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Yeovil District Hospital Good

Reports


Inspection carried out on 4 December 2018 to 17 January 2019

During a routine inspection

Our rating of services improved. We rated it them as good because:

  • There were systems and processes to keep patients safe and safeguarded from abuse. There was a proactive approach to safeguarding and prevention of harm. Staff had received up-to-date training. Staffing levels were planned and with staff with the right skills to keep patients safe. There were effective handovers so staff knew about the patients they were caring for. Medicines were used and provided safely. They were well managed. Lessons were learned when things went wrong, and staff were confident about reporting incidents.
  • Patients had good outcomes, and there was a strong culture of doing what was right for patients. Care was delivered in line with national guidance and legislation. There were good assessments of patients’ needs, including pain relief, hydration and nutrition. Staff were trained and their performance regularly reviewed. They were supported to gain new and improved skills to develop their practice and experience. Staff worked together to ensure care and treatment was effective.
  • Patients and relatives spoke highly of staff and the standards and quality of care. Feedback was positive, and patients we met said they had been treated with dignity and respect. Patients could make their own decisions, and the right people were involved if a patient was not able to do so. Patients’ emotional needs were recognised and supported.
  • Services were planned and arranged to meet the general and specific needs of local people. The needs and preferences of different people were accounted for to give patients the best outcomes. The hospital was treating most patients on time and within national targets and standards.
  • The staff leadership had the skills, knowledge, experience to oversee services. High-quality and patient-centred care was promoted. There was a clear set of values for staff which were based on the experience for the patient. Staff were well supported and there was good morale and a strong culture. Staff were willing to challenge poor practice and support each other. There was a strong culture around innovation, research, development and improvement. Staff had good systems to assure themselves they were providing a good, safe and quality service.

However:

  • Some staff had yet to update their mandatory training in line with trust targets. Not all resuscitation equipment was checked as required. There were some areas where infection prevention and control were not as strong as they should be.
  • Not all patients’ medical records were completed as well as they should have been. There were gaps around assessing patients’ mental health, risk assessments and responding to the needs of deteriorating patients. The paperwork documenting resuscitation discussions was not always completed in line with trust policy.
  • There were issues with the environment in the children’s ward which impacted on patients. A business plan to resolve much of this had yet to be approved. Some specialist training around eating disorders for staff looking after children had yet to be provided. There was limited access to therapy for children over the weekend. The processes for safe administration of medicines through a syringe driver were not sufficient to guide staff.

Inspection carried out on 15 – 17 March 2016 and 24 March 2016

During a routine inspection

The Care Quality Commission (CQC) carried out a comprehensive inspection between the 15 and 17 March 2016. We also carried out an unannounced inspection on 24 March 2016. We carried out this comprehensive inspection at Yeovil District Hospital Foundation Trust as part of our comprehensive inspection programme. The trust has one main location.

The hospital opened in 1973 and was established as an NHS Foundation Trust in June 2006. The trust delivers services to a population of approximately 200,000 primarily from the rural areas of South Somerset, North and West Dorset and parts of Mendip. The trust provides outpatient and inpatient consultant services for a range of specialties primarily from its main site Yeovil District Hospital. It also provides outpatient and diagnostic services in a number of hospitals in the surrounding area, including the Yeatman Hospital in Sherborne and Wincanton, Crewkerne, Chard and South Petherton community hospitals. We did not review the care at the community hospitals at this inspection. At previous inspections the trust had been found to be compliant with the regulations we reviewed.

At this inspection we found that the trust was working hard with other stakeholders to improve the services offered to the local community. We found a highly committed workforce who put the patient at the centre of care. We saw some examples of very good practice which included the stroke buddying group and the ways in which maternity staff were involving vulnerable young women in maternity care. However we also found an emergency department which when under pressure was not responsive to the needs of patients. We struggled to understand the rationale for placing adult patients on the children’s ward and had to formally request information and reassurances from the trust around the safety of doing this. We found that the trust were responsive to the concerns we raised on and after the inspection and put in place actions to address these.

