Chelsea and Westminster Hospital

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

At the last assessment, this key question was rated as good. At this assessment, the rating remained good. This indicated that people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed an exceptional standard. The service had a strong, proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Staff understood and reported incidents appropriately. Staff knew what to report and how to report it. Incident data showed consistent reporting across a range of safety themes, including access delays, medication incidents and communication failures. This indicated an embedded reporting culture.

The service had robust oversight of safety incidents and learning. Learning and safety responses were reviewed and triangulated through governance systems. This included oversight by safety improvement groups and escalation to organisational committees, providing assurance that risks and learning were scrutinised at multiple levels.

Incidents were investigated and learning responses completed. The service used structured approaches, such as after-action reviews (AARs), to investigate incidents, including medication errors and delays in acting on results. These reviews identified contributing factors and clear actions.

Staff were open and transparent when things went wrong. There was evidence that staff acted promptly following incidents, ensured safety, and followed duty of candour processes, including debriefing and communication with people and families. All staff we spoke with could tell us what happened when there had been an incident.

We saw evidence that learning was shared widely and embedded into practice. Learning and themes from incidents were shared through multiple forums, including governance meetings, safety reports, and teaching sessions. This indicated consistent dissemination of learning across the service and wider organisation.

The service was able to demonstrate evidence of change following incidents. We saw evidence that learning led to changes in practice, including, improved medication safety through changes to drug storage, labelling and training. Reinforced escalation processes and earlier senior involvement in deteriorating people. Standardisation of documentation and communication processes and improved handover, discharge communication, and follow-up pathways. These actions showed that learning was used to reduce risk and improve safety.

Themes and trends were identified and acted on. The service identified recurring themes such as escalation, documentation, communication and system pressures. Targeted improvement actions were implemented to address these risks and indicated a systematic approach to learning.

Staff reported they were supported following incidents. They took part in debriefs after significant incidents and were supported to reflect and learn, contributing to a positive safety culture and continuous improvement.

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.

The service used systems and data to manage demand, flow and safe pathways. The service monitored emergency department and urgent care attendances across adult and paediatric pathways and used this information to inform operational management, escalation and flow. High and sustained activity levels showed systems were in place to manage demand and maintain safe pathways.

Pathways were responsive to the needs of different groups of people, including people with mental health needs. The service identified and monitored people presenting with mental health needs as part of overall demand. This supported risk oversight and ensured appropriate referral pathways and specialist input was built into people’s journeys.

There were effective arrangements for timely specialist input such as support various specialists and site managers to facilitate continuity of care and flow through the department. All specialties were contactable on a dedicated telephone number with a named person identified daily to ensure timely attendance and review. Liaison psychiatry services responded to referrals within agreed timeframes, including during periods of increased demand. Performance remained consistently high, showing reliable pathways for mental health assessment and continuity of care.

The service worked in partnership with system providers to support safe transitions of care. We saw that data and performance information was used to inform system-level planning and escalation with internal and external partners. This supported coordinated care, particularly where people moved between emergency, inpatient and community services.

Handovers and internal transfers supported safe continuity of care. Structured processes were in place for handovers of people using the service, including real-time documentation, multidisciplinary communication and escalation where required. These arrangements ensured responsibility for people remained clear and risks were managed during transitions.

The service maintained clear processes for referral, assessment and follow-up. Referral pathways were supported by defined processes to ensure people were assessed, treated and transferred safely. Electronic patient records included documentation of referrals, follow-up arrangements and discharge communication, which were subject to audit and oversight.

The service monitored and responded to risks across pathways. The service used operational data, escalation systems and tracking processes to identify pressures and risks across the ED pathway. This included ambulance arrivals and flow of people through the service, with actions taken to maintain safety. To promote patient safety and timely identification of clinical deterioration, the adult waiting room was monitored by staff working in the streaming room inside the waiting area 24 hours a day and this is supported by CCTV cameras with screen placed in streaming rooms to support the oversight and safety of the waiting area. We were told that nursing staff undertook waiting room checks, there was 24-hour presence of security guards in the waiting area and patients were encouraged to notify staff immediately if their condition changed while awaiting assessment. Any concerns identified were escalated to the clinical team who would move the patient to the most appropriate clinical area.

