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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

People who use services receive effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

User experience

We observed patient care in the medical and surgical wards, outpatients and the minor injuries unit. We talked with patients who told us they had been involved in planning their care and treatment. Although patients told us they felt informed about their care, it was not recorded in their care plans whether and how they had been involved in developing their plans of care.

One patient said they had opted to attend the hospital because they had been impressed by the way their relative, who had complex needs, had been cared for: “The hospital’s excellent; I heard it was good and I’m not disappointed.” Another patient, who has a long term condition requiring coordinated care and support, told us that everyone involved is informed quickly about any changes in the treatment plan. Patients who answered questions about care and treatment in CQC’s trust-wide Survey of Adult Inpatients in the NHS (April 2011) were largely positive about their experiences.

We saw staff caring for patients in a sensitive and professional way, taking time to listen and answer questions. We saw staff respond to patients’ needs in a timely way, demonstrating they were familiar with the individual person’s needs and abilities. We observed staff involving relatives and carers in explanations about care and treatment. We heard staff explaining procedures and arrangement for appointments clearly and politely.

Other evidence

The patient records showed that patients’ individual needs were established on admission and reviewed regularly throughout their inpatient stay. Ward nursing staff told us the care plans are evaluated at least once per shift and some, such as surgical wound care, change quite frequently.

The care plans we saw related to patients’ physical, rather than mental, emotional or social, needs. The patient records included risk assessments appropriate to each patient, including the risk of falls, pressure sores, malnutrition, moving and handling and discharge; these were reviewed and updated at regular intervals appropriate to the person’s needs. The risk assessments we saw were usually personalised to take into account the patient’s choice but this was not always apparent.

On the medical wards we saw evidence of swift referrals to appropriate services such as physiotherapy, occupational therapy, and speech and language therapy. The patient notes also recorded conversations with relatives and community services. Staff told us there was good communication within staff teams and between different professions, such as the community tissue viability nurse specialist who advises on care to help prevent or manage pressure sores. Some told us it could be difficult to access specialists such as dietitian and speech and language therapists who were based at King’s Mill hospital, which could mean delays in assessment and treatment, to the detriment of the patient.

Staff told us they report adverse events, incidents, errors and near misses through the trust’s online patient safety reporting system. They told us the system is easy to access and use, and they receive good feedback quickly and can implement changes to practice as a result. We saw two patients recently admitted from another healthcare provider with significant pressure sores. Staff had submitted incident reports, and the reference numbers were recorded in the patient notes. The trust shared with us their reporting of incidents related to problems with notes or records at the hospital for the year April 2010 to March 2011. This shows an appropriate process of investigation and lessons learned, including communication with individual staff or managers as required.

All the nursing staff we spoke with were aware of National Patient Safety Agency (NPSA) alerts, medical devices alerts from the Medicines and Healthcare products Regulatory Agency (MHRA), and alerts about medication that are received through pharmacy bulletins. The hospital manager passes on national patient safety alerts to clinical governance leads and ward managers who inform their staff through meetings and memos. The ward managers complete a record of actions taken at ward level that they return to the clinical governance department. If the alerts are not relevant, the information goes back to the hospital manager who informs the trust’s patient safety manager, so that monitoring can take place. The trust has responded positively to incidents of over exposure to diagnostic and therapeutic ionising radiation, such as X-rays, especially with regard to patient identification errors which are significantly lower than average.

We saw an example of a safety alert from the NPSA concerning complications after a type of surgery. The alert advises actions such as specifying the observations required in the immediate post operative period, and on discharge giving patients verbal and written advice about signs of deterioration and when to seek medical advice. The ward leader copied the relevant information to staff and asked them to sign a record sheet when they had read it. We spoke with a number of senior staff and although they introduce changes in practice where necessary as a result of the safety alerts they did not formally check that staff were putting changes into practice and continuing to do so.