Our key findings were as follows:

  • Staff were caring in delivering care to patients. We observed many examples of compassionate care which staff delivered to patients with respectful and considerate approaches.
  • Feedback from patients, relatives and carers was positive throughout our inspection.
  • Staff were proud to work at Yeovil District Hospital. We found staff were part of a hospital based community in which staff worked together to try to meet the needs of patients.
  • In many areas staff felt well supported by their line managers and were aware of the trust’s vision and strategy. Many staff were aware of the trust’s iCARE strategy which incorporates the values of communicate, attitude, respect and environment.
  • We saw most staff complied with infection prevention and control best practice in relation to hand washing and remaining bare below the elbow. However, this was not consistent throughout the hospital.
  • Most areas of the hospital were visibly clean however we found equipment was not always stored appropriately and in a way which controlled and reduced the risk of infection.
  • Protected meal times were in place and staff offered patients food and drinks. Most areas assessed patients for their risk of malnutrition however we found nutritional screening assessments on surgical wards were not always completed in line with trust policies.
  • We found that whilst most patients received appropriate and completed risk assessments, on admission, the trust did not use individualised care plans to document on-going care, treatment and actions taken to mitigate risks to patients.
  • There were a greater proportion of middle grade and junior doctors employed at the hospital compared to the England average. We found emergency consultant cover in the Emergency Department did not meet the Royal College of Emergency Medicine standard for senior clinical cover in a listed trauma unit.

We saw several areas of outstanding practice including:

