Optegra Eye Hospital Uttoxeter

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 is the first assessment of Optegra Eye Hospital Uttoxeter. This key question has been rated
as 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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Optegra Eye Hospital Uttoxeter had a proactive, systematic approach to managing safety.
Leaders embedded, maintained and sought to continuously improve a culture of openness and collaboration, and safety was everyone’s top priority. Staff knew what incidents to report and how to report them. The organisation used an electronic reporting system to report and record any incidents. The service had effective policies and guidance for staff on how to identify, categorise by level of harm and report incidents.

All staff and patients were actively encouraged to raise concerns about safety and to share ideas to improve services. The value of learning was continually demonstrated and reinforced by leaders. New incidents were discussed at hospital-wide huddles at the start of each day. Senior managers reviewed all new incidents daily to identify any serious incidents that required immediate actions, such as escalation to the corporate provider or external reporting to organisations such as the Care Quality Commission (CQC) or NHS service commissioners.

The registered manager and the hospital manager told us if an incident was reported, it would be investigated by staff with the appropriate level of seniority. They said information about incidents was shared with staff through monthly newsletters and discussed during routine staff meetings to improve practice and the service to patients. We saw evidence of this in the meeting minutes and newsletters.

There was an effective system to ensure safety alerts relating to patient safety, medicines and medical devices were cascaded to staff and responded to in a timely manner. The registered manager and the hospital manager were aware of their responsibility to report notifiable incidents to CQC and other external organisations. When safety incidents occurred; they were reported and investigated appropriately. Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation, apology and information and support if things went wrong.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Patients had an initial assessment to determine whether they were eligible to receive treatment at the hospital. The hospital’s pre-assessment policy listed the eligibility criteria for patients to be admitted for treatment. The hospital admitted patients with an American Society of Anesthesiologists (ASA) score of 3 or below, which meant patients were generally healthy with some comorbidities. Patients who did not meet the admission criteria were signposted to NHS acute services so they could receive further treatment, if required.

Staff completed risk assessments for each patient on arrival. This included checking the patient’s medical history, any allergies, any medicines taken, as well as observations of vital signs and an eye examination by an optometrist. Patients were assessed by the ophthalmologist surgeon on the day of surgery to identify if there had been any changes to their medical condition since their initial consultation. Following that a decision was made whether treatment could commence.

The registered manager told us they would contact the emergency services if a patient’s health deteriorated during a procedure, so the patient could be transferred to the nearest acute hospital by ambulance. There had been no instances where a patient’s health deteriorated during or after treatment and required urgent transfer to hospital during the past 12 months.

Staff supported patients to be involved in their own care. This enabled patients to maintain as much control as possible throughout their care and treatment.

Staff used a recognised tool to assess patients, and reviewed this regularly, including after any incident. Staff used a National Early Warning Score system and carried out observations, and any additional checks based on the patient’s individual needs to ensure any changes to their medical condition could be promptly identified. Patients undergoing eye surgery were treated using local anaesthetic only.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Examples of the referral process showed essential information was recorded.

Following surgery, patients had access to a 24-hour helpline for any concerns. If the concern could not be resolved over the phone, on call staff were available to review a patient in an emergency. Patients were provided with information about how to access support when they were discharged from the hospital. Staff we spoke with told us they had opened the clinic out of hours to see patients in an emergency if required.

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. 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 service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. All clinical staff and staff who had face to face contact with patients and relatives had completed up to level 3 safeguarding adults and children training. The safeguarding leads had completed Level 4 training as required.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Information on how to raise concerns within the service and to external bodies, such as local authority safeguarding teams, was available for staff.

There was a commitment to taking immediate action to keep patients safe from abuse and neglect. Staff were knowledgeable about safeguarding and gave us examples of actions taken when potential safeguarding concerns were identified. Information was displayed strategically on noticeboards throughout the clinic highlighting types of abuse and actions to safeguard vulnerable people. Staff followed safe procedures for children attending the hospital. The hospital did not treat any patients under the age of 18, but staff recognised the need for such procedures as children may accompany a parent or relative for their appointment.

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.

Most staff had updated their mandatory training in life support, but some had still to complete this. Records showed 90.9% of staff had updated basic life support training as part of the mandatory training programme. Relevant clinical staff were required to undertake immediate life support training and 87.5% of staff had updated this training against a compliance standard of 95% or above of all staff. The service was taking action to improve compliance in line with the standard required.

