Rivers Hospital

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.

Patient areas were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

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

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 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.

Nursing staff for children and young people (CYP) knew how to report incidents and could explain how learning from incidents was shared across the service to improve patient experience. Staff were aware of incidents at a regional level of Rivers services through a childrens and young people working group that met regularly. Staff demonstrated professional curiosity in their approach to near misses, incidents and service user feedback to improve patient and parent or guardian experience. 

All staff understood their responsibility to be open and honest with patients and their families when things went wrong. Staff were able to explain and give examples of instances where duty of candour had been applied. Staff understood that duty of candour involved an apology to those affected as well as investigating certain adverse events. We were told that no duty of candour letters had been issued as they had not been required.

There had been no serious incidents reported in the 12 months prior to our assessment.

Staff at Rivers shared governance minutes, including incident learning, with the hospital. This meant learning was disseminated at a regional level and shared with hospital staff.

Staff were proud of the open culture that they had ownership of and contributed to develop. The service encouraged staff to raise concerns or suggest improvements where there was an opportunity to be more responsive to patient needs.

Please see surgery report for more information on learning culture.

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’s booking processes ensured that enough information was provided in advance to assess whether children’s needs could be safely met. Staff had access to patients’ clinical histories before appointments, supporting safe admission.

Risk assessments were carried out in person prior to treatment. Information about children and young people attending diagnostic imaging and outpatient services was shared in line with guidance between teams. Paediatric staff engaged with teams across the hospital to ensure they understood staffing competency requirements, the location of paediatric emergency equipment and their roles in managing a deterioration paediatric patient within the hospital.

Staff within the Children’s and Young Peoples (CYP) service worked with colleagues across the hospital to ensure that pathways into outpatients and diagnostic imaging were seamless.

Children and young people who were undergoing a day case surgical procedure had an admission process that ensured all essential information about a patient’s needs and circumstance were documented and understood by a named paediatric registered nurse. Following admission patients remained under the clinical supervision of a named consultant until the point of discharge. The service provided written communication to GP services to provide continuity in their healthcare records. We saw that there was communication with school where appropriate in order to help manage care and treatment.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

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.

Staff knew how to make a safeguarding referral and who to inform if they had concerns.

The national safeguarding lead was based at Rivers and was trained to level 4. There was also a Rivers designated safeguarding lead who staff could contact for advice and escalation.  Staff told us that the safeguarding team were easily accessible and could give examples of when they had contacted them for advice and what the outcomes were.

The hospital met the requirements of the ‘Safeguarding children and young people and CYP in care: competencies for health care staff’ guidance’, which recommends staff who are in regular contact with children and young people in both inpatient and outpatient clinics should be level 3 safeguarding trained. 

All post operative children and young patients were cared for on a ward with secure private rooms that provided space for family or guardians.

Staff were trained in learning disabilities and autism and understood how to identify adults and children at risk of harm. They could describe how to safeguard people from abuse, harassment and discrimination, including those with protected characteristics.

The service carried out appropriate recruitment checks. This included checks with the Disclosure and Barring Service (DBS) for both adults and children barred lists. There was a process to review risks identified in recruitment checks.

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.

The service worked with children and young people throughout the care pathway. Staff used age-appropriate resources to support communication. Parents and guardians that we spoke with said there was ample time to discuss concerns.

Staff utilised a Paediatric Early Warning Score (PEWS) system to identify and respond to any deterioration in a child or young person’s clinical condition. Nursing staff demonstrated a clear understanding of the actions required when PEWS scores exceeded expected levels. We reviewed 5 completed PEWS charts and confirmed that staff escalated concerns appropriately, with repeat observations undertaken when necessary and within the required timescales. Compliance with PEWS documentation and escalation processes was regularly monitored through audits of children and young people’s clinical records.

All nursing staff had completed Paediatric Basic Life Support (PBLS) training. There was always a member of the nursing team with European Paediatric Advanced Life Support (EPALS) training available in the department, ensuring competent staff were available to respond to a deteriorating patient. All paediatric trained consultants were required to complete emergency paediatric resuscitation training.

Staff took part in practice emergency scenarios. These were observed by a paediatric registered nurse who coordinated debriefs and shared learning.

The service had emergency resuscitation equipment specifically for children and young people located throughout the hospital. The service had identified the need to upgrade grab bags so that they are easier to access in an emergency.

Staff developed written bespoke communication for children with additional needs to support their understanding of medical examinations and procedures to inform consent.

We heard how staff took actions to safeguard the interests of patients during preassessment. This helped staff understand children's and young people's individual needs and any adjustments required to support their care.

The service had access to a Resident Medical Officer (RMO) trained in Advanced Paediatric Life Support (APLS). The RMO was available to provide specialist support to the Children and Young People (CYP) service in the event that a child or young person became clinically unwell.