  • Snack box training had been set up to deliver specific and focussed small pieces of training to staff that can be accessed during their lunch break.
  • Development of a hospital garden for the use of patients, including patients living with dementia.
  • Development of an integrated care model supporting patients with three or more long-term conditions.
  • A ‘buddy system’ was used in critical care where nurses were paired to work together, this was to ensure adequate supervision of patients during staff meal breaks and for checking medicines.
  • Patient diaries in critical care were extremely well managed. The unit kept a copy of the diaries to ensure staff knew what the diaries contained; this enabled on-going support to be given to patients families after the diaries had been collected.
  • At the foot of every bed space in the critical care unit there was an analogue clock, with the date also displayed and a very clear sign which said, ’You are in intensive care, you are in Yeovil Hospital.’ This had been provided in response to patient feedback and helped to orientate patients to where they were being cared for and to the time and date.
  • The critical care outreach team had produced and implemented a patient assessment document to aid the early recognition and prompt treatment of sepsis. As part of the education package unit staff had produced a video. A staff badge had been introduced to acknowledge hospital staff who had used the tool to identify and manage a patient with sepsis.
  • In maternity and gynaecology services, the Acorn team provided specialist care for women who were vulnerable, were known to be at risk of domestic abuse, who smoked or were prone to substance abuse. Women under the age of 19 and women who had a learning disability could also be referred to the Acorn team.
  • The children and young people’s services’ community nursing team provided a range of different services to meet the needs of patients. The team included specialists or nurses with an interest in specific conditions such as cystic fibrosis, oncology and end of life care.
  • Services for children and young people had a school based within the children’s outpatients department. The school had a qualified teacher, working Monday to Friday, to provide education to patients who had been in hospital for long periods.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure systems and processes to prevent and control the spread of infection are operated effectively and in line with trust policies, current legislation and best practice guidance. The trust must work to improve standards of hand hygiene across children’s services.
  • Ensure equipment is stored appropriately and in a way that reduces infection risk. Ensure equipment used by cleaning staff is not stored in the sluice area and toilet rolls are not stored on commodes. Ensure commodes are completely clean before returning them to clean utility rooms. Ensure clean equipment is stored off the floor to prevent contamination. Ensure the covers on metal linen shelving units are kept closed when not in use to prevent cross infection. Ensure contaminated disposable items are not stored with clean disposable items. Ensure systems and processes to prevent and control the spread of infection are operated effectively and in line with trust policies, current legislation and best practice guidance within the maternity operating theatre.
  • The trust must ensure resuscitation equipment is routinely checked. The emergency department must ensure all resuscitation equipment is checked. Children’s resuscitation equipment must be available in the children’s assessment area in the emergency department. The trust must ensure all emergency lifesaving equipment, is sufficient and safe for use in maternity and gynaecology services and that there is evidence it has been checked in line with the trust policy.
  • The trust must ensure medical and nursing staffing is sufficient to meet the needs of patients. The emergency department must undertake a review of staffing levels using a recognised assessment tool. The trust must recruit sufficient medical and nursing staff to enable the operational and staffing standards for intensive care units to be met. Ensure sufficient medical staff are on duty in the medical business unit at night. The trust must ensure staffing levels reflect the acuity of patients in accordance with British Association of Perinatal Medicine (BAPM) standards.
  • Ensure that all patients receive appropriate and completed risk assessments, including those for dementia, on admission and an individualised care plan commenced to demonstrate the on-going actions taken to mitigate risk. The trust must also ensure nutritional screening assessments on surgical wards are completed in line with trust policies. Ensure the completion of documentation and of patient risk assessments on the gynaecology ward.
  • Ensure that controlled drugs are managed in accordance with trust policies, legislation and best practice in the discharge lounge. Ensure oxygen, when required for patients, is prescribed appropriately. Ensure medicines are always safely managed in line with trust policies, current legislation and best practice guidance in maternity and gynaecology services. The radiology department must ensure that guidance is in existence surrounding patient group directive medications.
  • Ensure that at least 90% of all staff receive an annual appraisal. Ensure nursing staff in specialist areas are trained on recruitment or placement to become efficient and competent members of their staff team. The trust must train all staff who have direct input into assessing, delivering, and intervening in the care of children and young people, in level three child safeguarding in line with intercollegiate guidance. The trust must improve the numbers of staff trained in European Paediatric Life Support (EPLS) to ensure they meet Royal College of Nursing guidance of at least one EPLS trained member of staff working every shift. Ensure all overseas staff are supported to achieve a good standard of the English language to reduce risks to patients.
  • The emergency department must put systems and processes in place to ensure patients receive initial assessment (triage) by an appropriately qualified clinical member of staff within 15 minutes of arrival to the emergency department.
  • The emergency department must take action to ensure the safety of children in the waiting area of the emergency department.
  • The emergency department must provide daily clinical and managerial leadership with oversight of capacity and demand. The emergency department must develop robust escalation processes.
  • Ensure that all patient records are kept securely and located away from the public to maintain confidentiality.
  • Ensure all wards have single sex accommodation including sleeping accommodation, bathroom and toilet facilities and do not need to pass members of the opposite sex to use the facilities.
  • Ensure the sepsis protocol is embedded with all staff groups to achieve and maintain high levels of compliance with sepsis identification and antibiotic administration.
  • The trust must ensure young adults (patients between the ages 18 to 24) meet the criteria for admission onto the Young Persons Unit.
  • The trust must review the physical environment of Ward 10 and explore options to separate the Young Persons Unit from Ward 10 to ensure patients over the age of 18 do not have access to children.
  • Ensure 'do not attempt cardio-pulmonary resuscitation' (DNACPR) forms are completed appropriately and in accordance with national guidance and best practice. The trust must also ensure DNACPR decisions are documented fully in accordance with the legal framework of the Mental Capacity Act 2005.
  • Radiology must continue to target the quality assurance backlog of equipment.
  • The radiology department must develop audits and action plans to address incomplete five steps to safer surgery checklists. The radiology leads must ensure guidance surrounding trauma computerised tomography (CAT) scanning is clear and not open to individual interpretation.
  • The outpatients department must continue to support improvements to meet the national referral to treatment times.
  • The trust must ensure that fewer appointments are cancelled by the hospital at short notice.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 25 September 2012

During a routine inspection

Patients we spoke with in both inpatient and outpatient areas said their care and treatment options had been discussed with them. They were asked for their consent before treatment was provided. They said they usually gave �verbal� consent, although sometimes it was written consent. Patients knew they were able to change their mind or decline treatment if they wished to.

