The Priory Hospital Dewsbury

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

At our last inspection we rated this key question as good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed a sample of reported incidents during our visit and reviewed all information that had been reported to us by the hospital over the last 12 months. It was clear that systems were being used to effectively gather and process data in relation to incidents.

All staff knew what incidents to report and how to report them and had reported all incidents that they should have. Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong.

Staff received feedback from the investigation of incidents, both internal and external to the service. We saw examples of shared learning from other hospitals being displayed in staff areas, where incidents had occurred, and learning identified that would be useful to others.

Staff met to discuss feedback. These discussions occurred during ward-based team meetings, multi-disciplinary meetings and during hospital wide governance meetings attended by senior managers and other operational staff. There was also evidence that incidents were discussed at daily ward handovers in between each shift change and each morning when ward managers, senior managers and other staff came on duty. Feedback from incidents was also emailed to all staff and wards used a communication book to ensure messages were read by staff.

There was evidence that changes had been made as a result of feedback. Following an incident that occurred where a staff member was injured, a review and debrief took place and action was taken to improve the way that escalating incidents were managed, to trigger earlier action and a review of observations and alternative treatment where it was needed.

We found a small number of administrative errors on some incident reports, this meant that some reports should have been reviewed and closed sooner than they were. In a small number of reports we found that the wording could have been clearer to ensure the reader understood the outcome of the review. Both issues were discussed with the management team and rectified whilst we were on site.

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. There was evidence within the care records that information had been reviewed to ensure that staff had the necessary information ready to receive an admission of a patient to the ward, for example information about risks and physical health.

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 could see that efforts were made to encourage the necessary professionals to attend multi-disciplinary meetings and that there was evidence of robust discharge plans being implemented which had led to safe and effective discharges of patients to the next stages of their treatment.

All staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. Our review of records showed us that systems were working well and enabled all staff to submit alerts and that these would be reviewed and acted upon by other members of the team where necessary.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff followed safe procedures for children and other people visiting the service. There was clear guidance in place for staff to follow, if for example, the ward became unsettled.

Most patients said they felt safe on the ward. It was clear that where patient related safety incidents took place, staff took appropriate action to protect all patients and to prevent further incidents.

It was necessary for staff on the ward to use restraint on some occasions, but this was done so as a last resort and for as little time as possible. Staff had undertaken the necessary training to ensure that they carried out restraints safely and there were enough staff working on the ward to respond to these incidents where necessary.

Staff displayed and could talk about a least restrictive approach. There were some blanket restrictions, but these were ward specific and there was a log that ensured they would be periodically reviewed. Some patients had specific restrictions placed on them, these were necessary and proportionate to their treatment. The ward did not use seclusion or long-term segregation.

We looked at 3 risk assessments and risk management plans on this ward during the inspection. Staff involved patients in care planning and risk assessment, this was evident in some elements of each person’s care record. Not every patient wanted to, but each were encouraged to attend their multi-disciplinary team meetings and were offered a copy of their care plans.

Risk management plans were tailored to patients’ specific needs and correlated with their assessment. For example, patients that were assessed as being at risk of falling, choking, self-harm or violence and aggression all had risk management plans in place for these elements of their care. Risk management plans were updated as a result of incidents and changes to risk and staff we made aware of these changes daily.

Every patient on this ward had a positive behaviour support plan in place. It was clear from reviewing these that patients had been involved in describing their likes, dislikes, triggers and ways in which they could be calmed if they became agitated. These plans were easily available as a quick reference for all staff working on the ward and would be particularly helpful to staff that did not know the patients well, for example, temporary staff.

Staff enabled patients to give feedback on the service they received through regular community meetings. These meetings were well attended by the patients on the ward and there were a range of topics discussed. Patients regularly fedback that they would like more activities to be available on the ward and there was some feedback about the quality of the food on the ward. There was a piece of work being undertaken by staff to gather further patient feedback about food and this was to be presented and discussed to the catering staff at a joint meeting in the near future. Managers were also taking steps to oversee the activities to ensure that there were the correct staff to deliver them and that they met the needs of patients.

Staff ensured that patients could access advocacy. There were posters and contact details on the ward, and we saw an advocate on site whilst we were inspecting the ward. There was also reference to the advocate and which days they came onto the ward contained within the community meeting minutes.

Staff did regular risk assessments of the care environment. These were completed after the start of each shift by an allocated member of staff and a more detailed audit was carried out by the ward manager on a regular basis. We saw evidence of maintenance work being carried out as a result of these checks.

Health and safety checks were carried out and were up to date, these included regular audits of ligatures, fire safety equipment and procedures, portable appliance tests and patient and staff alarm systems.

Ward layout allowed staff to observe all parts of ward and there were staff working throughout the ward who were able to observe patients. There were potential ligature anchor points and staff had mitigated the risks adequately. This was done on a patient-by-patient basis and because of the purpose of the ward being rehabilitation, the risks in relation to ligatures were deemed to be lower. All the patients had personal evacuation plans.

Staff had easy access to alarms and patients had easy access to nurse call systems. Records showed that staff responded to incidents quickly, staff said they felt well supported during incidents and we observed staff responding quickly to the alarms during our visit.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

The ward had enough experienced and suitably qualified staff to keep people safe from harm. There were low numbers of vacancies for nursing and support staff and the hospital was actively recruiting to the few vacant positions.

Managers had calculated the number and grade of nurses and healthcare assistants required. The number of nurses and healthcare assistants matched this number on the majority of shifts, where they fell short, staff followed procedures to ensure that people remained safe. There were no safety issues in relation to short staffing.

The ward manager could adjust staffing levels daily to take account of patient mix and increases in acuity which might require additional staffing at short notice.

When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels. We looked in detail for the month of January leading up to the inspection and agency use was approximately 20% across nursing and support staff on this ward. When agency and bank nursing staff were used, those staff received an induction and were familiar with the ward, those that we spoke to appeared to have a good understanding of patients' needs.

Staffing levels allowed patients to have regular one-to-one time with their named nurse or another member of staff who knew them well.

Staff shortages rarely resulted in staff cancelling escorted leave or ward activities and if they did, staff offered an alternative or rearranged at the earliest opportunity.

There were enough staff to carry out physical interventions and observations safely and staff had been trained to do so.

There was adequate medical cover day and night, and a doctor could attend the ward quickly in an emergency.

Staff had received and were up to date with appropriate most of the mandatory training. At the time of the inspection only 49% of staff that required training in immediate life support had received it. However, the hospital made sure that suitably trained staff were always on duty and had arranged for those that needed to carry out the training. The training was appropriate for the patient group using the service.

Staff maintained equipment well and kept it clean. All ward areas were clean, had suitable furnishings in good condition and were well-maintained. Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing and where necessary were bare below the elbow.

We looked at 7 patient prescription charts. Staff followed good practice in relation to medicines management and did this in line with their own and national guidance. All the prescription charts we looked at were patients that were detained under a section of the Mental Health Act, all the prescribing complied with the necessary requirements of the Mental Health Act.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with National Institute for Health and Care Excellence (NICE) guidance, especially when the patient was prescribed antipsychotic medication. No patients were on high doses of antipsychotic medication and all prescribing was within BNF limits.