The children's waiting area is monitored by nurses working in the streaming rooms located in the waiting room providing continuous oversight of the waiting room. Children waiting to be seen are also monitored through ongoing visual checks and parents and carers were advised to alert staff if they had any concerns regarding their child's condition. This approach to monitoring both the adult and children’s waiting rooms promoted patients receiving timely clinical review when required.

Information was shared with health and social care partners to support continuity of care. Systems were in place to ensure that relevant information, including vulnerabilities and clinical risks, was communicated during admissions, transfers and discharge.

Systems were in place to manage investigation results and reduce risk of missed follow-up. The service had processes for managing diagnostic results, including timely review and clear allocation of responsibility. This supported safer care and reduced the risk of delays in treatment or follow up.

The department had a clear pathway for people with mental health needs. When people with mental health needs arrive in the department, triage nurses completed an initial assessment and identified which specific mental health needs the person had. Triage nurses completed an assessment of mental health risk as part of the triage process. They used an internationally recognised, evidence-based clinical triage tool to prioritise person-centred care, which included a section for mental health needs.

Members of security staff were in the department during the day. Security staff provided support where there was a risk of violence and aggression. Security staff received training in restraint and supporting people with mental health needs. This ensured that the least amount of force needed was used and deescalation was to defuse situations which might have developed otherwise.

The psychiatric liaison service was provided by another NHS trust. The service was commissioned to provide care in line with the Core 24 model (NICE), providing nursing cover 24/7. At the time of the assessment there was 1 registered mental health nurse on each shift, however, the team had plans for 2 registered mental health nurses on all shifts which would commence in the coming months. A consultant, clinical psychologist and the team manager worked Monday to Friday 9am–5pm. The team provided an all-age service. The team’s offices were in the building adjacent to the hospital. The team undertook assessments in parallel, not waiting until a person had been medically cleared to start assessments. This ensured people presenting with mental health concerns did not have to wait for both a physical and mental health assessment prior to treatment being commenced.

The trust had a drug and alcohol lead, who attended the department. This supported people who attended the ED to access advice and support regarding drug and alcohol misuse or treatment.

All referrals to the psychiatric liaison team were received online, ensuring timely response to referrals. The psychiatric liaison team responded to most emergency referrals within one hour. In March 2026, records showed they responded to 95% of referrals within one hour. Members of the psychiatric liaison team had access to and inputted into the electronic patient records system. Facilitating the maintenance of comprehensive patient records. The department had a process for supporting people subject to section 136 of the Mental Health Act.

The paediatric ED was supported by the child and adolescent mental health service (CAMHS) team. Staff in the paediatric emergency department told us they were responsive to requests for support and advice.

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 activity and learning was reviewed through formal governance routes. Safeguarding referral and information sharing activity was discussed at the provider’s joint safeguarding committee meetings, providing organisational oversight of safeguarding practice and themes.

Evidence showed that the service had clear processes for identifying and acting on safeguarding concerns in the emergency care pathway. Referrals to children’s social services were made when concerns were identified in the paediatric emergency department (PED). This ensured that the local authorities’ safeguarding teams were aware when concerns regarding children attending the paediatric emergency department were identified.

Staff we spoke with stated they had access to safeguarding policies and understood safeguarding concerns and how to escalate them in line with local procedures.

Staff took a rights-respecting approach and proportionate action to protect people from avoidable harm, including those experiencing domestic abuse, exploitation or neglect. Staff described how adult ED clinicians made safeguarding referrals for children when wider family risks were identified, including where a parent attended with domestic abuse, intoxication or drug misuse, or in a mental health crisis. This reflected a ‘think family’ approach to risk identification.

Clearly defined criteria supported staff decision-making in the paediatric emergency department. Staff accessed the safeguarding team for discussion and case support when required. Out of hours, clinicians contacted the out-of-hours duty social care team or the paediatric senior nurse for safeguarding support. The service reported 1,411 referrals and notifications to children’s social services across the year March 2025 to April 2026, which showed an established escalation of concerns pathway from urgent and emergency care.

