Birmingham Heartlands Hospital

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

We reviewed the assessing needs and evidence-based care and treatment quality statements from the effective key question. As this assessment was based on risk, we did not complete enough quality statements to re-rate the whole key question, effective therefore remained good.

The service had access to risk assessments which were based on nationally recognised, evidence-based assessments. However, staff did not always complete and update risk assessments for each patient and risk assessments lacked key detail. Managers were aware of the poor completion and were working with the staff to increase compliance. Managers used information from audits to improve care and treatment for patients.

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.

Nurses handed over patients to nurses using the electronic system. This meant they could alert staff they were handing over to about any risks the patients had and any outstanding care needs. Managers could monitor the completion of risk assessments using the clinical dashboard. For example, on 19 March 2024, on Ward 4, 56% of care plans were fully complete. Managers used the information from the dashboard within huddles to improve compliance where required. Staff told us managers fed back this information and they were aware that care plans and risk assessments needed improving.

Staff did not always complete and update risk assessments for each patient and did not remove or minimise every foreseeable risk. We reviewed 9 sets of records and all had a completed falls risk assessment and Waterlow assessment; however, the Waterlow assessments lacked detail and action. For example, a patient had a Waterlow of 23, which was considered very high, and there was no documentation that a mattress was in place, skin integrity checks were completed on 5 out of 14 occasions and there was no documentation of whether the patient required turning. This meant we were not sure the risks of patients developing a pressure sore were reduced. We saw that skin integrity checks were not fully completed in all notes that we reviewed. Within the 9 notes that we reviewed, patients' skin integrity was fully checked on 37 out of 102 episodes of care rounds. We did not see clear documentation of patients being turned when they were at risk of developing pressure sores. This had been recognised by the manager and posters prompting staff to turn their patients were on the walls. One staff member told us they had raised the poor completion of skin checks with the manager as they had seen it decline. Managers said they were aware that completion of risk assessments and daily care plans needed improvement and we saw evidence that managers were working to improve compliance.

There were processes in place for staff to follow to assess and meet the needs of patients. The trust used an electronic system which had all risk assessments embedded within this and staff were required to ensure these were completed on admission and through various stages of a patients admission. The assessments included, but were not limited to skin integrity assessments, Waterlow assessments, MUST (malnutrition risk assessment tool), bed rails assessment and manual handling assessments. Where concerns were indicated, there were further assessments for staff to complete or escalate for specialist nurse involvement, this included where patients required close supervision.

Bed rails assessments were not always completed daily as per protocol. We looked at 90 daily care plans across 9 sets of notes and found that of these 90, 31 bed rails assessments were completed. We found that bed rails were discussed regularly between staff and patients. We listened to a handover and the nurse handed over that a patient wanted their bed rails up even though there was no indication for it.

Managers regularly completed audits on the completion of risk assessments. In addition to audits, the service also used a clinical dashboard which gave real time data on the performance against a set of indicators. Risk assessments (Waterlow, falls, MUST) were included as key indicators on the dashboard. Information reviewed on the clinical dashboard review group minutes identified surgical wards had been identified as decreasing in their performance against some key indicators. This was believed on 1 ward to be due to removing the Surgical Assessment Unit SAU) from the ward area.

There was no information within these meetings in relation to any bed rails risk assessments and the performance in relation to them.

There was also a lack of outcomes in relation to the number of falls, pressure damage or patients who were harmed by the poor MUST assessment within the evidence provided.

The risk assessments which staff used were evidence-based and widely used and recognised across healthcare. Policies, processes and other supporting documentation in relation to risk assessments and the involvement of carers within patient care was based upon national guidance and polices. The carers Standard operating Procedure (SOP) referenced relevant guidance as well as legislation including the Care Act 2014.

The guidelines for the management and use of bed rails and trolley rails was noted to have relevant guidance referenced within this, including the Medicines and Healthcare products Regulatory Agency (MHRA) details around the safe use of bed rails which was also referenced within the never event description.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.