Parents we spoke with had given consent for their children to be treated. They told us this was handled very well by staff and that care and treatment options were always discussed with them. One parent told us �All of my questions were fully answered�. All of the treatment for their child had been �agreed between me and the staff who have been supportive and helpful�. The provider may wish to note that the care records we looked at did not consistently records patient�s decisions about their consent to their care and treatment.

Every patient spoke very highly of the care and treatment provided in the hospital. Comments from patients included: �I�m very happy with my treatment� and �The care was absolutely excellent when I was in A&E and has been brilliant since I came onto this ward�. Some had used this hospital for a number of years. One patient told us �the staff have cared very well for me. We are very lucky here. The staff really get to know you�. Another said they had always been �consulted on care plans. As an inpatient they �had never felt embarrassed or uncomfortable through the actions of staff. They respected my dignity and privacy� and provided �wonderful care�. The provider may wish to not that we found some patient�s care and treatment records were not well kept.

We asked patients about the food served in the hospital. They told us they had a choice of meals and that the food was generally very good. They knew they could request an additional snack if they wanted one. They could also purchase snacks and drinks from a trolley which was taken around each ward. One patient said �Yes, the food is very good. We had a lovely meal yesterday. I have my menu here so I will choose what I want for tomorrow. You can choose an extra snack if you want when you order�.

We asked patients about their views of being discharged from the hospital. They told us their discharges had been handled well. Some patients had been discharged from the wards; others had used the discharge lounge. One said �I�m going home tomorrow. They have already discussed this with me. I�ve asked to use the discharge lounge this time as I have so much to take with me. They have sorted this out for me�.

Patients told us they felt safe in the hospital. No concerns were raised with us during our two days of inspections. Patients we spoke with said they were happy with their care and treatment and were very complimentary towards staff. Comments included �I haven�t had any concerns at all. It�s all been fine since I have been here� and �I�ve not had any concerns and I have never been upset about anything here�.

Patients spoke very highly of the staff. Comments included �They are very good nursing staff� and �The doctors, consultants and nursing staff are all very good�. Patients told us that there were enough staff working to meet their needs. One said �It does feel like there are enough staff around. All of the staff are very friendly and helpful. I last came into the hospital in January. That stay was fine as well�.

Patients told us they were asked to share their views. They felt their views were very important to the trust, that they were listened to and acted upon wherever possible. The trust had a Patient Experience Committee which met regularly. Patient stories were often presented as part of this meeting. Some patients had been asked to help the hospital develop and improve their care for certain patients, such as those with dementia.

Patients spoke about the different ways that their views were captured. These included the use of questionnaires and surveys. One patient told us �I have filled in a card that asks about the care, how clean the hospital was and how the staff were towards me. I was very happy with all of it�. Another said they had not yet completed a questionnaire as �they normally do this when you are leaving. I haven�t filled one in yet but I did when I was discharged last time. I was very happy with my care and I said so�.

Patients told us they knew how to complain should they need to. None of the patients we spoke with said they had ever complained about their care or the hospital more generally.

Inspection carried out on 22 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 16 September 2011

During a routine inspection

People told us they were involved in decisions about their care and treatment and were kept informed of their progress. Some people we spoke with had been given leaflets about their treatments. Others told us they understood why they were in hospital and what treatment they needed.

Information about the hospital was not consistently available. Some people said that they had been given information about their treatment and the hospital although others were unaware of this. Some people had been in this hospital before so they knew what facilities were available and shared this with fellow patients. One person said �no information was given to me, but I have been in here before so I know what facilities there are�. Another person said �it does not seem to be automatic, but when I asked I was told about the facilities here, but no booklet was given to me�.

There were mixed responses when we asked people if they had been asked for feedback on their experience of using the hospital; most people said they had not been asked but a few had completed a questionnaire. We discussed this with senior members of the management team who said they wanted to increase the number of surveys people complete; this is noted as a priority in this year�s annual plan.

People's needs were assessed and reviewed to make sure that they received the right treatment. We saw staff treat people with dignity and respect. Staff were able to adapt their care to meet the differing needs of people. One person said �the staff are always respectful as I�m very independent and they do care for more dependent people. I�m always listened to and I can do my own thing�.

