Queens Hospital

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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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. COSHH was not always stored safely to keep people safe from avoidable harm. The service did not always have enough nursing and support staff to keep patients safe. Medicines and treatment were not always safe and did not always meet people’s needs.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a culture of safety within the medical care division and staff acted with openness and integrity. Staff were clear on how to report incidents and were able to describe incidents they would report and had reported.

When there were serious incidents or urgent concerns, staff said they were usually involved in any investigation and asked for their input. Staff we asked said they did not feel blamed or were treated negatively when things went wrong. Staff said they were supported by the managers and colleagues and treated with understanding. They felt lessons were learned from safety incidents and changes were made to reduce risks.

The service managed patient safety incidents well and used the NHS’s Patient Safety Incident Response Framework (PSIRF) to respond to incidents. Managers knew how to investigate incidents within the PSIRF system, and we saw example incident reports that demonstrated this was done effectively. Staff received feedback on incidents they had reported.

Staff on Ward 8 developed a ‘learning‑on‑one‑page’ (LOOP) document to reflect on incidents and support shared learning. The document set out what happened, the actions taken, and highlighted examples of good practice, alongside areas that could be improved. It also outlined the agreed next steps to help inform future practice and reduce the risk of recurrence. We found that LOOP documents were being produced and used to share learning and examples of good practice across divisions, supporting organisational learning and continuous improvement.

The Trust had clear processes for disclosing incidents to patients. We found the medicine division followed the duty of candour policy by providing feedback and investigation outcomes when necessary. Incidents were regularly audited where pressure ulcers, skin integrity, and falls were the most common issues identified. We reviewed 3 incident investigation reports and found all included clear action plans.

Debrief sessions were available following serious incidents, and staff described these as an opportunity to review what had happened.

Learning from incidents was shared through handovers, team meetings, and email updates, supporting a culture of reflection and continuous improvement.

The evidence showed some shortfalls. The service did not always work well with patients and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor patients’ safety. They did not always make sure there was continuity of care, including when patients moved between different services.

Some patients experienced delays in clinical pathways. Ward 6 provided both cardiology and general medical care, with clear and safe systems in place for patients requiring telemetry monitoring. However, following the decommissioning of the cardiac catheter laboratory in September 2025, staff reported delays in patients accessing angiograms and invasive cardiology procedures, as these services had moved to the Derby site. Staff raised concerns that these delays had led to prolonged hospital stays and patient deterioration, with incidents reported where patients’ conditions worsened while awaiting transfer. Additional concerns were raised about the lack of on‑site cardiac in reach nursing support and the use of catheter lab beds for escalation. Although clear pathways remained in place for angiograms, pacemakers and loop procedures, staff were concerned about patient safety and equity of access to care. Additional information provided by the Trust during the factual accuracy stage confirmed that a workforce review was underway, supported by cross-site working and clinical support. Between October and November 2025, 3 pacing-related incidents were reported and investigated, resulting in the development of a standard operating procedure, simulation training, updates to the transfer policy, cross-divisional walk-throughs, and communications to medical staffing.

We reviewed the records of 2 patients who were awaiting pacemaker procedures at the Derby site following the closure of the catheter laboratory. Both patients had been on the waiting list for over 3 weeks. During this time, their clinical conditions deteriorated, which delayed their transfer for the procedure until they were stabilised. At the time of inspection, both patients were expected to be transferred to Derby within 2 days.

There was an 8‑bedded SDEC assessment bay, which was equipped with 2 monitors. Staff told us the aim of the bay was to assess patients promptly, facilitate rapid turnaround, and enable patients to return home as soon as it was safe to do so.

Pathways and criteria for the Same Day Emergency Care (SDEC) were clearly defined. Each patient admitted to service was assessed using the emergency department nursing assessment documentation. This included risk assessments to identify and respond to patients’ clinical needs.

A ward sister acted as a navigator, reviewing patients who arrived through the emergency department to assess their suitability for SDEC. Staff told us that the SDEC could also, on occasion, accept patients directly from ambulances when clinically appropriate.

SDEC follow up reviews were recognised as an integral part of acute care. Patients were brought back to the clinics as required, and several follow‑up clinic appointments were available each day. This included patients’ returning for review over the following few days to ensure continuity of care and monitor their clinical progress.

