Worcestershire Imaging Centre

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

This means we looked for evidence that people were protected from abuse and avoidable harm. We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to 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.

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 managed incidents well. Staff knew what incidents to report and how to report them in line with the local incident reporting and learning policy. Incidents were investigated by the manager, and learning was shared with the whole team. When things went wrong, staff understood their responsibilities to apologise and gave patients honest information and suitable support.

The service had a current incident reporting and duty of candour policy, which reflected the provider and national guidance on reporting and learning from incidents. The Duty of Candour is a legal and professional obligation for health and care providers to be open and honest with patients (or their families) when mistakes happen that cause, or could cause, significant harm.

The service used paper-based incident reporting forms to document incidents that had occurred. These were then recorded on an electronic system, to be reviewed by the registered manager. The service recorded a total of 5 incidents in the 12 months prior to our inspection. Recent examples of incidents included a patient scanned under the incorrect first name and where multiple scans had been taken but only one set of images was reported on.

Managers reviewed incidents reported and identified any learning, trends and themes. Learning was shared with staff during quarterly updates. Incidents were discussed informally with the senior management team twice weekly. The service had recently introduced a management action log to formally record senior management discussions.

Staff also told us they received feedback and provided examples. For example, a patient was scanned under an incorrect first name, and the error was not identified during image checks before being uploaded to the Picture Archiving and Communication System (PACS). The issue was detected before reporting, and learning for staff focused on the Society of Radiographers Pause and Check process and thoroughly verifying patient details and image information before sending images.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. There had not been any repeated themes or trends in the year prior to our assessment. There was also a folder for staff to acknowledge and sign for any changes to local rules or policies.

Managers used changes in national guidance, incidents, safeguarding and appraisals to identify gaps in learning. For example, we observed both headphones and earplugs were worn by patients, to reduce the risk of tinnitus. This was in response to an incident that had occurred at another service.

The service had not reported any never events in the 12 months prior to our inspection. Never events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed.

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’s referral processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met.

There was an admission criterion for both private and NHS patients. The criteria set out specific clinical referral guidelines and patient preparation protocols. Referrals were based on medical necessity, ensuring the procedure was justified, safe, and complied with national imaging governance frameworks. For example, the service did not perform scans for cancer monitoring or accept scan requests outside of an approved area.

Systems and processes ensured the correct patients were treated and the procedure carried out was as intended and appropriate. We looked at the patient pathway from referral to scan and found all new referrals had been vetted by radiographers prior to the appointment and procedure being carried out. Patients were provided with written and verbal information to enable them to understand their procedure.

We saw complete referrals that documented patient details, symptoms, clinical history and the area to scan. It also included GP details, referring clinician details and MRI safety information. The referral ensured sufficient clinical and safety information was assessed to allow the MRI examination to be justified, risk assessed and performed safely.

Patient records were a mixture of electronic, and paper based and were kept securely. The information technology (IT) connectivity was consistently available across the service to meet the needs of staff completing the records.

We saw effective communication between the service and the NHS allowing for seamless transfer of imaging requests, the MRI scans and reports. Completed scan reports were sent electronically to the referrer and there was a system in place to ensure reports were generated and received. Patients we spoke to were aware of how they would receive the results.

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.

Staff understood how to protect patients from abuse. All staff received adult and children's safeguarding training level 3. Data showed 100% staff compliance. There were current safeguarding policies, reflecting national guidance for adults and children.

Although there had been no safeguarding incidents or referrals reported, staff knew how to identify adults and children at risk of, or suffering, significant abuse. Staff knew how to make a safeguarding referral and who to inform if they had concerns. Staff knew how to contact the appropriate teams for expert advice. We saw safeguarding from abuse information displayed, and a list of safeguarding contacts in the MRI tech room.

The service had a named safeguarding lead that knew how and where to escalate any concerns. Staff we spoke to knew who the safeguarding lead was, however, they did not have level 4 training. The service assured us that this additional training has been arranged.

We identified during our inspection the service did not have a chaperone policy in place. However, it was made clear to patients they could take family or friends with them. Although patients were informed that they could bring a family member or friend to their appointment, this does not replace a chaperone policy. A chaperone policy sets out when a trained member of staff should be offered or provided as a chaperone, their role in protecting both the patient and staff. Allowing patients to bring someone with them offers support but does not ensure the safeguards and consistency that a formal chaperone policy provides. The service has now introduced a chaperone policy.

The service worked 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.

Patients were informed about the risks associated with the MRI procedure and how to keep themselves safe. Information leaflets were given to patients before the appointment. They contained information about the procedure, the risks and provided clear instructions to patients and their family or companions about how to minimise risks prior to attending and during their appointment. For example, patients were advised of the risks of having any MRI unsafe equipment and clothing on them. It also contained key information about how to prepare for a procedure before the appointment if required.

