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Inspection Summary


Overall summary & rating

Updated 12 January 2017

  • Senior staff were aware of their responsibilities relating to duty of candour legislation and gave us examples of when it had been implemented. The trust had a duty of candour process in place to ensure people had been appropriately informed of an incident and the actions that had been taken to prevent recurrence. Duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of ‘certain notifiable safety incidents’ and provide reasonable support to that person.

  • The hospital told us that all the patients attending for surgical procedures had previously been identified, by their referring companies, as low risk for anaesthesia. We did see evidence in all of the records we reviewed of a pre-operative assessment, which included an assessment of risk of VTE and blood clotting factor. However, we were not sure who was assessing the patient pre-operatively, as there was no clear evidence of the profession or competencies of the professional undertaking the pre-operative assessment, included on the assessment sheet. However although there was there was a written patient exclusion policy in operation at FTH the hospital was dependent upon the robustness of the pre-operative assessment undertaken by another provider.

  • There was a lack of clinical oversight in the recovery area, where we observed that patients were not being monitored in line with national guidelines, a blood-filled suction tube being used after it had been used in theatre and patients’ privacy and dignity being compromised. We raised these issues during our inspection and they were addressed immediately by managers and clinical leadership.

  • There was a system in place to analyse each incident as it occurred which included the cascading of the investigation to relevant staff. The process of identifying themes and trends was embryonic and required further development. We saw little evidence themes and trends were discussed regularly at team meetings.

  • There was no monitoring of compliance with the hospital hand hygiene policy. We observed poor compliance with the hand hygiene policy and patient feedback had identified that ward staff were not always washing their hands before touching them.

  • Three pieces of anaesthetic equipment were out of date for servicing according to the label on them.

Inspection areas

Safe

Updated 12 January 2017

Effective

Updated 12 January 2017

Caring

Updated 12 January 2017

Responsive

Updated 12 January 2017

Well-led

Updated 12 January 2017

Checks on specific services

Surgery

Updated 12 January 2017

  • The hospital told us that all patients attending for surgical procedures had previously been identified, by their referring companies, as a low risk for anaesthesia. We did see evidence of a pre-operative assessment in all the patient records that we reviewed.

  • There was a lack of clinical oversight in the recovery area, where we observed patients not being monitored in line with national guidelines.

  • The arrangement for managing medicines was not robust. There was a system in place to monitor the safe keeping of drugs in fridges. However, we found the monitoring processes had not been clearly adhered to. Managers were responsible for investigating incidents and we saw evidence of this. Managers were responsible for investigating incidents and we saw evidence of this taking place. There was a system in place to analyse each incident as it occurred. The process of identifying themes and trends was embryonic and required further development. to prevent reoccurrence.

  • The system for identifying surgical site infections was not robust and we were not assured that all infections occurring from surgical procedures were being identified.

  • We identified that managers were unclear about the policy and procedure for securing large volumes of blood for patients requiring a transfusion. There was a service level agreement in place with the local acute hospital to provide emergency blood supplies to FTH. The documentation for the agreement  was found to be out of date, a matter which was immediately rectified.

  • There was limited monitoring of compliance with the hospital hand hygiene policy undertaken by the hospital. We observed poor compliance with the hand hygiene policy.

  • The majority of provider’s policies such as the appraisal policy and complaints policy were out of date.

  • Three pieces of anaesthetic equipment were out of date for servicing according to the label on them.

  • The provider had begun to develop its governance structure and developed both a vision and strategy for the service. Governance arrangements were embryonic and the service was not able to robustly assess, monitor and improve the quality and safety of the services they provided.