Nightingale House Surgery

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 people were protected from abuse and avoidable harm.

At our last assessment in 2017, we rated this key question as Good. At this assessment, the rating remains the same.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents, near misses and safety events. However, there was a low number of incidents recorded. Staff were aware of the incident policy and had received training but further specific training in significant event identification and recording was needed as there was a culture of sorting events out as soon as they happen and not identifying them effectively in order to record them. We were not assured that all incidents were being appropriately recorded.There was a system in place to record and investigate complaints, however it was apparent that there was under reporting of incidents and therefore it was difficult for the practice to have evidence to learn from incidents.

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.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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. Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. This was kept in a restricted room where staff could access if needed. Staff could recognise a deteriorating patient and knew of action to take. Continuing training took place within staff meetings where scenarios would be discussed on a regular basis to ensure staff continued to be aware of how to handle them. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. For example, clinicians were aware of the details of the local crisis team if a patient’s mental health was deteriorating.

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

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

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.

There were a range of clinical and non-clinical roles within the practice. We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence.

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 practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning was carried out by an external company, and we found evidence that cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Our remote clinical searches identified that patients who had a long-term health condition or on high-risk medicines were being monitored appropriately. Staff followed processes to ensure people prescribed medicines with higher risks received recommended monitoring. Steps were taken to ensure staff prescribed medicines appropriately to optimise care outcomes, including antibiotics.

The prescribing data reviewed as part of our assessment showed that the practice prescribed antimicrobials at a level in line with local and national averages, and the prescribing of pregabalin and gabapentin (used for treating long term conditions such as epilepsy and neuropathic pain) was lower than the local and national averages. Controlled medicines were not given to patients on a repeat prescription, allowing the practice to review each time a patient requests them.

Clinical audits of prescribing were conducted which showed the drive to improve care and treatment for the patients.

There was an appropriate system in place for the monitoring and actioning of Medicines and Healthcare Products Regulatory Agency (MHRA) alerts. Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training which included how to deal with emergencies and how to identify when patients became unwell. Staff managed prescription stationery appropriately and securely. Protocols were followed to ensure staff prescribed all medicines safely and recommended reviews and monitoring was done with patients. Staff regularly checked the stock levels and expiry dates for vaccines and controlled drugs. Emergency medicines were placed in an area accessible to all at the practice. A risk assessment was in place for all emergency medicines that the practice did not hold. Systems were in place to ensure that these were appropriately monitored. At the time of the visit, all emergency medicines that the practice documented that they held were present and in date.

Staff stored medical gasses such as oxygen, safely and completed the required risk assessments.