Patients were advised of how their test results would be communicated to the referrer and when they should expect to receive their results following their scan. This ensures patients know what will happen after their scan and what they should expect. Clear communication reduces the risk of misunderstandings, delayed follow-up, and missed results.

Staff assessed patient risks to ensure they were safe to have the procedure they were booked in for. Staff had a comprehensive understanding of specific risks for MRI. They assessed risks such as allergies, renal function, pregnancy status, medical history, previous reactions, and whether implants or pacemakers were present. We saw the MRI safety questionnaire was used to assess these risks.

Staff checked whether patients had any MRI unsafe equipment and clothing on them. Gowns were provided to patients to reduce this risk for patients undergoing MRI.

All records we reviewed demonstrated patients had completed safety questionnaires and they were reviewed with staff. Where risks were identified, staff took action to mitigate the risk.

We spoke to 4 patients during our assessment who told us they felt listened to, everything had been explained, and they were involved in decisions about their care and treatment. For example, the service worked together with a patient who was paraplegic, to enable the scan to go ahead. The service had a magnetic resonance (MR) safe wheelchair the patient could transfer into. Patients told us staff were, “very helpful” and they “couldn’t fault them”. A patient also told us that after struggling to print the MRI safety questionnaire at home, the service suggested that they arrive early and that they would print them.

The service had an emergency and major incident policy. This policy followed guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) MRI safety guidance and Resuscitation Council UK.

This included information on the management of medical emergencies, fire, MRI incidents and magnet quench. A quench is an emergency measure used only in exceptional circumstances to safely remove the magnetic field where there is an immediate risk to life or safety. Staff were aware of the procedure and appropriate monitoring systems were in place to protect patients, visitors and staff.

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 design of the environment followed national guidance. The service had a reception area, an accessible changing room with locker, accessible toilets, an MRI scanner room, an MRI control room and a general office. The MRI scanning environment was secure and designed to protect patients from the risks associated with the strong magnetic field.

Access was restricted by a remotely controlled doorbell and intercom system. There was keypad entry to the clinical area that had recently broken, but a temporary barrier was in place to prevent unauthorised access. This incident had been recorded on the service risk register with actions in place to reduce any potential risk.

MRI local safety rules were in place and reflected best practice and guidance from MHRA (Medicines and Healthcare products Regulatory Agency) MRI Safety Guidelines, IR(ME)R 2017 (Ionising Radiation (Medical Exposure) and SCoR (The Society and College of Radiographers) MRI Safety Guidance. This meant there were clear procedures to ensure patients, visitors and staff were protected from the risks associated with MRI scanning, including the scanner's powerful magnetic field. Staff were trained to carry out safety checks, control access to scanning areas and respond appropriately to any safety concerns, helping to ensure scans were carried out safely and effectively. There was appropriate signage which detailed the MRI safety rule. These signs warn people about the magnetic field and the dangers of bringing metal objects into the MRI environment. Restricted areas are identified so only authorised and appropriately screened individuals can access higher risk zones around the scanner. This supports staff in maintaining a safe environment by clearly communicating local safety rules and emergency procedures.

The service had enough suitable equipment to help them to safely care for patients. All the equipment used in the scanner met the MHRA safety guidelines for MRI equipment. The MRI scanners were fitted with emergency buttons, which stopped scanning and switched off power to the magnet.

There was suitable equipment provided, such as for patients who needed assistance with their mobility. However, the department did not have a hoist but had an MR safe wheelchair that patients could transfer into, an MR safe trolley and pat slide to help with patient transfer.

There was resuscitation equipment in the department, including a defibrillator and a medical device designed for the rapid, safe, and easy self-administration of medication. These were available in the event of patient collapse or an allergic reaction to injected contrast.A spill kit was available, which is a pre-packaged, portable set of equipment designed to immediately contain, disinfect, and safely clean up hazardous liquid or solid spills.

Fire safety equipment was present within the department and had been serviced. Fire exits were clear and free from obstruction and staff received training on evacuation from the MRI scanner.

Patients could summon assistance and help as needed and we saw how patients followed this. We saw a patient use the call bell to stop a scan.

Staff disposed of clinical waste safely. Waste was segregated and labelled in accordance with the local policy. Hazardous substances were stored safely following the services Control of Substances Hazardous to Health (COSHH) policy. The safe storage of potentially harmful substances, such as cleaning products and other chemicals, help protect patients, visitors and staff from accidental exposure and reduce the risk of harm.

We saw that checks on the MRI scanner's helium and oxygen monitoring systems were carried out weekly. These checks are important because MRI scanners use liquid helium to keep the equipment cool. Although leaks are very rare, a helium leak could reduce oxygen levels in the room. The monitoring systems help detect any changes quickly, allowing staff to take immediate action to keep patients, visitors and staff safe.

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 had enough radiographers with the right qualifications, skills, training and experience to keep patients safe from avoidable harm Staff included 1 whole time equivalent (WTE) lead radiographer who was also the registered manager and 2 senior radiographers. The service did not have any vacancies and during the assessment, we saw the actual staffing levels were as planned.