There were safeguarding safety nets in place to reduce the risk of missed referrals or missed opportunities to share information, including daily monitoring and structured multidisciplinary review meetings.

The service maintained daily reports for paediatric emergency department attendances and a failsafe report to identify missed referrals, which the safeguarding team monitored daily. This provided additional assurance that safeguarding concerns were identified and progressed.

The service held weekly paediatric emergency department and ward multidisciplinary team (MDT) safety net meetings to discuss cases of concern. The hospital’s link social work team joined these meetings and provided feedback on previous referrals, supporting multi-agency review and learning.

Safeguarding information was supported by clinical record alerts and national information-sharing systems. Where a child or young person was known to social services, there were safeguarding alert entries in the electronic patient record which supported staff to recognise risk promptly.

Staff considered people’s capacity when assessing them. Staff had recorded a consideration of capacity in all records reviewed.

The service reported training compliance data showing safeguarding training was monitored through the provider learning management system against a stated target of 90%. Compliance levels were high across most staff groups and levels.

For medical staff, data showed all levels for adult safeguarding training and safeguarding children training were above the service’s 90% target, with safeguarding adults’ level 1 at 94%, level 2 at 92% and level 3 at 100% completion. Safeguarding children level 1 at 96% and level 2 at 95% completion.

For registered nursing staff, safeguarding adults level 1 at 95%, level 2 at 94% and level 3 at 100% completion; safeguarding children level 1 at 97%, level 2 at 97% and level 3 at 100% completion.

For unregistered nursing staff, health care assistants (HCAs): safeguarding adults level 1 at 100%, level 2 at 100%. Safeguarding children level 1 at 100% and level 2 at 100% completion.

The service provided compliance data for combined mental capacity act (MCA) and deprivation of liberty safeguards (DoLS) training for ED staff which showed that training had been made mandatory in February 2026. Completion rates at the time of assessment showed the following completion rates by staff groups. Medical staff: 74%, registered nursing staff: 68% and unregistered nursing staff (HCAs): 42%. Which were below the service’s target of 90%. However, the service described this as an early‑stage uptake position following implementation in February 2026 and reported ongoing work to improve uptake amongst unregistered staff, with targeted follow‑up and local oversight.

The service reported a total of 39 restraint-related incidents recorded in the emergency department in the first quarter of 2026.

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

The service involved people in understanding and managing risks associated with their care. Staff completed person-centred risk assessments, which reflected individual clinical risks, vulnerabilities and preferences. Risk management plans included the person, and where appropriate their relatives or carers and were reviewed to ensure they remained up to date. Staff involved families, carers and advocates in risk assessment and decision making, particularly for people who were vulnerable or lacked capacity.

Staff explained risks in a clear and accessible way, supporting people to make informed decisions about their care including when people chose to take positive risks in line with their wishes and needs.

The service had systems to identify, monitor and respond to deterioration, including structured triage processes, early warning scores (such as NEWS2 and PEWS) (NEWS and PEWS are standardised observation and tracking systems used by hospitals to quickly identify when a person's condition is deteriorating) and defined escalation pathways. However, not all people were reassessed at regular intervals, including those waiting in non-treatment areas. We were not assured from our observations that the risks were always reviewed and acted on without delay.

People said they felt safe and supported in the emergency department. People said they could approach staff if their condition deteriorated and were confident staff would respond appropriately. Posters within the departments highlighted Martha’s Rule, which allowed people, families and carers to refer directly to the critical care outreach team if they were concerned a person’s condition was worsening.

Staff recognised when people expressed distress, anxiety or behaviours that communicated a need and responded in ways that protected dignity and reduced risk. The service used proactive and preventative approaches, including de-escalation techniques and behavioural support strategies, to reduce the likelihood of incidents and manage risks safely. However, reception staff said they were subjected to verbal and physical abuse daily. This was raised with the service at the time of assessment. The service provided evidence of actions taken to reassure staff and processes implemented to reduce risk, these processes included a review of security presence, incident reporting processes, and the acceptable behaviour approach.

Learning from incidents and behavioural events was used to identify triggers and inform improvements in care. The service applied a balanced and proportionate approach to risk, supporting people’s rights and independence while maintaining safety.