The service had oversight of the patients who were medical outliers. They were discussed at the daily safer staffing meeting which was held during the day. These were patients who were on different wards due to a lack of bed space. The needs of these patients were discussed and the responsibility of medical staff for oversight of these patients was agreed.

At the time of our inspection, there were 5 medical outliers on ward 19. We reviewed the records for these patients and found they were reviewed daily by the medical team. This provided assurance that patients continued to receive appropriate medical oversight despite being cared for outside their usual specialty ward.

There were clear protocols for managing patients requiring enhanced observation for example patients at a high risk of falls. Patients had been risk assessed and were nursed within a bay setting without the need for one‑to‑one supervision. We reviewed the records of 2 high risk patients and found risk assessments were completed and updated.

We reviewed the care plans records of 6 patients and found that all had risk assessments completed on admission to support holistic care. Individualised care plans had been developed from these assessments and were reviewed and monitored on each shift.

Patients living with asthma and chronic obstructive pulmonary disease were added to the outpatient clinics and were usually seen within 4-6 weeks. Patients from Staffordshire were either reviewed at Queen’s Hospital or seen in a neighbouring hospital, and they were typically advised to contact the respiratory team directly if they required support.

Patients attending the short stay unit were reviewed by consultants in a timely manner. Consultants undertook clinical assessments and triaged patients to appropriate specialties based on presenting conditions and required interventions.

Key blood tests results were available within 1 hour of arrival at the pathology laboratory. There were systems for tracking and reviewing any outstanding blood test results after patients had been discharged. Staff told us that blood test results could sometimes take several hours to be returned. When results were not received before the end of a shift, staff handed these over to the on‑call team, who followed them up to ensure continuity. There was a system for tracking reviewed and outstanding results post-discharge.

Handover processes supported continuity of care and ensured that outstanding tasks were handed over. For example, staff highlighted patients living with Parkinson's disease on handover sheets to ensure they received their time critical medication promptly.

Records were clear, accurate and files were stored securely and not accessible by anyone other than staff working at the service. Digital systems supported secure, up-to-date sharing across care partners.

Consultants led daily ward rounds on all wards, including weekends. Patients were reviewed by consultants depending on the care pathway. Staff we spoke to said they could call for support from doctors and other disciplines, including mental health services and diagnostic testing.

There was a discharge pathway to support safe home discharge. Staff demonstrated a clear understanding of each patient’s plan of care and treatment. This provided assurance that patients received coordinated and timely care.

A discharge ward was available for patients who were independent or medically fit for discharge, and these patients were transferred to that area once ready to leave the hospital.

The evidence showed patients were safeguarded. The service worked well with patients and healthcare partners to understand what being safe meant to them and how to achieve that. They shared concerns quickly and appropriately. However, not all staff were trained to the national guidance recommended levels of safeguarding.

The trust had a target of 95% for the completion of safeguarding training for the various levels that different groups of staff were expected to achieve. The overall compliance for safeguarding training was at 85%, below the trust’s target of 90%. Compliance varied across safeguarding levels with 94% of staff compliant in safeguarding level 1 training, 79% compliant on level 2 training, and 86.3% compliant on safeguarding level 3 respectively.

However, staff we spoke with were confident in identifying and reporting abuse and neglect. Staff across various areas demonstrated a clear awareness of safeguarding and were alert to safeguarding concerns. Staff told us 1 patient had an identified safeguarding concern, and safeguarding patients were clearly highlighted on handover sheets and discussed during handover.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff were aware of safeguarding responsibilities and escalation processes. They were able to recognise safeguarding concerns and make appropriate referrals. However, some staff said the safeguarding team was not visible on the ward. They reported having to follow up referrals externally and did not always feel supported by the safeguarding team. This was varied as staff in some areas said they knew how to access the safeguarding team and where to seek advice when required.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

We saw an example where a safeguarding alert had been raised on the electronic system. Staff had clearly documented their concerns and notified the local authority in line with safeguarding procedures. The discharge liaison team had contacted the local authority to follow up the alleged concern, and an urgent Deprivation of Liberty Safeguards (DoLS) referral had been submitted and approved.