We observed the care people received. We saw that staff were well organised, cheerful and friendly and that they had time for people. There appeared to be enough staff to meet people�s needs and we saw call bells were answered reasonably quickly. One person said �staff come quickly when I need them, you don�t have to wait. All the staff are excellent. There is plenty of staff day and night�.

People were protected from abuse and the risk of harm. People told us they felt safe in the hospital. There were very few concerns raised with us during our two day inspection. The majority of people we spoke with said they were happy with their care and treatment and were very complimentary towards staff.

People spoke very highly of the care that they received from individual staff. Their comments included �I am very happy with how staff treat me, they are very respectful and kind�, �they are extremely kind, caring and respectful. All the staff are very cheerful and positive� and �all of the staff have been wonderful, kind and patient. They always have time for you�.

People we spoke with told us they felt they were cared for by competent staff. Comments included �yes, I feel the staff are very competent, they know what care I need�, �they always make me feel they know what they are doing� and �I have found all the staff here, including the doctors, very good and they certainly know what they are doing�.

We spoke with people who had used the hospital on separate occasions over recent years and one person said �I have been in this hospital before and I thought they have always been very good, but things seemed to have improved and it�s a lot better now�. Another person said �over the years I have been a patient in the hospital and used outpatients as I am today. The hospital is very good and they always seem to be trying to make things better. When you hear stories about other hospitals we are very lucky to have one like Yeovil�.

Inspection carried out on 16 September 2011

During a routine inspection

People told us they were involved in decisions about their care and treatment and were

kept informed of their progress. Some people we spoke with had been given leaflets about their treatments. Others told us they understood why they were in hospital and what treatment they needed.

Information about the hospital was not consistently available. Some people said that they had been given information about their treatment and the hospital although others were unaware of this. Some people had been in this hospital before so they knew what facilities were available and shared this with fellow patients. One person said "no information was given to me, but I have been in here before so I know what facilities there are". Another person said "it does not seem to be automatic, but when I asked I was told about the facilities here, but no booklet was given to me".

There were mixed responses when we asked people if they had been asked for feedback on their experience of using the hospital; most people said they had not been asked but a few had completed a questionnaire. We discussed this with senior members of the management team who said they wanted to increase the number of surveys people complete; this is noted as a priority in this year's annual plan.

People's needs were assessed and reviewed to make sure that they received the right

treatment. We saw staff treat people with dignity and respect. Staff were able to adapt their care to meet the differing needs of people. One person said "the staff are always respectful as I'm very independent and they do care for more dependent people. I'm always listened to and I can do my own thing".

We observed the care people received. We saw that staff were well organised, cheerful and friendly and that they had time for people. There appeared to be enough staff to meet people's needs and we saw call bells were answered reasonably quickly. One person said "staff come quickly when I need them, you don't have to wait. All the staff are excellent. There is plenty of staff day and night".

People were protected from abuse and the risk of harm. People told us they felt safe in the hospital. There were very few concerns raised with us during our two day inspection. The majority of people we spoke with said they were happy with their care and treatment and were very complimentary towards staff.

People spoke very highly of the care that they received from individual staff. Their

comments included "I am very happy with how staff treat me, they are very respectful and kind", "they are extremely kind, caring and respectful. All the staff are very cheerful and positive" and "all of the staff have been wonderful, kind and patient. They always have time for you".

People we spoke with told us they felt they were cared for by competent staff. Comments included "yes, I feel the staff are very competent, they know what care I need", "they always make me feel they know what they are doing" and "I have found all the staff here, including the doctors, very good and they certainly know what they are doing".

We spoke with people who had used the hospital on separate occasions over recent years and one person said "I have been in this hospital before and I thought they have always been very good, but things seemed to have improved and it's a lot better now". Another person said "over the years I have been a patient in the hospital and used outpatients as I am today. The hospital is very good and they always seem to be trying to make things better. When you hear stories about other hospitals we are very lucky to have one like Yeovil".