Where restrictions or restraint were required, staff described how these were used only as a last resort, were proportionate to the risk, and were consistent with legal and best practice guidance. Electronic patient records reflected foreseeable risks and included strategies to minimise the need for restrictive interventions.

The service ensured that risks were managed during transitions between care areas, including admission, transfer and discharge. Staff communicated risk information clearly through structured handovers and referral processes. People were reassessed if delays occurred, and staff-maintained oversight of risks throughout the person’s journey through the ED. Emergency pathways were clearly defined and enabled timely and safe access to care, including escalation to higher levels of care when required.

The service incorporated mental health risk assessment within initial assessments, including screening for self-harm and suicide risk. There was access to specialist mental health support, and staff made timely referrals to ensure people received appropriate care. Arrangements were in place to manage people at risk of absconding or requiring enhanced observation safely. Electronic patient records for 3 mental health patients, showed psychiatric liaison staff responded to referrals and attended the department within one hour. The psychiatric liaison team uploaded a full bio-psycho-social assessment onto the electronic patient records system within three hours of the referral. This assessment was used to identify any internal and external services that might be suitable to support the person.

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

Overall, the service maintained a safe and appropriate environment for the delivery of care and treatment. We raised a concern about the safety of seating in the paediatric ED waiting area which was a potential risk to children using the service. The service acted quickly to arrange building works to rectify this issue and reduce the risk to children.

In most areas, the premises were designed and managed to protect people from avoidable harm and to meet people’s needs. Facilities were well maintained. Systems were in place to monitor safety, cleanliness and the ongoing condition of the estate.

Clinical areas were suitably configured. They included dedicated spaces for higher acuity care, including resuscitation areas that were appropriately equipped and standardised to support safe practice.

Most confidential conversations and staff handovers, were undertaken in suitable areas, supporting privacy and effective communication. Most confidential conversations took place in private areas to maintain privacy and dignity. However, we observed isolated conversations taking place at the nurse’s stations in majors for people in the fit‑to‑sit area.

Staff used the environment to support flow and safe observation, with clear zoning between different clinical areas.

The service did not deliver care in corridors. The only temporary escalation space used was a bench opposite the nurse’s station. Staff demonstrated awareness of the limitations of this area and described how people were monitored and how escalation processes were followed to maintain safety.

Facilities for specific groups of people were appropriately considered. The paediatric areas had recently been renovated, it had been designed with children and young people in mind, with mostly appropriate equipment and environments that supported their care and wellbeing. However, we raised concerns about the seating.

Mental health assessment rooms were designed to reduce risk, including the removal or mitigation of ligature points. They included safety features such as alarms and layouts that enabled observation while maintaining dignity.

Equipment and technology required to deliver care were readily available, well maintained and fit for purpose. Systems were in place to ensure that equipment was regularly checked, serviced and safe to use. All equipment seen had been serviced and was fit for use.

There were also robust processes for the safe storage, handling and disposal of waste, clinical specimens and hazardous substances, which reduced the risk of harm to people, staff and visitors.

Overall, the service demonstrated that the environment was safe, well maintained and effectively managed, with clear systems in place to identify and mitigate environmental risks and support the safe delivery of care.

The evidence showed a good standard. 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.

The service had established staffing levels for nursing, healthcare assistants and medical staff. These were monitored against planned workforce requirements. Data showed the total funded establishment across the emergency department and associated urgent care services was approximately 118 whole time equivalents (WTE), with actual staffing levels ranging between approximately 106.9 WTE and 114.8 WTE over the most recent reporting period. This showed the service generally maintained staffing close to its funded establishment, with small shortfalls that were actively managed.

Leaders monitored workforce indicators, including vacancies, turnover and sickness rates. Nursing and healthcare assistant vacancy rates in the adult emergency department fluctuated between approximately 5.7% and 8.6% over the most recent period. Voluntary turnover was generally between approximately 2.5% and 4.7%. Sickness absence was typically between approximately 4% and 6%.