A patient requiring constant supervision was supported with appropriate mental capacity assessments and a Deprivation of Liberty Safeguards (DoLS) application. Multidisciplinary working and escalation pathways were in place.

We observed a patient receiving continuous one‑to‑one supervision by a healthcare assistant due to risks associated with wandering. Mental Capacity Act assessments had been completed, and a DoLS application had been submitted, with plans to involve an Independent Mental Capacity Advocate if authorised.

Not all staff were trained to the levels of safeguarding as outlined by national best practice documents. In particular non-clinical staff who had contact with adults and children were trained to level 1. The Intercollegiate Document: Adult Safeguarding: Roles and Competencies for Health Care Staff (2018) set out that staff with regular contact with service users should be trained to a minimum of Level 2. This ensures they are able to recognise potential signs of abuse or neglect and take appropriate action, including escalation and referral.

The evidence showed a good standard. The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patient’s’s needs that was safe, supportive and enabled patients to do the things that mattered to them.

Patients we spoke to said their treatment had been explained to them and tests results and further treatment discussed, risks of procedures had been explained to them and discussions had been had about aftercare.

There was a standardised approach to assessing and recording each patient’s condition using nationally recognised tools. Patients received a comprehensive assessment on arrival, and this was updated dependent on their condition, needs and risk score. Examples included assessments of risk from deep vein thrombosis, pressure ulcers, nutrition and hydration, and falls.

Risk assessments aligned with national guidance. Documentation of appropriate escalation for deteriorating patients in response to raised National Early Warning Scores (NEWS2) showed generally high compliance (typically 90–100%), although some variation between areas remained.

Falls prevention standards were largely met, with most assessments and safety measures achieving over 90% compliance, however, daily review of bed rail assessments and alignment of care plans was lower in some areas, falling to around 70–85%. Action plans were in place where compliance was below target.

Patients and their families could raise concerns through Martha’s Rule. Martha’s Rule is a patient safety initiative in NHS hospitals in England that gives patients, families, and carers the right to request an urgent clinical review if they are worried that a patient’s condition is deteriorating and staff are not responding adequately. There was an outreach team that provided 24/7 cover in line with Martha’s Rule. The service was staffed by experienced professionals with experience in dementia care.

Staff we spoke with demonstrated awareness of Martha’s Rule and escalation processes. Staff said they would listen to concerns raised by families, provide reassurance where appropriate, and escalate concerns to the nurse in charge and medical team if required.

On Ward 20, patients requiring one-to-one care were appropriately identified through individual risk assessments and allocated enhanced supervision as needed. Staff told us that this approach contributed to a measurable reduction in patient falls. Despite the ongoing staffing gaps on the ward, there had been a sustained decrease in fall incidents, with only 2 falls reported during January 2026.

Staff could request additional support from a registered mental health nurse when a patient was identified as being at risk of harm. They were able to contact the mental health coordinator and had established links with the hospital’s mental health liaison team. There was a hospital‑wide approach to the management of deterioration, including processes to support patients who deteriorated out of hours.

The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care.

The service did not always have suitable facilities to meet the needs of patients’ and their families. The sluice rooms across several areas such as ward 20 had unrestricted access, as they were not fitted with locks or controlled swipe card entry systems. Control of Substances Hazardous to Health (COSHH) cupboards located within these rooms were left unlocked, with chlorine tablets accessible to unauthorised individuals. This created a risk that patients, including those who may be confused or vulnerable, could gain access and ingest hazardous substances, potentially resulting in harm. We raised these concerns with senior staff at the time of our visit. They informed us that immediate action would be taken to ensure access to sluice rooms and COSHH cupboards was appropriately restricted across the relevant areas.

The environment in wards 4 and 5 was cluttered with equipment. However, patient bays were free from obstructions and allowed safe movement around patient areas. We observed several computers on wheels positioned around the wards; these were stored safely and did not obstruct walkways or evacuation routes.

Clinical waste was disposed of safely. Staff conducted daily safety checks on specialist equipment, and cleaning records showed no gaps. We reviewed cleaning audit reports for several medical wards covering the period from December 2025 to January 2026. Compliance levels across the wards ranged from 97% to 100% across the areas audited.

