New Royal Liverpool University

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question good. At this assessment the rating has remained good.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. People always had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Peoples experience

People we spoke told us their needs were met and staff kept them updated of changes to care and treatment plans. Most people we spoke with told us they were visited by a consultant or medical doctor every day who involved them in conversations about their care. People who were waiting in temporary escalation areas told us privacy screens were provided and accessible call bells to get staff attention. When delays being admitted to wards were experienced, people told us staff kept them up to date with the reasons for the delay.

Feedback from staff and leaders

Staff could describe the processes in place to assess patient need and identify any potential risks. A full patient assessment was undertaken on admission to the wards and this was updated as patient need changed or at least once every 5 days. For example, daily review of falls risk assessments for those patients who were at risk of falls to ensure they had the appropriate falls prevention equipment and mobility plans in place. Nutritional risk assessments were undertaken in line with speech and language assessments; these provided patients with the correct diet and food to meet their needs. Paper patient records were kept to record peoples’ fluid and nutritional intake, repositioning and body maps to record skin integrity and blemishes. Staff told us they completed patient documentation at the time observations and care interactions took place to keep both electronic and paper records up to date.

Staff used nutritional and hydration charts to record food and meals. Fluid balance charts were in use and mostly completed properly. Where it was noted they were not completed, staff explained these patients had been risk assessed as no longer requiring a fluid balance chart. We checked electronic patient records and saw this was the case.

Observations

We reviewed a sample of paper and electronic patient records. We saw that patient events were documented and kept up to date real time. Fluid balances were used appropriately however they were not always discontinued when they were no longer required. Patient record templates reflected individual patient information was available, such as the name a patient wished to be called by, next of kin, first language, religion, any communication requirements, mobility, social history and family support, pressure area and falls history.

Discharge care plans were in use in the discharge lounge and included information such as tablets to take home, patient discharge plan, mobility care plan, transport arrangements They also included if the patient needed to be repositioned regularly or required a specific diet.

Feedback from staff and leaders

During the onsite visit the senior leaders explained how they had implemented the changes to the Management of Sepsis Guideline from National Institute for Health and Care Excellence (NICE). At the time of the inspection, the Sepsis checklists were being updated on the patient record system. The Sepsis lead (Consultant) attended quality meetings, and the practice educator attended specifically to teach the new sepsis guidelines.

Ward Managers in several different wards told us policies were regularly updated, reviewed and accessible in line with best practice guidance. All policies had been reviewed since the transition from the old building to the new building in 2022. Staff could describe how they would access a doctor during the out of hours period. Doctors prioritised the most poorly patients to be seen first, which meant delays for those with less urgent needs. Doctors and allied health professionals were located on the ward during day time hours which was welcomed by other staff and patients as they were accessible.

Peoples experience

Patients we spoke with described staff as working together as a team to meet their needs and commented it was nice to see doctors and allied health professionals in the ward environment, as well as the usual ward based staff.

Feedback from staff and leaders

Staff described good working relationships with colleagues across the division. Medical staff and allied health professionals worked from areas on the ward so were accessible for patients when they needed them. Staff described this as supporting the patient journey and helped plan for discharge.

Patients were assessed within the acute medical unit when they required specialist care, such as cardiology. Wherever possible, patients could be directly admitted to the cardiology ward if there was a room available. Staff told us how this supported them to deliver appropriate care and treatment to patients and supported them with appropriate discharge plans. Specialist nurses (vascular, orthopaedic and stroke) were also available in clinical areas to promote best practice and support patients. For example, one ward had specialist dialysis staff available to support people undergoing dialysis.

Consultant-led ward rounds took place daily followed by multidisciplinary team meetings. Staff welcomed the multidisciplinary meetings and representatives of each role attended as well as discharge liaison staff and community teams. Staff told us they were actively involved in these and that good working relationships existed between medical and healthcare staff.

Observation

We observed staff working well together, sharing information and coordinating care. An example of this included consultation between the patient, physiotherapist and nurse discussing the best time for a patient to have some pain relief prior to a physiotherapy session.

Review of patient records demonstrated fully completed and timely risk assessments for each patient. These were recorded daily within a short stay or 7 day patient booklet. This included, but not limited to, fluid and food charts, behaviour ABC chart, body map for pressure ulcers and international rounding. Environmental, ward/zone and falls daily check lists were fully completed generally within the relevant timeframes.

Fluid balance charts were reviewed and were found to be correctly completed in detail. However, when some specific pathways were deemed no longer appropriate for patients, supporting documentation was not always stopped. This meant that some patient observation charts and records were initially thought to be incomplete until staff explained they had been discontinued.

We observed access to ward managers and medical staff was readily available. Ward round and MDTs took place and were attended by relevant specialisms dependent on the ward.

Processes

Mental Health support was available to patients and the team visited patients regularly throughout their stay where it was identified.

The SWAN (Palliative care - Signs, Words, Actions, Needs) team supported the medical division to help advise for end of life care planning. Information about the team was available to people via notice boards.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.