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BMI Bishops Wood Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 December 2017

BMI Bishops Wood is operated by BMI Healthcare Limited. It is a private acute care hospital built on the grounds of Mount Vernon Hospital - a facility operated by a National Health Service (NHS) trust. The hospital specialises in cancer services but also provides a wide range of services and specialities to adults and children over the age of three.

Pinner Park Oncology Ward (which will be referred to as Pinner Ward in this report) is the medical ward at BMI Bishops Wood. Pinner Ward is one of the two inpatient wards located on the first floor of the hospital. There are 42 beds spread between Pinner Ward and the surgical ward (Northwood). The 42 beds are made up of 29 inpatient beds, five day case beds, one enhanced recovery bed and seven chemotherapy day rooms. Beds on the surgical ward can be used to admit medical patients if all medical beds are full and vice versa. Staff from the medical ward are responsible for any medical patients on the surgical ward. Pinner Ward is open 24 hours a day, seven days a week. The hospital also provides outpatients and diagnostic imaging services.

We inspected this service in October 2016 using our comprehensive inspection methodology. We found BMI Bishops Wood to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including regulation 12, which relates to safe care and treatment. We identified concerns about the administration and prescribing of chemotherapy at this location. We also found that BMI Bishops Wood was in breach of regulation 17 which relates to good governance. This was based on a failure to assess, monitor and mitigate risks related to chemotherapy as well as failure to maintain complete and accurate records for some chemotherapy patients.

We asked BMI Bishops Wood to provide an action plan detailing how they would make improvements to become compliant with the regulations and the hospital provided this action plan. On 4 October 2017, we carried out an unannounced focused inspection to follow up on concerns around the administration and prescribing of chemotherapy and to check whether the provider had made the improvements set out in the action plan provided to us.

Services we rate

We did not rate this hospital following the inspection on this occasion. This was because we only looked at one aspect about which we had concerns at our previous inspection. Our inspection focused on the chemotherapy concern only.

The concerns we had following the October 2016 inspection were:

  • Staff administered part bags of chemotherapy to patients putting them at risk of harm.

  • There was no uniformity in the protocols and guidance staff referred to in relation to chemotherapy treatment at the hospital.

  • We found evidence of staff without prescribing qualifications prescribing or amending prescriptions.

  • Not all paper chemotherapy prescriptions altered by Registered Medical Officers (RMOs) were countersigned by a consultant. Failure to countersign prescription alterations made by RMOs in the absence of a consultant was not in line with good practice.

  • The hospital did not always use proformas for paper prescribing of chemotherapy and this was not in line with best practice and increased the risk of errors.

  • Some chemotherapy prescriptions had been prescribed with no route, volume or diluent. This put patients at risk of having chemotherapy administered via the wrong route or being given the incorrect dose.

  • Chemotherapy had been stored in the same fridge as other medicines.

However, during our 4 October 2017 inspection, we found the provider had made changes and improvements which were:

  • New processes and procedures had been implemented in relation to chemotherapy in order to improve the clarity and safety of processes at the hospital.

  • The administration of part bags of chemotherapy had stopped.

  • Staff told us over 93 to 94 % of chemotherapy prescriptions were electronic and this reduced the risk of errors involved with paper prescribing.

  • The paper prescriptions we checked during the inspection were on proformas, were legible, and had been completed fully.

  • New processes for staff training had been implemented since our visit in October 2016. This included competency based training for oncology pharmacists.

  • Staff were able to access and demonstrate how they used BMI policies for chemotherapy and there was uniformity in what protocols and guidance were referred to.

  • We also found that staff in the oncology department were continuing to develop further policies and procedures to make processes more robust.

We found the following areas of good practice:

  • Improvements had been made in response to our findings during the 2016 inspection. For example, the administration of part bags of chemotherapy had stopped.

  • There were clear protocols for the administration and prescribing of chemotherapy which staff were aware of.

  • Staff in the oncology department were developing further policies and procedures to further improve medical services in relation to chemotherapy.

  • The majority of chemotherapy prescriptions were on the hospital’s electronic system and this meant more safeguards against errors in prescribing and administering chemotherapy.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 20 December 2017

Effective

Requires improvement

Updated 20 December 2017

Caring

Good

Updated 20 December 2017

Responsive

Good

Updated 20 December 2017

Well-led

Good

Updated 20 December 2017

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 20 December 2017

BMI Bishops Wood Hospital is a 42 bedded independent acute care hospital providing services to adults and children over the age of three. The hospital specialises in cancer services. BMI Bishops Wood also provides medical services, surgery, and outpatients and diagnostic imaging services including physiotherapy. Medical services are those services that involve assessment, diagnosis and treatment of adults by means of medical interventions rather than surgery.Chemotherapy treatments undertaken as a day case are also included within medical care.

We inspected the service in October 2016 and published the report in June 2017. We had concerns about the prescribing and administration of chemotherapy within the service. Following the inspection we asked BMI Bishops Wood to make changes to the way chemotherapy was prescribed and administered. In October 2017 we carried out an unannounced inspection as a follow up to check if BMI Bishops Wood had made improvements following our inspection in 2016.

We found BMI Bishops Wood had addressed our concerns from the previous inspection by making changes which improved the service. We also found that changes were continuing in order to make the systems and process around the administration and prescribing of chemotherapy more robust.

We did not rate this service because we only looked at part of the service. During the inspection we focused on the prescribing and administration of chemotherapy.

Outpatients and diagnostic imaging

Good

Updated 2 June 2017

Surgery

Good

Updated 2 June 2017