for these for last year.

Patients and their families received information about their medicines, and if they did not understand the information, staff explained it to them.

Standardised drug charts were in use, which included risks, consent, infusions, immediate doses emergency medication prescribing. These were overall printed, clearly written in line with good practice.

There was a service level agreement with the local trust for medicines supply with no issues reported, there was timely access to medicines. Clinical support to staff was by the local trust oncology pharmacist, who provided a clinical visit weekly; although on occasions was fortnightly (depending on available capacity) and was available to contact for advice and support, with out of hours provision from the on call pharmacist.

Medicines were stored in a central medicines room, in a locked cupboards with keys held by nurses. There was a dedicated medicines fridge, however the hospice did not have a service record (or maintenance sticker) as to when it was last serviced.

Medical gases were stored in a secure room with safety signage; however the portable cylinders were not secure, leaving a risk of them falling when being accessed by staff.

The defibrillator machine was stored in the ward office. Checks were undertaken regularly however day staff were unclear of process, due to night staff undertaking checks. Therefore nobody could locate the battery date for checking.

The local trust visited with a pharmacist and technician to undertake destruction of controlled drugs (CDs). Waste CDs were securely stored, although not all were clearly segregated and labelled as waste awaiting destruction.

The hospice had a CD Accountable officer was in place and this was correct on the register, we found evidence of Local intelligence network (LIN) attendance quarterly occurrence reporting.

The service had no non-medical prescribers, all prescribing undertaken by the doctors.

There was an adequate supply of syringe drivers for every patient if needed, policy in place, comprehensive records and checks.

The service had a comprehensive medicines policy, specific to this service, with a number of underpinning procedures for medicines related elements.

The hospice also had a medicines management group who met quarterly to consider all issues related to therapeutic substances and the devices used to deliver them (including prescribed drugs, supplements and gases; and those provided by alternative practitioners or obtained by patients from other sources) for in-patients, those accessing Living Well services and those under the care of Hospice at Home.