Queens 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 verbally face to face, by email and on a learning and sharing whiteboard 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 critical care environment was clean and tidy. Medications were stored safely with appropriate processes in place to safely manage medication.

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.

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. All learning on a page from the previous two years had been collected and placed in a folder on the nursing station allowing easy access to staff.

A new initiative had been devised to encourage staff to share topics of interest relating to critical care. Leaders encouraged staff to present published articles or research to the team.

Delays in accepting patients on to the unit did not happen due to strong cohesive working between both Queen’s Hospital Burton and Royal Derby Hospital.

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 Queen’s Hospital Burton and Royal Derby Hospital 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 was a priority that involved everyone, including staff as well as people using the service. Staff made sure that people understood the care and treatment that was being provided.

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

Staff closely monitored patients so they could respond quickly if their health deteriorated quickly.

Nurses worked in line with the UK Critical Care Nursing Alliance minimum standards. 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 a critical care outreach team who worked closely with patients and their relatives. The critical care outreach provided a service which was in line with national guidance.

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 was had two areas, ‘pod A and B'. Both areas were quiet, and staff understood the importance of this. Staff had requested visual decibel monitors to monitor noise levels to support people but that this request had not been actioned.

The unit was clean and tidy with appropriate equipment available to maintain safe levels of care. Sharps bins were available at all bedsides and were labelled correctly. Medical equipment in the ward area had been appropriately tested and was within date. Sterile equipment was stored off the floor on appropriate shelving and when we checked expiry dates, all equipment was in date. Side rooms had positive and negative air pressure to allow for appropriate isolation of infectious patients. However, we found antichlor tablets stored incorrectly in the sluice area. This created potential risks of inappropriate use and risk to people.

Patients had access to a garden area that was safe for patients to use when appropriate. Staff risk assessed the area, emergency bells were available for patients, family or staff to summon help if required. Staff told us that the doctors would encourage people to access the ward as part of their treatment plan.

Pod A and B had a resuscitation and difficult breathing trolley available. During the inspection we found that each emergency trolley had all the required equipment available and was in date. Staff carried out daily checks of both trollies and recorded this. However, this was recorded on one checklist. It was not clear that this checklist was to be used for both the resuscitation and difficult airway trolley. Due to this we were concerned that this posed a potential risk of one of the trollies not being checked and confusion for staff that are not familiar with the service.

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.

46% 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, 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 practice educators working with nursing staff to complete this training.

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.

The unit had support from specialist teams such as physiotherapy, occupational therapy, speech and language therapist and dietitians.

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

Infection and prevention audit data from the six months prior to our assessment was reviewed. These audits showed that the service was 99% compliant with hand hygiene in 2024.

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.

The side rooms in ‘pod A’ had separate doffing and donning areas and staff nursing patients in these side rooms used walkie talkies to communicate with staff on the unit reducing the need to leave the room and remove personal protective equipment.

The unit used disposable curtains which were changed regularly in line with trust guidelines.

Processes were in place for managing medicines and safe storage. Staff completed regular checks of medications and controlled drugs in line with trust policy. Medications were stored in an air conditioned room in locked cupboards with clear labelling on all cupboards.

We saw evidence that regular counts of controlled drugs were taking place and that two registered nurses were signing off the administration of all controlled drugs. Medication stock levels were checked daily by a pharmacy technician.

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.

The pharmacy team attended the unit daily to review people's medications.