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

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.

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. We could see that systems were being used to effectively gather and process data in relation to incidents. Debriefs and outcomes were shared with team members and briefings were displayed in the nurses’ office.

All staff knew what incidents to report and how to report them and had reported all incidents that they should have. Staff, when asked, did not seem to understand what ‘duty of candour’ was, however, during further discussion it was clear that they were open and transparent and gave patients and families a full explanation if or when 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. The introduction of zonal observations had ensured the overall safety and increased support for patients, within communal spaces. Staff were rostered on daily to undertake the observations for set periods of time. Staff members fed back that the introduction had been effective and had reduced, for example, altercations between patients or falls and the escalation in incidents. The multi-disciplinary team meetings noted that incidents had reduced on this ward.

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. Management explained that additional discussions had taken place with staff members and ensured such errors would not occur in future.

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, for example, children were not able to visit the ward itself however, provision of a room was made available elsewhere in the hospital, should it be required. Visiting could be facilitated at any time during the day or through the night, if appropriate.

Most carers we spoke with said their family members felt safe on the ward and the majority of patients we spoke with also told us they felt safe, albeit a small number did voice that they didn’t; although there were no themes evident. It was clear that where patient related safety incidents took place, that 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 appeared to be done as a last resort and for the minimal time 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 considering the patient group on the ward and there was a log that ensured they would be periodically reviewed. Some patients had specific restrictions placed on them, these were necessary and proportional to their treatment, these were also documented accordingly and with all the staff team knowing what these were. The ward did not use seclusion or long-term segregation.

We looked at 4 risk assessments and risk management plans on the ward during our assessment visit. Staff involved patients’ families in care planning and risk assessments for those patients with documented lack of capacity or cognitive impairment. Where patients had not been able to explain their likes or dislikes, family members had updated staff on patients’ preferences and care needs, and this had been evidenced accordingly. For those patients that could engage it was documented that collaboration between patient and staff in the completion of such plans had occurred.

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.

For the patients on this ward, who had a positive behaviour support plan in place, it was clear from reviewing these, that patients’ family members 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 didn’t know the patients well, for example, temporary or agency staff.

Staff enabled patients to give feedback, in a way appropriate to them, on the service they received, and family members or carers were also invited to give feedback on their loved one’s care and treatment. The carers that we spoke with told us that they knew how to and felt comfortable to offer feedback.

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 undertook regular environmental risk assessments. 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, these included regular audits of fire safety equipment and procedures, portable appliance tests, ligature points and patient and staff alarm systems.

Ward layout allowed staff to observe all parts of the ward as staff were working and moving around the ward this meant staff were able to observe where patients were and what they were doing. 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, the risks in relation to ligatures were lower. All of the patients had personal evacuation plans. All patients had sensor mats in their rooms, as some patients may not have had the capacity to utilise their nurse call alarms. These alerted staff if a patient got out of bed, to reduce the risk of falls. This equipment was checked regularly.

Staff had easy access to staff personal alarms and patients had easy access to nurse call systems. Records showed that staff responded to incidents quickly, staff said they generally felt well supported during incidents and we observed staff responding quickly to the alarms during our visit. Staff would only respond if appropriate training had been received, and rosters ensured that enough trained staff were on duty at any one time.

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. Albeit with the current reduced MDT some activities were not offered however, staff members were allocated to offer alternative activities on the ward.

There were enough staff to carry out physical interventions safely, for example restraints and observations 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 most of their appropriate mandatory training. At the time of the assessment visit 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 to complete this. 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 good furnishings and were well-maintained. Cleaning records were mainly up to date and demonstrated that the ward areas were cleaned regularly, however, some clinical room audits had gaps where they had not been signed, which were administrative errors as opposed to the task not having been undertaken.

Staff adhered to infection control principles, including handwashing and where necessary were bare below the elbow. PPE was available for staff to use when required for supporting patients.

We looked at 3 patient prescription charts. Staff followed good practice in medicines management and did it in line with their own and national guidance. All the charts we looked at were patients that were detained under a section of the Mental Health Act, all of 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.