Hartlepool MRI Unit

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that leaders had systems for identifying and responding to deteriorating patients in the department and that safety checks were completed prior to entering the MRI environment.

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

The service had a good learning culture and staff and patients could raise concerns. There were enough staff with the right skills, qualifications and experience in the department to ensure high quality care.

Managers made sure that staff received training and had regular appraisals to maintain high quality care. Staff managed medicines safely and the facilities and equipment met the needs of patients. The environment was clean and well maintained.

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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learned to continually identify and embed good practice. Learning was shared with staff.

The service managed patient safety incidents well. Staff knew how to report incidents and near misses in line with the local procedure. We saw evidence of incidents reported with actions taken to mitigate risk. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

The service had a current incident management framework policy, which set out clear responsibilities for different grades of staff in terms of reporting and investigating incidents.

There were electronic systems in place for reporting incidents, and incidents were reported via the NHS and the provider's systems to ensure learning occurred across both organisations.

In the year prior to our inspection the service reported no never events or serious incidents. A never event is a serious, preventable safety incident which should not occur if the available preventative measures are followed. Examples of more minor incidents which occurred at the unit within the last year included a patient being identified incorrectly by the wrong name, which resulted in strengthening of identity checks, and a minor injury to a patient after a headset broke, where staff followed correct procedures.

Clinical staff we spoke to were able to tell us that duty of candour meant being honest with a patient, but they were not able to give details about how this might be carried out. There were no serious incidents, which met the duty of candour threshold, in the twelve months up to our inspection. However, we saw evidence that patients had been contacted and apologies given where minor incidents had occurred.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates.

Staff received and kept up to date with their mandatory training. The data showed a completion rate of 96%.

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 and between providers.

Safety and continuity of care was a priority throughout people’s care pathway. Patients were assessed prior to the referral for diagnostic imaging, and all images were based on a formal request from a member of the medical team.

There were admission criteria for both private and NHS patients and there were protocols and flow charts showing different clinical pathways, which were easily accessible to staff. Patients requiring tests and investigations were given enough information to enable them to understand the procedure.

There were systems and processes to ensure the correct patients were treated throughout the patient journey and they only received the procedure which was intended. We followed three patients from entering the scanning department to leaving. Staff completed risk assessments for each patient on arrival, using a recognised tool. The service used The Society of Radiographers’ ‘Pause and Check’ system. Pause and check consisted of the 3-point demographic checks to correctly identify the patient, as well as checking with the patient the site to be imaged, the existence of previous imaging, and for the operator to ensure the correct imaging modality was used. We observed staff always used the 3-point demographic checks in line with the correct procedure.

All patients were required to complete MRI safety questionnaires. The safety questionnaires included asking patients if they had cardiac pacemaker, defibrillators or other devices in their chest and female patients were asked if they were pregnant. We saw these were completed. Family members were asked to complete a visitor’s safety questionnaire prior to the scan. Gowns were available for patients to change into if their clothing contained metal, such as metal zips. All referrals included patient identification, contact details, clinical history and examination requested, and details of the referring clinician/practitioner.

Patient records were a mixture of electronic and paper based and were kept securely. The IT connectivity was consistently available across the service to meet the needs of staff completing the records and we saw a business continuity plan, which outlined the pathway to be followed in case of any system failure.

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer. Care and support were planned and organised with people, together with partners and communities in ways which ensured continuity.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff 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 provider shared concerns quickly and appropriately.

Staff we spoke with knew how to find information about how to make a safeguarding referral and who they needed to inform. Staff received adult and children’s safeguarding training. Data showed that 78% of staff had completed their level 3 safeguarding, 88% had completed their safeguarding children training, and 92% had completed their safeguarding adults at risk training. The service had new members of staff, who had not yet fully completed their mandatory training which may have affected these numbers.

There was a safeguarding lead for the provider who was trained to level 4 Safeguarding. Staff we spoke with were not able to name the safeguarding lead, but they knew where to find this information if needed.

There were current safeguarding policies at a national and local level, and these reflected the national guidance for adults and children, and local practices within the host trust. There was also an up-to-date chaperone policy and a poster on display which told patients how to request a chaperone.

The IT systems were able to flag patient records if there were any concerns, for example about violence, so that staff could take precautions.

Staff told us that if Lasting Power of Attorney was claimed, the referrer would need to verify this, so it would not be accepted without proof.

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 patients to understand and manage risks. The treatment and care met patients’ needs in a way which was safe and supportive. We spoke with 1 patient on-site, who told us that they felt listened to and supported, and risks had been explained. We also observed the journeys of 3 additional patients through the department and saw that they were involved in decisions about their care.

The service did not always detect and control potential risks in the care environment. However, they did make sure equipment, facilities and technology supported the delivery of safe care.

Staff did not always dispose of clinical waste safely. During our visit we observed a used needle, which had not been properly disposed of in the sharps bin. However, this was rectified immediately when pointed out. Waste was segregated and labelled in accordance with the trust policy. Hazardous substances were not always stored safely. We saw cleaning fluids in an unlockable cupboard during our visit, although the cupboard was in a secure area where access was restricted to staff and patients. The service has since provided evidence that the storage cupboard is now locked.

The design of the environment followed national guidance around the built environment. Where required, areas were secure and afforded protection to patients. Access was restricted by keypad, and the combination was changed whenever a staff member left the service.