Paediatric emergency department vacancy rates were higher at points in the reporting period, reaching over 12,9% in September 2025 but was at it’s lowest rate of 7.3% in March 2026. Turnover was variable and sickness absence was monitored. This showed there were some workforce pressures in specific areas, but leaders had oversight of workforce risks and trends. Average actual nursing staff numbers across the whole emergency department for the months January to March 2026 ranged from day shift 101% to 104% and for night shifts 109% to 112%.

Managers had calculated the number and skill mix of nurses and healthcare assistants required to provide safe care. Evidence from planned versus actual staffing data showed that, across the emergency department and ambulatory emergency care services, staffing levels generally met or exceeded planned requirements. Average fill rates for registered nurses were consistently above planned levels, meaning shifts were fully staffed or overfilled. Healthcare assistants fill rates were slightly lower but remained close to planned levels across day and night shifts.

Staffing levels generally matched the planned numbers on most shifts. Rostering data for the adult and paediatric emergency departments demonstrated consistent shift coverage. There were multiple shifts showing full allocation of staff across early, late and night shifts.
Where staffing gaps occurred, these were limited and not widespread. The service maintained consistent coverage across weekdays and weekends, supporting continuity of care.

Department managers were able to adjust staffing levels daily to respond to changes in acuity and case mix. Rosters demonstrated use of a range of shift patterns, including early, late, twilight and night shifts, alongside management days and supernumerary roles. This showed flexibility in workforce deployment and the ability to respond to changes in demand and need.

When required, managers deployed bank and agency staff to maintain safe staffing levels. Rostering data showed regular use of bank shifts across the adult emergency department, paediatric emergency department and ambulatory emergency care, including both daytime and overnight cover. This showed the service had systems in place to mitigate staffing gaps and maintain safe staffing levels.

When bank and agency staff were used, there was evidence that they were integrated into the workforce and supported through established processes. The consistent use of recurring bank staff within the same clinical areas supported familiarity with the environment and workflows. Rosters also showed induction, supernumerary shifts and training days, which supported safe onboarding and competency.

The service provided adequate 24-hour medical cover. Medical rotas demonstrated continuous shift patterns including early late and night shifts. There was coverage across all days of the week. Rotas were compliant with working time regulations and included appropriate rest periods and shift limits. This supported safe staffing, staff wellbeing and continuous medical input.

However, the service did not meet the Royal College of Emergency Medicine (RCEM) staffing ratio of 1 WTE consultant for every 4,000 annual attendances. This equated to 18 to 25 WTE consultants for a department of this size. During our assessment the consultant rota’s showed 3 consultants in the morning from 8am – 5pm, 2 consultants from 12pm – 8pm and 1 consultant from 3pm to 11pm. Weekend consultant cover was 1 consultant from 8am – 5pm and 1 consultant from 3pm to 11pm. Evening consultant cover was below RCEM standards and weekend consultant cover was suboptimal. There was also a lack of senior surgical decision makers for walk in trauma patients presenting to the ED after 8pm.

Staff had received mandatory training relevant to their roles. Compliance data showed that mandatory training across key modules, including resuscitation, safeguarding, infection prevention and control, and health and safety, was consistently monitored and achieved high levels of completion against the trust target of 90%. Medical staff were slightly below the 90% target: for adult resuscitation level 2 (86%), and information governance for (87%). Following our inspection we were provided with evidence to demonstrate that supported by the trust’s resuscitation team and the department’s advanced Life support Instructors, additional training sessions had been delivered, and medical staff were now compliant with the trust’s 90% target. The electronic training system that monitors staff compliance has also been updated to reflect those staff who hold ALS and ILS certificates. There was clear oversight of training compliance by staff group, with systems in place to identify and plans in place to address areas of lower compliance. This showed staff were appropriately trained and equipped to deliver safe care.

The evidence showed a good standard. 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.

Staff followed effective infection prevention and control (IPC) policies and procedures to protect people and staff from avoidable harm. The service had a clear infection prevention and control programme. It was aligned with national guidance and regularly reviewed. Risks relating to infection were identified, assessed and managed promptly. Information about emerging infection risks was shared with staff and partner organisations to support safe care. Staff demonstrated good compliance with standard IPC precautions.

This included appropriate hand hygiene, adherence to ‘bare below the elbows’ guidance, and correct use of personal protective equipment (PPE).