Staff completed the World Health Organisation (WHO) safety checklist for surgery that had been adapted and improved following learning from previous incidents within the whole organisation. We observed the use of the adapted ophthalmic surgical safety checklist and found this was completed appropriately. Staff carried out regular audits to monitor adherence to the WHO guidelines and completion of the surgical checklist record. The audit results ranged between 93% and 100% demonstrating a high level of staff compliance.

There was an endophthalmitis standard operating procedure and a specific endophthalmitis kit to treat patients should they develop a severe infection. Endophthalmitis is an infection of the tissues or fluids inside the eyeball. Managers reported this standard operating procedure was shared with all staff. Staff we spoke with knew where to find this kit and how to treat the condition should it ever occur.

The service had several lasers for laser eye surgery or yttrium aluminium garnet laser treatment which was used to clear any frosting from the back surface of a lens. Laser equipment was stored in designated areas. Checks and risk assessments were carried out by trained staff before use, including use of appropriate personal protective equipment. Temperature and humidity in the designated laser rooms was monitored daily to ensure machines operated within the manufacturer’s parameters.

Each laser had a set of local rules, policies and procedures and a designated list of staff that were trained to use the equipment. Records showed the service had designated staff members that had completed laser protection training. There was a designated laser protection supervisor (LPS) who oversaw the laser protection policies and risk assessments. The LPS also carried out annual competency assessments for staff using the laser equipment. The
competency record showed staff underwent suitable training and assessment prior to using laser equipment. The service also had an external laser protection advisor (LPA). The LPA carried out an annual review of policies and risk assessments and provided guidance and support in relation to laser protection. The latest review had recently taken place, and the LPA reported the hospital as compliant with relevant laser protection standards.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

All clinical areas were well maintained, free from clutter and provided a suitable environment for providing care and treatment to patients. The design of the hospital environment followed national guidance. Clinical areas were located on the ground floor of the building, with easy access to the entrance for patients with mobility difficulties.

Patients attending for surgical appointments followed a defined route from the waiting area, through pre-admission checks to theatres and post-surgery recovery bays.

Staff carried out daily safety checks of specialist equipment. There was a thorough system to ensure safety, upkeep, and repairs for buildings and equipment. Managers ensured the facilities, premises, equipment, and technology were maintained. They supported staff use the equipment to consistently deliver safe and effective care. There were arrangements for medical device servicing and decontamination, and staff received relevant training.

There was well-sited emergency equipment which was maintained and fit for purpose. An emergency resuscitation trolley was located next to the operating theatres. Staff undertook and recorded daily, weekly and monthly checks of the equipment on the trolley, including the automatic electronic defibrillator. Breakable tags were used to secure the contents of the trolley and to show they had not been tampered with. The check logs were fully completed as
required by the hospital’s policy; we found no gaps or omissions in the check logs we looked at.

Cleaning kits were available in the event of any spillage. Any chemicals were stored in a locked cupboard identified for control of substances hazardous to health (COSHH) in a locked room. However, we saw some out of date products, although staff took action to remove these on the day of our visit when it was pointed out.

The service had enough suitable equipment to help staff safely care for patients. The service held sufficient stocks of lenses to complete the number of procedures to be undertaken each day, including spare lenses for use in the event of a lens failure or damage. The hospital used single-use, sterile instruments as appropriate and those we reviewed were within their expiry dates. The hospital had arrangements for the sterilisation of reusable instruments under a
contract and monitored through a service level agreement with an external provider.

Staff disposed of clinical waste safely. There was appropriate segregation of clinical and nonclinical waste. Sharps containers were clean, labelled and not overfilled.

There was clear signage throughout the hospital, including emergency exit signs. Fire extinguishers were located throughout the hospital; all extinguishers we checked had been tested. Trained staff were allocated daily to the fire marshal role and identified during the morning quality and safety huddle.

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. Staff worked together well to provide safe care that met people’s individual needs.

The service was fully staffed and had low rates of sickness. The registered manager told us the hospital occasionally used bank staff to cover leave or unplanned absence. Managers made sure all bank staff had a full induction and understood the service.

