Royal Derby 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

We assessed all quality statements within safe. Following this assessment safe is rated as good.

There was a proactive approach towards learning and safety, staff reported incidents, and these were investigated by leaders. Learning was shared in a number of ways to ensure that staff were able to access this.

The service worked collaboratively with the local critical care network to provide safe care.

Staff understood their safeguarding responsibilities.

Where appropriate staff involved people in discussions around care and ensure that they understood the care and treatment being provided.

There was good awareness of risk and staff completed risk assessments in line with national guidance.

Whilst the service had appropriate levels of staff, the service had not met national guidance for numbers of nursing staff who had received a post registration qualification in critical care.

The environment was mostly safe however hazardous chemicals were not always stored appropriately.

Medications were not always managed appropriately.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders promoted a culture of safety and learning within the service. Staff reported incidents in line with trust policy. We reviewed 163 incidents reported through the trust’s incident reporting system over the past 3 months. This showed that all incidents reported were thoroughly investigated and there was evidence of learning with action plans where required. Incidents reported were predominately low or no harm and the themes varied demonstrating that staff were reporting a variety of incidents.

Learning from incidents was cascaded and used to continually identify and embed good practice. Learning was shared using an easily accessible learning and sharing whiteboard, email, through regular team days and where appropriate, verbally on a one-to-one basis. For any incidents which were rated as moderate harm or higher a learning on a page exercise was completed and shared with staff. Known risks were communicated with staff through the learning and sharing whiteboard. Consultants held focussed training sessions for junior doctors three times a week.

The majority of the trust worked on electronic prescribing and patient records the intensive care unit remained paper based. Staff reported that this worked well unless a member of staff came to work on the unit from Queen’s Hospital Burton or from the step-down ward as these staff required additional support initially. There had been no incidents related to paper-based records in the four months prior to our assessment. To ensure continuity of care when a patient was transferred from the unit to another area within the trust paper discharge records were completed which would be used to handover patient care.

Delays in accepting patients on to the unit did not happen due to strong cohesive working between both Royal Derby Hospital and Queen’s Hospital. The step-down ward was fully utilised by the intensive care unit. Delays did occur when transferring patients to the step-down wards and ward-based beds due to challenges with flow across the site.

The unit worked with other trusts across the region and utilised the Adult Critical Care Co-ordination and Transfer Service when transferring patients to a different hospital. This allowed transfers to take place without compromising staffing levels on the unit.

Leaders worked across both Royal Derby Hospital and Queen’s Hospital Burton with shared governance, quality and risk. Leaders told us that whilst shared governance and standard operating procedures and policies were in place it was recognised that both hospitals were different in size and in the type of patients that were treated there and as a result of this some standard operating procedures and policies had been tailored to the individual unit.

Staff understood their safeguarding responsibilities and knew how to take appropriate action when necessary. The trust had a clear safeguarding policy which was available for staff to access. All staff received appropriate safeguarding training. We saw evidence of staff seeking support and making appropriate referrals for vulnerable patients within patient records.

Safety is a priority that involves everyone, including staff as well as people using the service. Staff made sure that people understood the care and treatment that was being provided. We observed the consultant led ward round, during this the consultant involved patients and their relatives in discussions around care and treatment plans which were in place.

Risk assessments such as venous thromboembolism and falls assessments were completed and documented in line with national guidelines.

Staff closely monitored patients so that they could respond quickly if their heath deteriorated quickly. We observed level 3 (intensive care) patients receive one to one nursing care and level 2 (high dependency) patients being nursed by one nurse per two patients.

Allied health professionals who attended the ward were included in handovers to ensure that all staff involved in patient care were fully informed.

There was organ donation and critical care outreach teams based within the unit who worked with patients and their relatives. The critical care outreach team were available 24 hours each day and provided a service which was in line with national guidance.

The unit was secure with access available via an intercom. There was a seated waiting area, we observed visitors using this area and taking turns to visit their relatives to avoid overcrowding at the bedside.

The unit provided mixed sex accommodation for patients requiring high dependency and intensive care. Bed spaces were separated by curtains to maintain privacy and dignity. The unit had two areas with intensive care and high dependency patients being nursed separately. Both areas in the unit were quiet, and staff understood the importance of this. Visual decibel monitors were in use to monitor the sound level throughout the unit.