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.

Children and young people’s staff conducted environmental risk assessments throughout the hospital to identify and mitigate risk to service users. We reviewed patient records that included environmental risk assessments completed throughout the patient pathway through the hospital. The hospital had dual use rooms that could be adapted for use by children or adults depending on planned service demand. There are two ward areas consisting of 4 beds. The ward areas were dual use and were used by both adults and children but not at the same time. Each bed was in a private room with ensuite facilities that included showing facilities. Doors to the area were secured by keypads, and entry to the area was monitored by CCTV. At the time of the inspection there were no paediatric patients in the ward area.

The hospital had appropriate provision for children and young people. For example, we saw a section of the waiting area with small tables and activities. Children and young people admitted to the ward were encouraged to bring a toy or game from home.

Staff monitored the experiences of children and young people and were aware of the risks associated with using the service. The service had an embedded audit process for assessing environmental risks and included observations for potential slip, trips and falls within the hospital.

Resuscitation trolleys were checked daily to ensure they were stocked, equipment was in working order and medicines were in date.

Please refer to surgery, outpatients and diagnostics and imaging reports for more information.

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 had enough nursing and support staff to keep children and young people safe. The hospital had a lead registered children’s nurse (RCN), 4 permanent RCNs. Staff completed European Paediatric Advanced Life Support (EPAS) and PILS (Paediatric Immediate Life Support) training.

The hospital employed a registered children and young people’s (CYP) nurse who was accountable for all the children’s services at the hospital. This met the Royal College of Nursing guidance on defining staffing levels for children and young people’s services.

The EPALS course is a collaboration between Resuscitation Council UK and the European Resuscitation Council. It is endorsed by the Royal College of Paediatric and Child Health (RCPCH) and approved by the Royal Colleges of Emergency Medicine (RCEM), and Anesthetics (RCoA), as well as the Association of Paediatric Anesthetists (APAGBI). 

PILS provides a variety of skills, from managing a deteriorating patient, identifying causes of deterioration and treating cardiac arrest in children, to developing team leadership abilities and finding out what it takes to be an effective team member in a cardiac arrest emergency.

The service did not use agency RCNs and used bank staff from other locations run by the provider. All staff received an induction that was specific to the role and were required to meet core competencies. The embedded experience of nursing and medical paediatric staff meant there were clear pathways and continuity of patient care. There was always a named RCN to each patient throughout their care pathway.

Mandatory training was comprehensive and met the needs of children and young people. Paediatric nursing staff also completed inhouse training such as sepsis in children and pre-and post-operative care in children and young people. All staff received mandatory training on learning disabilities and autism delivered by trainers with lived experience.

Consultants retained overall clinical responsibility for the care of patients care and ensured appropriate consultant cover was in place during periods of planned absence. A Resident Doctor was present on site 24 hours a day, providing immediate medical support and escalation as required.

All services at the hospital were planned so the service could ensure adequate staffing levels for procedures and outpatient appointments. During surgical procedures involving children and young people, a registered children’s nurse was always present at the hospital.

The service ran regular drills led by the children and young people’s lead nurse.

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.

All clinical areas were clean. We saw evidence that rooms were cleaned regularly and were audited. There were hand sanitiser dispensers in clinical areas.

Infection prevention and control (IPC) practices were embedded in routine care. Staff followed hand hygiene principles and used personal protective equipment (PPE) as required.

The theatre environment followed national guidance, with separate areas to enable flow from clean storage, preparation through to an area for dirty equipment and waste management. There was storage for equipment including sterile packs, uniforms and linen. 

The service performed well in local IPC audits. In the most recent audits, the scores showed compliance with infection prevention and control measures in all clinical areas, with all audits achieving over 95% compliance. There was a regular assessment of hand hygiene for staff members. We observed consultants being bare below the elbows and regular audits to assess compliance with hand hygiene infection prevention and control measures.

There was a provider infection and prevention and control policy and supporting guidance that was accessible to staff. The providers guidelines reflected national Infection Prevention Control (IPC) guidance from Public Health England (PHE), and the Royal College of Surgeons. Staff had access to expertise in infection control as needed.

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. We reviewed 5 medical records and saw allergy status and weights were clearly documented and were accessible as people moved between services with the hospital.

The service used systems and processes to safely prescribe, administer, record and store medicines.

Staff completed medicines records accurately and kept them up to date. There were accurate records of medicines administered in the operating theatre, recovery and wards.

There was a protocol in place to discuss and inform parents about medication management at discharge. This included written instructions on how to escalate concerns and for medical advice.

Emergency medicines and reversal agents were available and checked regularly. Staff were aware of which medicines required consultant authorisation.

Please refer to surgery, outpatients and diagnostics and imaging reports for more information.