Patients could reach call bells from their beds. Patients could access call bells in the toilets and wash areas if they needed assistance. During our inspection we observed staff attending to patients promptly when a call bell had sounded.

We observed on the respiratory ward that chest drain trolleys and non-invasive ventilation (NIV) equipment were stored appropriately in cupboards, along with NIV machines and related equipment. All items we checked were in date and ready for patient use.

Resuscitation trolleys were checked daily. We reviewed these checklists, and each had been completed appropriately. The resuscitation trolleys were correctly stocked, oxygen cylinders were full, suction machines and defibrillators were in working order.

The Same Day Emergency Care (SDEC) environment was shared with the Acute Medical Unit (AMU), which resulted in a busy and congested layout. We observed frequent movement of staff and equipment between clinical areas, and some equipment was stored in corridors. This increased the risk of obstruction and safe patient flow.

The 9‑bedded trolley area within SDEC was visibly clean at the time of our inspection. Staff told us that SDEC had only recently relocated into this area, and therefore the clinical environment was still being developed. The service had 3 monitored beds, 2 seated patient areas, and 3 clinic rooms, 1 of which was used for a dedicated deep vein thrombosis clinic. When SDEC was closed, the area was used to accommodate ED patients when required in response to operational demands to support ambulance off loads and the safety of the department. This provided additional capacity during periods of operational pressure and helped maintain patient flow and safety with the appropriate staffing resource allocated

Due to the recent move, there was limited fixed areas to support nursing staff, such as a dedicated nursing station. Staff also told us that essential equipment and furnishings were still being introduced to support safe and efficient working practices. The service was in the process of making further improvements to ensure the environment was fully fit for purpose for staff working in this area.

The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff.

The service did not always have enough nursing and support staff to keep patients safe. Whilst the service used nationally recognised staffing tools to calculate required staff, the number of nurses and healthcare assistants did not always match the planned numbers. We identified gaps in nurse staffing, with consistent shortages of both registered nurses and healthcare assistants across several areas we visited. These included AMU, Ward 20, Ward 3, and Ward 7. Staff reported that they were frequently moved to provide cover in other areas, even when their own wards were already operating with insufficient staffing levels.

Staff told us there was a recruitment freeze that had been implemented due to budgetary pressures. This had limited the service’s ability to replace vacant posts in a timely manner and had contributed to ongoing staffing shortages. Whilst the service used nationally recognised staffing tools to calculate required staff, the number of nurses and healthcare assistants did not always match the planned numbers.

Band 7 ward managers across multiple areas were acting as bleep holders for staffing 3 hospital sites, despite not having the authority to make autonomous decisions. This created additional pressure on senior staff and contributed to further instability in staffing arrangements.

We found that shift vacancies were being capped and required approval from an executive before being released to the staff bank. This process contributed to delays in filling staffing gaps. Ward managers were also expected to work clinically when shortages occurred, which placed additional pressure on their ability to fulfil their managerial responsibilities.

The trust had established and maintained chief nurse staffing principles for the 51 inpatient wards and paediatrics, which had been approved through the trust delivery group. These principles included a day shift registered nurse to patient ratio of 1:6, which exceeded national guidance, a minimum of 3 registered nurses on night duty, and band 6 nurse cover provided 24 hours a day through a phased implementation approach. Staffing compliance was monitored through a roster confirm and challenge process, and any unfilled shifts against the agreed templates were escalated and booked to bank in line with established trust processes.

At the time of our inspection, there were no gaps in Same Day Emergency Care (SDEC) staffing. Actual staffing levels within the service included 5 registered nurses and 1 healthcare assistant (HCA) at band 3. The service was overseen by a band 7 ward manager, supported by band 6 and band 5 registered nurses.

Within the 9‑bedded trolley area, including the 3 monitored beds, patient care was mainly provided by band 6 nurses, supported by band 5 nurses in the SDEC. Clinic areas were staffed by a band 6 nurse, supported by a band 5 nurse and an HCA. This staffing arrangement helped ensure appropriate skill mix across both the trolley and clinic areas.