The unit was clean and tidy with appropriate equipment available to maintain safe levels of care. Sterile equipment was stored off the floor on appropriate shelving and when we checked expiry dates, all equipment was in date. Sharps bins were available at all bedsides and were labelled correctly. Side rooms had positive and negative air pressure to allow for appropriate isolation of infectious patients. Each bed space had access to water which allowed patients who required dialysis to receive this easily.

However, staff did not store chemicals appropriately at bedsides and on the unit. We found chlorosan solution, which should have been discarded following use at each bedside sink and hydrex surgical scrub stored on top of a trolley on the unit. This created potential risks of inappropriate use and therefore we were not assured that this was safe. We found a syringe containing blood left on top of a bin in the blood gas laboratory.

Staff did not dispose of medicines correctly. Staff had disposed of medicines in orange lidded, healthcare waste bins which is non-compliant with HTM 07-01: Safe and sustainable management of healthcare waste. This was raised with leaders when we were on site who assured us that this would be addressed immediately.

The majority of medical equipment in the ward area had been appropriately tested and was within date. However, we did identify a piece of equipment in the blood gas laboratory, which was due to be tested in November 2021, but this testing had not been completed.

The unit had access to a garden area which staff had fundraised to create. Staff had risk assessed the area to ensure that it was safe for all patients to use the area when appropriate. The garden area had an emergency call bell available should this be required.

Both areas of the unit had a resuscitation and difficult airway trolley available. We checked all emergency trollies, and all equipment was available and in date. Staff completed daily checks of the trollies however there was no set process in place to check the trollies and restock them after use.

A transfer grab bag was available on the unit. There was a process in place for checking this after use and we saw evidence of these checks taking place.

44% of nursing staff working in the intensive care unit had a post registration critical care award. This was not in line with the UK Critical Care Nursing Alliance minimum standards for which states that 50% of staff must be in possession of a post registration critical care award. Leaders had a plan in place which would see this being exceeded by the end of 2025. We acknowledged that the unit had four practice educators working with nursing staff to complete this training.

We were told that when there were issues with staffing levels the unit would be supported by staff at Queen’s Hospital Burton and over the winter period staff from Queen’s Hospital Burton were temporarily redeployed to Royal Derby Hospital to assist with winter pressures. The trust also had escalation procedures in place for when unexpected staffing issues occurred.

Medical staffing levels exceeded the acceptable levels set out in the guidelines for the provision of intensive care services.

There was a dedicated physiotherapy team based on the unit who had a daily presence.

Infection prevention control policies were in place and there was a named nurse responsible for the oversight of infection prevention control.

The unit had a recent Acinetobacter outbreak, staff and leaders appropriately managed this in line with the trusts outbreak policy and a full deep clean was undertaken on the unit. As part of the ongoing monitoring of standards hand hygiene audits were increased to daily audits throughout January and February 2025

Infection and prevention audit data from the six months prior to our assessment was reviewed. These audits showed that the service was 100% compliant with hand hygiene for the six months prior to our assessment.

There was hand gel available at all bedsides and at entrances to the unit. We saw staff wearing appropriate personal protective equipment and maintaining good hand hygiene when providing care.

We saw maintenance of water fountains taking place and staff told us that this was part of the regular maintenance routine to reduce the risk of water borne infection.

Processes were in place for managing medicines and safe storage. Staff completed regular checks of medications and controlled drugs in line with trust guidance. However, we were not assured that these checks were being completed accurately as we found three tubes of Aquaform which were out of date, one of which went out of date in 2020. We also found two bags of intravenous erythromycin in a fridge which had been prepared on 24 February 2025 and should have been discarded after 24 hours. This was raised with staff on the day who removed the medications immediately.

We saw evidence that regular counts of controlled drugs were taking place and that two registered nursed were undertaking the second checking process in line with trust policy.

There had been 21 medication related incidents in the three months prior to our assessment. 15 no harm, 4 low harm and 3 near misses. These incidents were all investigated appropriately with action plans in place where required.

There was a pharmacy team based on the unit who attended daily.