Most staff received and were up to date with their mandatory training, with compliance ranging between 85% and 97%. The training system alerted staff when each individual module was due to expire or when it was overdue. Senior managers had full oversight staff training records and completion rates. The training was appropriate for the patient group using the service. Most staff had received their appraisals, though some had not yet due to reasons such as sickness.

The provider encouraged and supported staff to complete a mental health first aid course. Many staff had completed this course provided by Optegra, along with cognitive behaviour type therapy. Staff felt extremely supported to attend additional training.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had sufficient personal protective equipment to carry out procedures and personal care activities. Handwashing sinks and hand sanitiser dispensers were available and accessible throughout. Staff washed their hands and used hand sanitiser between contact with patients.

All areas of the hospital were visibly clean with suitable furnishings which were well-maintained and easy to clean. The hospital sub-contracted cleaning to an external cleaning provider under a service level agreement. The housekeeper had a schedule of works’ log which set out the specific areas to be cleaned each day, each week or each month. The external cleaning provider’s supervisor attended often to review the logs and identify and address any concerns or gaps. The registered manager and cleaning provider met regularly to discuss cleanliness, audit and scheduling.

Clinical staff were responsible and trained for cleaning the clinical area they were assigned to that day. Each clinic had cleaning record schedule forms, and these were complete and up to date. Cleaning plans and schedules were, where appropriate, individualised to the room and the equipment within it.

Environment hygiene audits were carried regularly, and records showed 96% compliance. Staff also carried out routine decontamination and clinical waste audits and compliance was at 100%. All staff were required to complete an annual infection prevention and control course as part of mandatory training requirements.

Patients were assessed for any potential infection or illness preoperatively. The NHS pre‑operative assessment was conducted for most patients through an online form that followed a standardised algorithm of up to 53 questions. This process was designed to initially assess each patient’s suitability for surgery, covering key areas such as medical history, current medications and significant systemic conditions. As part of the screening, patients were asked specific questions about their health. This included whether they ever had an infection such as MRSA or a skin infection after a hospital stay or been diagnosed with HIV or hepatitis. These screening questions were repeated during the patient’s diagnostic appointment and again on the day of surgery at admission to ensure information remained accurate and up to date.

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. Staff involved people in planning, including when changes happen.

Medicines were appropriately prescribed. Most of the medications given were eye drops and low dose of sedation medication as optional for a patient. Medicines were supplied and administered in line with the relevant legislation, current national guidance or best available evidence. Staff maintained accurate and clear records of medicines given to patients and recorded when medicines were not given and the reason for this. Staff recorded patients’ allergies on their electronic treatment charts. Allergies were also written on patients’ wristbands which came in a red colour to make them highly visible.

There was a medicines management policy that provided guidance on the handling, storage and administration of medicines. Staff also undertook competency-based training in relation to the administration of medicines. Medicines used during eye surgery procedures and given to patients to take home were prescribed by the ophthalmologist. The hospital had an arrangement with a local pharmacy for the supply and disposal of medicines. Staff could contact the pharmacy for advice and support if needed. The external pharmacy contractor also carried out an audit of medicines stocks at the hospital every 3 months.

Staff reviewed patient’s medicines regularly and provided advice to patients and relative about medicines. Patients were given information on ‘to take home’ medicines as part of their discharge consultation and aftercare leaflets with relevant information and guidance including administering eye drops.

Medicines, including controlled drugs, were securely stored. Staff carried out routine checks on controlled drugs and medicine stocks to ensure that medicines were reconciled correctly. We looked at a sample of controlled drugs and routine medicine stocks and found stock levels were correct. Medicines that required storage at temperatures between 2ºC and 8ºC were safely stored in medicine fridges. Fridge temperature logs showed these were checked daily and medicines we checked were stored at the correct temperatures. There were effective processes to follow if temperatures were ever out of range.

Staff followed a process for the safe and appropriate disposal of controlled drugs and other medicines when they were no longer required or had become out of date. The hospital had a controlled drugs accountable officer who presented an annual report to the clinical governance committee.

Staff completed medicines records accurately and kept them up to date. We looked at medicine administration records for 5 patients. Patients were given medicines in a timely way, as prescribed, and records were completed appropriately. The records we looked at also showed the patient’s allergy status had been documented.

Staff carried out routine audits to check compliance against medicines management policies and Medicine records audit, results showed staff achieved between 95% and 99%.