Royal Derby 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 assessed all quality statements within effective. Following this assessment effective is rated good.

Staff worked well together as a team and provided good care and treatment in line with latest evidence and good practice. Staff worked well with specialist teams such as speech and language, dietitians, physiotherapist and occupational therapists to provide a multidisciplinary approach to care.

Staff made sure people understood their care and treatment to enable them to give information and gain informed consent where this was not possible staff acted in the best interests of the patient. Where appropriate, people were involved in assessments of their needs and discussions around their treatment.

The service had a well-established critical care outreach team.

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.

There was a physiotherapy team based within the unit. Specialist support from speech and language therapists, dietitians and occupational therapists was available for patients on a referral basis.

Weekly multidisciplinary team meetings took place with the medical team, speech and language therapists, dietitians, physiotherapists and occupational therapists.

Patients who were not able to eat or drink were provided with nutrition and hydration through intravenous fluids and specialist feeds supported by the dietitian service.

The unit had processes in place to ensure that peoples nutritional needs were closely monitored and where appropriate we saw that alternative methods to deliver nutrition and hydration were in place.

Pain was assessed using the critical care pain observation tool and we saw evidence of pain relief being provided following assessment. Intubated patients were assessed using the Richmond Agitation Sedation Scale.

Microbiology attended the unit daily to discuss laboratory results with consultants and adjust treatment where required.

We observed staff completing repositioning of patients and skin integrity checks. Patient records that we reviewed evidenced that this was being completed in line with trust policy and best practice.

Policies and procedures were in place which were based on NICE guidance, the intensive care society and the faculty of intensive care medicine. These policies were accessible for all staff.

People were assessed in line with national and best practice guidelines, and we saw evidence of this in the patient records that we reviewed.

The unit actively promoted organ donation in keeping with NHS Blood and Transplant guidance. There was a unit lead for organ donation who was also the clinical lead for organ donation in the Midlands. There was twenty four hour access to the organ donation specialist nursing team.

The unit had processes in place to ensure that people’s nutritional needs were closely monitored. Dietitians were involved in patient care, and we saw evidence that best practice was followed. Where patients were sedated or nil by mouth, we saw that alternative methods to deliver nutrition and hydration were in place.

Staff prided themselves on good teamwork and communication throughout the multidisciplinary team. We observed this throughout all areas of the unit.

A critical care outreach team was based on the unit. This team was staffed separately to the unit and did not impact staffing levels on the unit. There was a process in place for staff to escalate patients to the critical care outreach team.

Staff handovers took place between the nurse in charge of an area so that they could have full oversight of all patients, with further bedside handovers taking place between the nursing staff responsible for the individual patient care. Medical handover took place off the unit.

There were processes in place to ensure multidisciplinary working throughout the unit including regular multidisciplinary team meetings.

The unit worked closely with the intensive care unit at Queen’s Hospital Burton and staff would work across both sites to support when required. Staff reported good working relationships across the intensive care units within the Midlands network.

People who had been admitted to the intensive care unit were able to access a follow up clinic following discharge. This clinic allowed people to discuss their admission and understand what had happened to them during their time on the unit. People could also access additional support to assist them in returning to their usual daily living.

It was recognised that admission to an intensive care unit could have a psychological impact on people. Patient diaries were completed during the admission. This was a tool which could be used following discharge to assist with filling in gaps in a patient’s memory and provide context to the memories that they may have. Staff recognised the importance of people having access to psychological support. However, the unit did not have access to a psychologist, staff and leaders told us that this was something that they were hoping to introduce to the unit.

The service contributed to the Intensive Care National Audit and Research Centre audit. The most up to date audit data was for 2023-2024. This data showed that for all monitored quality indicators the unit was within the acceptable ranges except for high-risk admissions from the ward where Royal Derby Hospital was shown to have accepted a slightly higher than expected number of high-risk patients.

The service monitored patient outcomes and completed regular audits. There was a clinical audit team who collated this information to ensure that any areas of concern, themes and trends were logged and used to facilitate learning and improvement.

Staff gained consent from people in line with legislation and guidance and documented consent within the patient records that we reviewed. We observed staff obtain verbal consent from people before delivering care and treatment and where this was not possible, we saw staff deliver care in the patients’ best interests.

Staff understood the mental capacity act and their responsibilities when assessing capacity to consent. Staff recognised that a patients’ capacity changed regularly due to the nature of treatment and their clinical condition, so they ensured that capacity was assessed at each interaction.

Staff understood their responsibilities around Deprivation of Liberty Safeguards and there were hospital policies in place to ensure that staff were aware how to request Deprivation of Liberty Safeguards for a patient.