Staff understood their responsibilities to prevent the spread of infection and applied these in day-to-day practice, including the use of barrier nursing where required. The environment and clinical equipment were visibly clean and well maintained. There were systems in place to ensure that cleaning standards were met and monitored. Hand hygiene facilities and signage were readily available throughout the department. This supported staff, people and visitors to maintain good infection control practices.

The service had effective systems to identify and isolate people with suspected or confirmed infections. Staff isolated people promptly on arrival in line with national guidance. This reduced the risk of cross infection. These arrangements were consistently applied, including during periods of high demand.

Waste and clinical specimens were handled, stored and disposed of safely. The service followed appropriate systems for segregation, labelling and disposal of waste, in line with national guidance. This reduced the risk of contamination and infection transmission. Leaders monitored IPC compliance through regular audits and performance reviews. Where issues were identified, action was taken to address them and improve practice. Staff showed a proactive approach to maintaining high standards of infection prevention and control. They were supported to learn from audit findings, incidents and feedback to strengthen infection control arrangements.

The evidence showed a good standard. 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 happen.

Medicines and prescribing stationery were managed in line with trust guidance and stored safely. They were stored safely and accessed only by authorised staff. They were accessed only by authorised staff.

There was a clear process for ordering and maintaining stock. Staff knew how to obtain medicines out of hours. Pharmacy teams worked with a linked consultant to review stock lists and levels regularly. This supported timely access to medicines.

Emergency medicines were available and regularly checked. There was a clear process for obtaining stock not normally kept in the unit. Staff said stock was generally supplied promptly. However, delays sometimes resulted in missed or delayed doses. Records showed medicines were generally given as prescribed and on time. However, in one of the 15 records we reviewed, we saw there were delays in accessing a time critical medicine. This was raised with the trust, and action was taken to promptly address this.

Staff monitored people and escalated to a doctor for review. The service had recently introduced an electronic dashboard to monitor delays and omissions of critical medicines. Leaders said this was being used to drive improvement in the department.

The service was supported by pharmacy support teams for managing stock and had clinical support though the use of an ED link pharmacist. The pharmacist attended and reviewed people who had been admitted to the ED and was available to staff when required. Whilst this support was not in line with national guidance produced by the royal college of emergency medicines (RCEM), there was no dedicated pharmacist or pharmacy technician support to the ED. However, we were told of work by pharmacy leaders which was to improve clinical pharmacy presence in areas with extended length of stays in the department. This improvement had been identified through incident review and review of timely medicines reconciliation.

Staff had access to people’s relevant medicines history though local and national care records. Relevant details were generally recorded in the electronic patient records. Time critical medicines were flagged by doctors during triage. The service used a “hard stop” to ensure allergy status was recorded before prescribing. The electronic patient records we reviewed generally showed allergy status clearly. However, 1 instance out of 8 records reviewed showed an allergy identified at triage was not accurately recorded in the electronic patient record. This was raised with the service and resolved immediately. Administration of time critical medications was a regular audit completed by the department, using data from the electronic patient record. The audit monitored compliance with RCEM timely medication management standards. Data for the period 2023-24 period showed overall, identification and timeliness outperform national averages. This demonstrated significant improvement in the speed and reliability of identifying patients on TCMs (Levodopa or Insulin) upon arrival at the ED) and administering these medicines.

The 2025 RCEM data was not available at the time of our inspection, as it had not yet been published. However, we noted real‑time performance charts were available via the RCEM online platform and were used by the team to support ongoing monitoring and improvement. There was an identified RCEM consultant audit lead who provided clinical oversight of audit participation, reviewed findings and progression of actions through local governance arrangements.

There were effective systems for the supply of medicines when leaving the department, including the use of To Take Out (TTO) packs and prescriptions.

The service was working to improve antimicrobial prescribing to prevent increases in antimicrobial resistance. The service had access to antimicrobial specialists who provided guidance and training. Staff told us they knew how to report incidents and told us they received feedback about incidents. Medicines related incidents were discussed at monthly governance meetings and relevant learning was shared with staff at team meetings and in regular medication safety bulletins.