A senior nurse on‑call service operated across both Derby and Burton sites, providing cover on weekdays between 5pm and 8pm and on weekends and bank holidays between 10.30am and 6pm. The nurse on call provided clinical leadership and oversight to support the safe and effective running of services, while senior nurses offered professional advice to operational teams to maintain patient safety and effective patient flow.

There was adequate 24-hour medical cover. Consultant cover was available overnight, and staff were able to request support from the on‑call consultant when required. Consultants worked in multi‑day blocks to support continuity of care. There was daily senior input to provide community advice to avoid unnecessary admissions and facilitate timely discharge.

Consultants reviewed their patients once a day, usually during the morning ward round. Doctors told us they were able to contact their consultants at any time if they had concerns about a patient. There was 7-day advanced healthcare professional cover in place to support discharge and maintain patient flow.

There was consultant-led oversight and consultant review within 24 hours of admission to a virtual ward. Virtual wards only covered the Staffordshire area, and doctors decided which patients were clinically well enough to be eligible for a virtual ward placement. Staff transferred clinical responsibility on step-down to a virtual ward from being a hospital inpatient.

From August 2025 to January 2026, medical staffing experienced notable fluctuation, with sickness reaching approximately 10% in November 2025 before declining to around 5–6% by January 2026. Nursing and midwifery sickness levels remained relatively stable at approximately 4–5%.

Mandatory training topics were in line with national guidance and training was delivered through e-learning modules with some face-to-face training. Completion rates for the medical care division was slightly below the trust target of 95% in several areas. Overall compliance for mandatory training for both nursing and medical staff was 91.8%.

The service had named education or practice development leads. Training and continued professional development was aligned with role-specific needs. For example, the service was managing a patient requiring non‑invasive ventilation (NIV) at the time of our inspection. Nurses working on the unit had attended NIV study days, ensuring they maintained the required competencies to deliver this level of care. A respiratory education sister was in post, providing specialist teaching and support across the site. Staff reported having access to a learning passport, in which all training and competencies were recorded and monitored.

We spoke with a member of staff who was completing a Health and Social Care learner placement. They told us they found working for the trust very helpful, and that staff were well supported to engage in continuous professional development.

The percentage of staff that had had an appraisal in the last 12 months was 88.1%. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

A physiotherapist was based on ward 20 and at the community hospital. They were responsible for ordering equipment and prioritising patients according to clinical need. The physiotherapist worked with a mixed caseload, including both patients living with stroke and those requiring general medical care.

The evidence showed a good standard. The service assessed and mostly managed the risk of infection. They detected and controlled the risk of it spreading.

Staff assessed and managed the risk of infection in line with current national guidance. Managers carried out infection prevention and control audits including for hand hygiene.

Staff received suitable training in infection prevention and control (IPC) through their induction and as part of their mandatory refresher training.

Staff maintained equipment well and kept it clean. Any ‘I am clean labels’ were visible and in date. A cleaning rota was in place and displayed on wards. The schedule was signed and dated, providing assurance that cleaning tasks were completed as planned. One housekeeping staff member was allocated to each ward.

Commodes stored in the sluice room of the short stay unit appeared visibly clean; however, none had ‘I am clean’ labels attached which was not in line with practice. This meant there was no assurance or documented evidence that they had been appropriately cleaned. We also found a used bedpan left on the worktop within the sluice room, which posed an infection prevention risk. We saw ‘I am clean labels’ used appropriately in all other clinical areas we visited.

There were systems in place to monitor IPC compliance across clinical areas we visited. Overall, IPC audit results demonstrated good levels of compliance, particularly in Ward 3, Ward 4 and Ward 6, which achieved consistently high scores with several indicators reaching 100%. This provided assurance that IPC practices were well embedded in these areas.

Staff adhered to infection control principles, including handwashing. Written IPC prompts were displayed at ward entrances. We saw posters reminding staff, patients, and visitors about the importance of hand hygiene.

We observed that personal protective equipment was used appropriately when delivering care in side rooms. Staff were seen cleaning equipment between uses to prevent cross-contamination and washing their hands after patient contact.