The service employed administrative staff, finance staff and medical secretaries. There were 4 bank radiographers who were used based on the demands of the service. Bank staff had a local induction to the area in which they were working.

Managers supported staff to develop through constructive recorded, annual appraisals and clinical supervision of their work. New staff had a full induction tailored to their role, which included training in using the MRI scanner and equipment, staff were supported until they felt competent. We saw evidence of completed inductions and compliance to local rules within the service.

The service did not employ any medical staff. Radiologists reporting on the procedures for the service were self-employed. Six radiologists held practising privileges and reported on patient scans either by attending the location or remotely reviewing the scans. At the time of the assessment all radiologist appraisals and self-declarations were completed. Practicing privileges are granted to healthcare professional with the right qualifications, skills and experience to provide services within a specific healthcare facility, like a hospital or clinic, without being directly employed by that facility.

Staff understood what action to take if concerns were identified during a procedure, with radiologists available to provide immediate clinical advice. Staff also followed the standard operating procedure for managing unexpected findings. This ensured concerns were assessed promptly, appropriate clinical decisions were made without unnecessary delay, and patients were referred for further investigation or treatment when required, reducing the risk of harm and supporting safe, effective care.

Suitably skilled and qualified staff accompanied patients in all areas, checked the safety questionnaire verbally with the patient and undertook the required diagnostic procedure.

The service supported staff with their learning and professional development needs and ensured they received any specialist training required for their roles. For example, MRI specific training including MRI safety and MR authorised persons. Managers monitored training requirements and staff told us they were given both the time and opportunities to build their skills and knowledge. For example, during a governance meeting we saw discussions around arranging medical secretary training for staff, with suitable courses already being explored and actioned.

The service provided mandatory training in key skills to all staff, provided by external NHS providers. Managers monitored mandatory training and alerted staff when they needed to complete updates. Staff were reminded to complete their mandatory training in a quarterly newsletter and were given sufficient time to complete training.

Training included basic life support, infection prevention, manual handling, safeguarding adults and children, fire safety, preventing radicalisation, equality and diversity, magnetic resonance (MR) authorised persons and health and safety. The data showed a completion rate of 100% for substantive members of staff and mostly 100% for bank staff. Clinical staff completed training on recognising and responding to patients with mental health needs, learning disabilities and dementia.

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 managed infection risks 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 an infection and prevention and control (IPC) policy which was accessible to staff. There was a programme of IPC audits which included hand hygiene and cleaning audits. The service performed well in local IPC audits. Suitable handwashing facilities were in place and there were signs to prompt handwashing. We observed staff decontaminating their hands before and after patient contact including using antibacterial gel and effective handwashing.

In the most recent audits, the scores showed 100% compliance with hand hygiene and 97.2% compliance in the cleaning audit. We observed evidence of action being taken following audit findings. For example, drains had been cleaned following a cleaning audit after finding an odour from a sink. We observed that staff cleaned equipment after each patient and filled in a daily cleaning sheet for the scanning room.

Staff understood the process for managing spillage of body fluids in the department and we saw that a spill kit was safely stored and within the stated expiry date.

Staff complied with effective ICP best practice. Personal Protective Equipment (PPE) was available if needed and we observed staff using it appropriately. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination.

The service did not have a legionella policy or risk assessment, although this was rectified immediately following our inspection. Regular running of all taps has been added to the cleaning schedule.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The service used systems and processes to safely prescribe, administer, record and store medicines. The service did not store any controlled drugs.

Staff had access to required medicines for both scanning with contrast and for emergencies. Contrast is a specialised agent injected intravenously to improve the clarity, detail, and diagnostic accuracy of images. These compounds highlight tissues, blood vessels, and abnormalities. Contrast was only given when there was a doctor on site.

Staff had EpiPen and auto injector training. An EpiPen is a pre-filled automatic injection device that delivers medication to treat a severe allergic reaction (anaphylaxis). It is used in emergencies to help open the airways, improve breathing, and support blood pressure while urgent medical assistance is sought.

The service stored medicines in line with best practice. We saw medicines such as contrast, allergy medication and oxygen, were securely stored in a locked cupboard, in a locked air-conditioned room. A portable oxygen cylinder was stored upright in a purpose-designed cylinder stand. The service was in the process of implementing a temperature monitoring system within the storage room to ensure they met manufacturers storage recommendations.

Medicines were administered under Patient Specific Directions (PSD). A PSD is a written instruction signed by a qualified prescriber to administer or supply a medicine to a named individual patient. It is used to authorise the administration of medication by a competent professional. We saw evidence of staff authorised to administer medicine under the PSD.

Staff completed medicines records accurately and kept them up to date. We saw effective governance processes relating to medicines. For example, we checked that all medicines were in date, stock checks were completed and signed, and there was a monthly drugs audit. The service had a contract with a local pharmacy to supply requested medicines for the service.