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Medway Maritime Hospital Requires improvement

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Inspection report

Date of Inspection: 26 August 2014
Date of Publication: 26 November 2014
Inspection Report published 26 November 2014 PDF | 83.12 KB

Overview

Inspection carried out on 26 August 2014

During an inspection in response to concerns

On 31 December 2013 we carried out an unannounced inspection of the Emergency Department (ED) at Medway Maritime Hospital in response to information we had received from an anonymous source regarding the safety and effectiveness of the ED. We found that the service was failing to meet the national standards that people should expect to receive. As a result, we issued formal warning notices to Medway NHS Foundation Trust, telling them that they must improve in a number of areas within a specified period of time.

Medway Maritime Hospital was inspected again as part of a comprehensive inspection of Medway NHS Foundation Trust because Medway NHS Foundation Trust was rated as high risk in the CQC's intelligent monitoring system and the trust had been placed into 'special measures' in July 2013 following a Keogh review. This inspection took place between 23 and 25 April 2014 with an unannounced inspection visit on 1 May 2014.

As a result of the comprehensive inspection, overall, the hospital was rated as inadequate. We rated it good for being caring but improvement was required in providing effective care and being well-led. The safety of the hospital and being responsive to patients' needs were rated as inadequate. Whilst some core services were rated as good overall, for example critical care and services for children and young people, the emergency department and surgical services were both rated as inadequate.

We carried out a further unannounced inspection of the ED on 27 and 28 July 2014 to follow up on our findings in April and in response to us receiving information of concern from two separate sources.

Our key findings from our inspection on 27 and 28 July were as follows:

The ED was in a state of crisis with poor clinical leadership. This was despite there being an ED consultant in the department at the time of the inspection and a designated Band 7 nurse in charge. Similar to our previous inspection there was no evidence that nursing, medical and other allied health professionals were working in a joined up manner.

The ED had failed to review and optimally utilise its escalation policy within the ED to avoid the need to 'stack' patients. Whilst patients were being stacked they were not undergoing regular nursing observations, and were not being seen in a timely manner by medical staff.

This was not due to the department being 'overrun' with patients (there were empty cubicles at the time of the inspection) but rather due to poor organisation of staff and lack of appropriate prioritisation of patients.

The ED continued to fail to ensure that children attending the department underwent initial assessment which was in line with national standards.

As a result of the inspection on 27 and 28 July and considering the findings from our comprehensive inspection in April 2014, we asked the trust to provide us with immediate assurances that necessary action would be taken to safeguard patients from the risk of harm.

On 30 July 2014 we formally wrote to the Chief Executive of Medway NHS Foundation Trust setting out our concerns and to request the necessary assurances that appropriate action would be taken to ensure the safety and welfare of patients who used the service. The trust responded, in a timely fashion, to our request for a robust action plan.

We carried out a further inspection of the ED on 26 August 2014; we were accompanied by specialists in the field of emergency and general medicine.

Our findings from our inspection on 26 August were:

The ED continued to lack any form of effective clinical leadership and there remained a lack of cohesive working amongst nursing, medical and allied healthcare professionals.

The process of initially assessing patients in a timely manner remained flawed; in some instances we found that patients were experiencing delays of more than two hours before any effective clinical intervention or treatment was commenced.

We have, and continue to liaise with external stakeholders including Monitor, NHS England and local clinical commissioning groups who have agreed a to work in partnership to support Medway Maritime Hospital. We will continue to monitor the performance of the trust and will report on any regulatory action we may take in the future.