There were side rooms available on various wards for patients with communicable diseases or who required isolation. The side rooms were of adequate size to safely accommodate patients and support isolation requirements. SDEC did not have side rooms and therefore could not accept patients requiring isolation.

Between October 2025 and January 2026, there was a seasonal increase in respiratory illnesses as winter approached, with flu cases highest at around 55 patients in hospital each day, RSV affecting about 20–25 patients, and COVID‑19 staying below 20 before all began to fall in January; the Trust used this information to plan how to keep patients safe by isolating those with infections, grouping similar cases together, and making changes to reduce the spread of illness.

The evidence showed shortfalls. The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were not always stored safely and securely. Medicines were stored in treatment rooms and had instructions about safe temperature levels for storage. Some of these rooms had reached or surpassed maximum room temperatures and actions had not been taken to escalate this as per local policy. This put patients at risk of receiving medicines that were no longer safe to use.

On one ward, medicines storage was not secure, as cupboards and trolleys could not be locked despite escalation by the ward, leaving medicines at risk of unauthorised access. Additionally, a medicines fridge recorded repeated temperature breaches above safe limits and used a keypad for access, which was not in line with trust policy.

A patient was on a Percutaneous Endoscopic Gastrostomy feeding tube, but an incorrect medication route had been prescribed. The medicines were wrongly written down as if to be taken orally, instead of by the feeding tube, creating a choking risk. Formulations of medicines were not suitable for use by feeding tube. Information to support staff with medicines administration by this route was not always documented in full, which could risk medicines being given unsafely or the tube becoming blocked. This issue was identified and escalated by the inspection team for immediate review.

We noted insulin administration for 1 patient was recorded as overdue. However, staff explained this was a clinical decision following a hypoglycaemic (low blood glucose) episode, and insulin was appropriately withheld. This decision was not clearly documented at the time. The lack of accurate documentation posed a risk to continuity of care and reduced the ability to monitor clinical decision making effectively.

Audits did not always highlight the risks we found. We reviewed the last 3 controlled drug audits prior to inspection which demonstrates 100% compliance for some controlled drug standards including secure storage of controlled drugs and appropriate CD key management. However, the last 3 audits of general medicines storage did not always highlight the risks we found. Standards were shown to be 90 - 100% for management of general medicines keys, fridge temperature monitoring and locked treatment rooms. Some variation was identified in general medicines storage, where not all stock cupboards were locked when not in use, and this was addressed through local action.

We found clear pharmacist support in several areas. Pharmacy teams used tools to prioritise new patients and checked medicines carefully. This helped improve oversight during admission and transfer. It also supported safer prescribing and use of medicines.

Medication charts were correctly completed and maintained electronically, with red flag alerts for overdue medicines. Patient weight and allergy status were recorded, and identification was used for patients with allergies. Antibiotic indications were documented on electronic prescription records, but disease severity was not always clear to see. We identified an instance when an antibiotic was prescribed against the advice of the antimicrobial policy and at the time, no rationale for this had been documented.

Pharmacy teams provided good support on wards, including managing stock and checking medicines. They prioritised patients on the admissions unit to ensure medicines were reviewed, even out of hours, and paid close attention to critical medicines. Staff also identified patients who could be referred to community pharmacies after discharge to support their ongoing medicine needs.

Controlled drugs were stored securely and record-keeping was accurate, with processes in place to report any discrepancies. Trolleys used to store resuscitation equipment were checked daily and medicines were kept securely and in date.

FP10 prescriptions (standard official paper form used to prescribe medications by NHS) were kept in admission areas to support discharge, with processes in place to maintain security and keep records to monitor usage. However, prescription records were missing in 2 areas we inspected. We asked staff to escalate to ensure they could appropriately investigate to ensure they were appropriately used.

Venous thromboembolism risk assessment outcomes and prescribing were completed on all patient records that we reviewed. The discharge unit had a dedicated pharmacy team to support safe and effective discharge processing for medicines. Staff had processes in place for patients who could remain in this unit for longer than 24 hours and regular meetings to support discharge. We were informed of work that had been done by the unit to reduce use of taxis to transport medicines and ensure medicines were available at the point of discharge, but we were told that delays could happen when patients required monitored dosage systems for their medicines as these were dispensed off-site.