InHealth MRI - Wansbeck 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

The service had a good learning culture, where staff and patients knew how to raise concerns and managers ensured that learning from incidents was shared. There were enough staff with the right skills, qualifications and experience to ensure high quality care. Managers made sure that staff received appropriate training and had regular appraisals. The facilities and equipment met the needs of the patients, were clean and well-maintained and any risks were mitigated.

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 provider 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.

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. We were also told about examples of wider learning within the organisation taken from incidents. For example, following an incident at a different site where the wrong person was scanned, the process for checking a patient’s identity was changed across all sites at the trust to prevent a similar incident happening.

There were electronic systems in place for reporting incidents, and incidents were reported on the trust system and on the InHealth system 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.

Staff understood duty of candour, but there were no events at the service in the previous year which required duty of candour to be carried out.

The service had a current incident reporting and reviewing policy, which reflected the provider and national guidance.

The service had a compliance training policy, which listed the training requirements by role and was in line with national guidance and best practice. The compliance rate for mandatory training for clinical staff was 100%. The compliance rate for administrative staff in some areas such as basic life support and MRI safety was low, but this was explained by recent changes to the way these training modules were delivered. Staff told us that they received reminders when their training was due, and that they were allowed time to complete the training or could choose to complete it at home and claim time back if preferred.

The provider 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.

Safety was a priority throughout the patient journey in the department. We observed four patients from arrival into the department through to completion of their scan. Before being referred for a scan, patients were assessed by a clinician who completed a formal request for an MRI scan. The referring clinician completed a risk assessment to check for any reasons why the scan might not be safe for that patient, and we saw evidence of these risk assessments. All referrals included patient identification, contact details, clinical history, examination requested and degree of urgency, and details of the referring clinician.

Recognised safety questionnaires were sent to patients with their appointment letter before they came to the department. We saw staff checking patients’ identities and asking to see the safety questionnaires. If patients did not bring the completed questionnaire to their appointment, another questionnaire was given to them to complete before the scan. If patients needed to have contrast dye injected before the scan, they were given separate safety questionnaires for this. Radiography staff then repeated these safety checks immediately before the scan. Visitors or family members accompanying a patient to a scan were also asked to complete a safety questionnaire.

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. The service provided a pause and check safety audit which showed 30 records were reviewed each quarter, and 3-point checks had been checked against the referral.

Patient records were electronic, with paper-based safety checks, and IT connectivity was consistently available across the service to meet the needs of staff completing the records. There were contingency plans in place for several scenarios of IT failure, but staff told us that this rarely happened.

When responsibility for the care and treatment of a patient moved to a different service provider, such as transfer back to the NHS Trust, there was effective communication, which allowed for seamless transfer.

The provider 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 understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff received adult and children’s safeguarding training. Data showed that 100% of clinical staff were trained to level 3 safeguarding adults. Administrative staff were trained to level 2 safeguarding adults, but one member of administrative staff had not yet completed this training. All staff were trained to level 2 safeguarding children.

Posters were displayed in staff offices with the name and contact details of the safeguarding lead for the organisation and all the staff we spoke with knew how to find these and knew who to contact to raise a safeguarding concern.

When relevant, staff checked that people claiming lasting power of attorney had the appropriate documents to support this.

The service had up to date policies in place for adult and children’s safeguarding and an up to date chaperone policy. There were posters displayed in the department informing patients of their right to request a chaperone. Staff followed safe procedures for visitors attending the department. Children were not allowed to be left unsupervised in the department, so no children under the age of 16 were allowed to accompany an adult attending for a scan and patients were informed of this prior to attending their appointment.

The provider 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 and met patients’ needs in a way which was safe and supportive.

We spoke to three patients during our inspection, and received written feedback from a further four, and they told us that staff explained what was going to happen at each stage of the scanning process. We tracked the patient journey through the department of four patients and we saw that risks were explained and patients were given opportunities to ask questions.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely. Access to the department was restricted by a keypad, so patients had to ring a doorbell to be admitted. There was a removable barrier between the waiting area and the scanning area so that patients or visitors couldn’t accidentally enter a restricted area. Staff told us that the department, scanning area and all medicines cupboards were locked out of hours.

