Royal Victoria Infirmary

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• 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

We assessed 5 quality statements under the safe key question. Safeguarding was firmly embedded within the SARC and referrals made when required. Care was provided in a way that kept patients safe from avoidable harm. The environment was well maintained and kept clean, although somewhat cramped while in a temporary facility. Medicines were safely prescribed.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

The Trust had child safeguarding policies and procedures which provided information to staff about how to identify, and report suspected abuse. Most staff had completed appropriate level training for their role with further training planned for those staff whose training had expired. The Trust had a specialist safeguarding nurse who offered monthly sessions where staff could bring concerns, seek advice and request additional safeguarding supervision if they needed support after a complex examination.

A safeguarding assessment was completed for all patients, which identified whether the child or young person was already known to social services. Where concerns were identified, they were recorded by staff, along with any action taken. Safeguarding referrals were made as required and followed up with attendance at a strategy meeting if necessary. In some cases, if a child was already known to the local authority, then staff would send relevant information to their social worker.

Staff received safeguarding supervision, and cases were discussed during group peer review meetings to ensure that appropriate action was being taken in each case. Self-harm risk assessments were also completed for patients to identify possible support needs during their time at the SARC and afterwards.

Freedom to Speak Up Champions were available if staff wanted to raise any concerns and staff were aware of this.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The permanent SARC was located in the Children and Young People's clinic of the hospital, and therefore essential premises and safety checks such as fire, portable appliance testing, legionella management and equipment maintenance were completed regularly by the hospital estates department to ensure a safe environment.

To allow for changes that were needed to meet the new standards for UKAS ISO accreditation for forensic services, the SARC had temporarily moved to a different site within the hospital. A comprehensive assessment had been undertaken by the SARC quality and assurance lead to identify any risks to patients and staff in their new environment.

All doors to clinic rooms in the SARC were fitted with specialist locks, allowing them to be opened easily in the event of an emergency. Essential medical equipment and medicines for any emergency situations in the SARC were available in the nearby children’s outpatients’ department.

Staff undertook mandatory training in life support, health and safety, and fire safety. A ligature and self-harm risk assessment had also been completed, and a load release anti-ligature curtain track was installed in the pre-examination room to keep patients safe. Staff had access to a ligature fish cutter in the medical storage cupboard.

The SARC service was staffed by a well-established and experienced team, consisting of 7 paediatric consultants, 3.2 whole time equivalent nurses and one healthcare assistant. At the time of our visit there was one vacancy for a lead nurse, but this had already been recruited to. Plans were in place to develop a new staff role of ‘SARC support worker’ who would provide additional support to the team.

Staff told us that staffing levels were good and that patient care had never been compromised due to shortages. On the few occasions where the SARC’s permanently employed nurses could not cover a shift, staff from the surrounding hospital wards could be called upon to assist.

Staff recruitment was managed centrally by the Trust’s human resources department. Information we reviewed for the most recently recruited staff member demonstrated that appropriate pre-employment and vetting checks had been completed to ensure they were suitable for their role.

All new staff underwent the Trust induction which covered essential training in moving and handling, infection control, safeguarding and information governance. They then shadowed a nurse until assessed as competent to undertake the role. Figures provided to us by the Trust showed that 98% of SARC staff were compliant with mandatory training requirements.

All but one of the paediatric consultants held the Licentiate in Forensic Legal Medicine Sexual Offences Medicine qualification which demonstrated their knowledge and competence in this specialist field. However, none of the nursing staff had undertaken a specific accredited sexual offences medicines course to ensure they had the most up to date skills and knowledge in this specialist field.

All staff received regular supervision and appraisal to identify any training needs and ensure their practice met professional standards, evidence of which we viewed. Staff reported to us that they received good support from colleagues and managers, especially after dealing with distressing cases. Staff had access to Trust wide welfare services, and a psychologist attended peer review meetings once a month to offer additional support to staff if needed.

It was clear staff enjoyed and took immense pride in their work, describing it to us as a ‘privilege’ to work there.

There were appropriate policies in place in relation to infection prevention and control, and staff received training in this area. Daily cleaning checks were undertaken alongside a weekly clean of all areas. In addition to this, a monthly deep clean of the premises was carried out. The Trust employed a ‘rapid response team’ who cleaned forensic rooms immediately after a patient had been seen. Monthly environmental monitoring was in place to test the efficacy of cleaning procedures and DNA management.

We noted that all areas of the SARC, although cramped in places, were visibly clean and hygienic, including the waiting areas, bathroom, and corridor. The forensic examination room surfaces including walls, floors and cupboard doors were free from dust and visible dirt. The room had sealed flooring so it could be cleaned easily. There were no work surfaces available, but equipment was prepared and kept in sealed plastic boxes in a cupboard until needed.

Staff scrubs were laundered on site in the hospital laundry. A bin was available for the disposal of sharps, which was dated when opened and not overfull.

There was controlled access to the forensic examination room and bathroom to minimise the risk of DNA contamination. Logs were kept recording their use and the two doors were sealed after they had been cleaned. All staff entering the forensic medical examination room wore appropriate PPE, including face mask, inner and outer gloves, mob cap and disposable barrier clothing.

The Trust infection control team carried out audits of compliance with required standards and fed the results back to the SARC team so that any improvements could be implemented

Paediatric consultants prescribed medicines individually to patients which included emergency contraception, Hepatitis B vaccines and post exposure prophylaxis drugs (PEP). We viewed standard operational policies in place for these. A small stock of medicines such as inhalers, worming treatment and analgesics was also available to give to patients if needed.

The need for HIV PEP medicines was fully assessed before being prescribed to patients to ensure nationally recommended guidance was followed. We found follow up appointments had been made for patients for further HIV testing and Hepatitis B boosters if needed.

The room temperature where some medicines were stored was not monitored to ensure it met the safe temperature ranges, and we noted it to be very warm. There were no stock records kept of the medicines to identify if any had gone missing. However, these issues were rectified during our visit by pharmacy staff.

Prescription pads were stored securely and appropriate records kept of their use.

Staff maintained a record of all medicines issued to patients in their care record, evidence of which we viewed.