The unit had a secure area with restricted access, containing one MRI scanner / examination room, an MRI control room, a preparation area, changing cubicle and cannulation area. There was also a locked equipment / storage room, a waiting room and reception area. We observed staff and patients walking into the secure patient area only when permitted to do so.

MRI local safety rules were in place and reflected best practise. There was signage which detailed the magnet strength and safety rules. The MRI scanner was fitted with an emergency button which stopped scanning and switched off power to the magnet.

The service had enough suitable equipment to help them to safely care for patients. All the equipment used in the scanner met the Medicines and Healthcare products Regulatory Agency (MHRA) safety guidelines for MRI equipment. Equipment was calibrated in line with manufacturer’s guidelines, and we inspected the quality assurance log, which was up to date.

The service had service level agreements with manufacturers to ensure that the MRI equipment was properly maintained, and staff told us that engineers responded quickly to calls. Handover forms were used when equipment was handed to engineers and physicists for servicing and testing, in line with best practice. Whilst on-site we saw a completed form for the last handover, which was filled out correctly.

There was suitable equipment provided and used correctly, such as for patients who needed assistance with their mobility or to transfer onto equipment. The resuscitation equipment was stored in the CT department next door, and entry was restricted via a keypad. However, a risk assessment was in place, and emergency drugs, including adrenaline, and medical gases were available in the MRI department to mitigate any risk. There were emergency procedure sheets for all MRI scanners.

We checked the equipment and found all single use items were in date.

The environment used for patient care reduced the risk of patient harm, and included for example, safe flooring, handrails and window restrictors. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair of replacement of broken or missing equipment.

Patients could summon assistance and help as needed and we saw how patients were shown this.

The service had suitable facilities to meet the needs of patients’ families when necessary.

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 clinical staff including radiographers and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and diagnostic assessment.

Staff included 1 whole time equivalent (WTE) clinical lead, 3.4 WTE senior radiographers, 1 WTE radiographer, 2.5 WTE graduate radiographers 1 WTE apprentice assistant practitioner and 1.75 medical secretary / receptionists. Staff worked very closely with the MRI unit at a different site within the host trust to ensure that the service was always adequately staffed, so there was frequent staff rotation across both sites. Staff used an app to contact each other in case of sickness or absence, so that replacements could be found quickly. Staff told us that there were always at least 2 clinical staff members on duty each day, one of which was always a senior radiographer, but the usual staffing would be 2 radiographers and 1 assistant. The service did not employ bank staff.

At the time of our visit the service had no vacancies, and the actual staffing levels were as planned.

The service had 4 senior radiographers who were able to report within a defined scope of practice. Where scans were outside of this scope, or needed to be escalated, radiologists employed by the local trust provided the reports for NHS patients, and radiologists with practicing privileges with the provider reported on scans for private patients. 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. There was a system of peer review and audit in place to monitor the quality of reporting.

New staff had a full induction tailored to their role before they started work. Interviews for clinical staff included tests of knowledge, and clinical competencies were checked as part of the induction process. Managers supported staff to develop through constructive recorded, annual appraisals and mid-year reviews, and constructive clinical supervision of their work. We saw several examples of completed appraisals and mid-year reviews. All radiologists were required to provide evidence of appraisal and re-validation.

Staff we spoke with said they felt the service was safe. Patients felt their needs were met in a timely way. Patients appeared comfortable and were engaged in conversations because there were sufficient staff.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. Staff told us that they received time and funding for training and that requests for training were usually granted.

Diagnostic imaging procedures were carried out by professionals with appropriate seniority and speciality training.

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. The department was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained.

There was a provider infection and prevention and control (IPC) policy and supporting guidance that was accessible to staff. The policy was up to date.

There was a programme of infection and prevention and control audits including for example, regular hand hygiene audits. A poster demonstrating the most recent IPC audit compliance was displayed on the notice board and all areas were shown to be compliant.

We observed staff cleaning equipment after patient contact, and we saw cleaning schedules for the department.

There were processes in place to enable staff to respond to infection prevention and control risks such as transmittable infections. Staff told us that patients with transmittable infections were scanned at the end of the list, so that equipment could be decontaminated thoroughly afterwards.

We observed staff following infection control principles including compliant handwashing and the use of personal protective equipment.

Staff understood the process for managing spillage of body fluids in the department, and we saw that staff had access to spillage kits in the department.

Staff supported infection prevention and control measures by following the uniform policy. 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 made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The staff had access to required medicines, including emergency medicines and these were appropriately stored. Medical oxygen was safely stored away from the magnet, and in date.

Staff told us that medicines were prescribed by patient group directive (PGD) or patient specific directive (PSD) and we saw 6 examples of PGDs. A PGD is a legal framework that allows authorised healthcare professionals to administer specific medicines to a defined group of patients without a prescription. A PSD is an instruction from a prescriber to administer a medicine to a named individual after assessing their clinical needs. The service used systems and processes to safely prescribe, administer, record and store medicines.

The provider had a medicines management policy, which was current, and there was also a local service medicines management procedure. We saw examples of medicines audits and audits of patient records which showed that appropriate PGDs were in place. Staff completed medicines records accurately and kept them up to date. There was effective governance of medicines, and there were quick reference guides available for staff to identify any adverse reactions to contrast media injections. We checked a sample of medicines and saw that they were all in date.