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 requires improvement.

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

Staff did not always carry out comprehensive risk assessments for people who used services and this was not in line with national guidance. For example, ward 26 was a specialist cystic fibrosis unit which cared for patients from all over the Midlands including transitional patients. The service only had side rooms and had developed a standard operating procedure which did not require the ward to receive any patients at risk of falls. We were told the service did not have any patients at risk of falls at the time of our assessment. However, we found a patient had had a fall 3 days prior to our onsite assessment. The patient had a bedrail in place and there was no evidence of any person-centred risk assessments being done. Staff said they had discussed the use of bedrails with relatives but there was no evidence to support this.

In addition to the regular risk assessments, we also found a patient who had been moved to Ward 32 under the ‘Push Model’ was sitting in the corridor despite a potential diagnosis of stroke. The patient had been sitting in the corridor since earlier in the morning and no risk assessments had been completed to identify the risks and needs of this patient. We raised this with senior staff at the time of our onsite assessment who said they would take action to keep the patient safe.

There were processes in place for staff to follow to assess and meet the needs of patients. The trust used the 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, including where patients required close supervision.

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 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 were noted to have relevant guidance referenced within these, including the Medicines and Healthcare products Regulatory Agency (MHRA) details around the safe use of bed rails which were 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.