The unit had a preparation area and changing cubicle, an MRI examination room and an MRI control room. There were two small office spaces and a kitchen for staff to use. We checked the equipment and all single use items that we checked were in date.

MRI safety rules were in place and reflected best practice. There was signage which detailed the magnet strength and safety rules. The MRI scanners were fitted with emergency buttons 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. We saw the service log, which showed that the equipment was calibrated in line with the manufacturers’ guidance, and the manufacturers’ instructions for the safe use, cleaning and maintenance of the equipment was readily available to staff. Staff completed daily checks of equipment, and we saw evidence of this in the maintenance log.

There were handover forms used when equipment was handed to engineers and physicists for servicing and testing, according to guidance and best practice.

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. There was access to resuscitation equipment in the department which was all in date.

Patients could summon assistance as needed and we saw that patients were provided with buzzers and encouraged to test them prior to the scan for reassurance.

Staff disposed of clinical waste safely. Waste was segregated and labelled in accordance with the trust policy.

The provider 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 radiography 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 treatment.

The service had six whole-time equivalent (WTE) radiographers but in order to ensure that there were always sufficient appropriately qualified staff available, the service worked together with staff employed at other sites at the host trust. Therefore, staff rotated across four different hospital sites on a regular basis. This made sure that all staff were familiar with the different types of scanners at each site and could cover in the event of staff sickness. Staff used an app to contact each other in the event of staff sickness, so that replacement staff could be found quickly.

The service did not employ any health care assistants at the time of our inspection, but they were training reception staff to take on health care assistant roles so that they could support the radiographers with clinical duties. Staff told us that there were always two radiographers on duty each day, one of which would always be a senior radiographer with specialist skills if required based on the type of scans being delivered on the day.

There were no clinical staff vacancies and the actual staffing levels were as planned during our inspection. There were administrative staff vacancies, but there was a recruitment plan and time scale in place.

Medical staff employed by the host trust reported on scans for NHS patients. InHealth Limited used an external company to report its images for private patients.

New staff had a full induction tailored to their role before they started work and were subject to a three-month probationary period. Competencies were checked before staff were allowed to work without supervision and we saw evidence of completed competency checklists with feedback. Managers supported staff with annual appraisals, mid-year review and constructive supervision. The compliance rate for appraisal was 100%. All radiologists were required to provide evidence of appraisal and re-validation.

Managers told us that there was an in-house learning and development programme delivered by InHealth, and where appropriate external courses were funded.

The staff we spoke with said that they felt the service was safe.

The provider 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. We saw evidence of hand hygiene and cleaning audits for the three months prior to our inspection, which all showed compliance in most areas. We saw an example of an email that was sent to all staff as an action from an audit where compliance was less than 100%, reminding them of the need to clean hands after removing gloves.

We observed staff cleaning equipment after patient contact, and we saw that equipment was labelled to show when it was last cleaned.

There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections. Staff told us that any patients with a transmittable infection were scanned at the end of the list and all equipment thoroughly decontaminated after.

We saw staff following infection control principles including compliant handwashing and the use of personal protective equipment (PPE) as outlined in the service’s standard operating procedure.

Staff understood the process for managing spillage of body fluids in the department and we saw that spill kits were available.

Staff supported infection prevention and control measures by following the uniform policy. Nail varnish and jewellery was not worn by clinical staff, although we saw that one member of non-clinical staff wore nail varnish. Staff in clinical areas were bare below their elbows to allow for full hand decontamination.

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 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 or patient specific directive. A patient group directive is a legal framework that allows authorised healthcare professionals to administer specific medicines to a defined group of patients without a prescription. A patient specific directive 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 service had a medicines management policy, and we saw examples of medicines audits. Staff completed medicines records accurately and kept them up to date. There was effective governance of medicines, and we saw spreadsheets and forms which were used to reconcile medicines usage and stock. We checked a sample of medicines and saw that they were all in date.