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 looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last inspection we rated this key question requires improvement. At this inspection the rating stayed as requires improvement.

There were not always enough skilled staff to deliver safe care that promoted patients’ wellbeing. Pathways out of the department were not always robust and resulted in delays to treatment. Medicines were not always stored safely.

However, safety was generally a priority for everyone and when people raised concerns about safety the primary response was to learn and improve. Patients were safeguarded from abuse. The environment was suitable although too small for the number of patients. Staff followed infection prevention procedures.

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 service had a proactive and positive culture of safety, based on openness and honesty. Managers listened to concerns about safety and investigated safety events. Staff learned from incidents to continually identify and embed good practice.

All staff, including those who had been newly recruited knew how to report incidents and had been given training.

Staff recorded incidents on an electronic incident logging, tracking and reporting system and all staff were trained in its use. Managers used the NHSE patient safety incident response framework (PSIRF) to investigate and analyse incidents. If necessary, changes were made.

Managers ensured staff had debriefs following incidents and these were used to reflect on what had happened, both good and bad and how it could have been better. If needed staff were given support and time to reflect. Learning from incidents was fed back to staff through meeting notes. Managers shared learning with staff following patients’ complaints and trust wide meetings such as the mortality and morbidity meetings that took place. These are peer review meetings to discuss patient outcomes, including deaths and complications to identify learning and good practice. However, staff meetings where learning should also have been fed back had not happened for some months due to how busy the ED was. This meant these opportunities for learning were missed. To mitigate this, we were told information was put on the back of toilet doors for staff to read.

Many staff were able to give us examples of recent serious incidents and how changes had been implemented. Staff also told us they received emails about things that had gone well to reinforce good practice.

The duty of candour (DoC) regulation requires providers to recognise what are classified as “notifiable patient safety incidents”. These are when things that have gone wrong reach a certain threshold of harm. When this happens patients, and if necessary, other persons must be told what happened, receive an apology and be kept informed of any safety investigation.

Staff and managers knew about the DoC and could describe their individual role as staff had been trained in the DoC. We saw evidence of the DoC being correctly applied through recent reports and correspondence with patients and their families.

Patients were not always able to easily access the next stage of their healthcare or discharge needs often due to capacity issues in the wider system healthcare system and the hospital outside of the emergency department. The service worked with people and healthcare partners to make patient pathways as safe as possible. Staff made sure there was continuity of care, including when people moved between different services. However, because of the capacity issues outside of the department, these arrangements were not always fully effective.

Patients either self-presented to the department as “walk-ins”, came by ambulance, or were referred by another service such as 111 or their GP.

Pathways out of the department were varied. Amongst other options patients could be sent home, admitted to the hospital, transferred to another hospital or referred to another provider. There were pathways to admit patients into other departments and wards, known as the hospital’s “bed base”, and this involved decision making as to the appropriate speciality with input from that speciality. These were based on standard operating procedures (SOP), and there were performance expectations set out in internal professional standards (IPS).

Patients did not always get sent in a timely manner to the place which was optimal for them. Because of the demand on the department, and the inability for the hospital and other health and adult social care providers to take patients, discharge pathways could not always operate effectively.

This particularly affected patients needing mental health referrals and lack of available mental health beds in other providers meant that patients presenting with severe mental health symptoms did not always get onward support or treatment quickly enough. Senior managers told us there were often different experiences for transferring or arranging support for mental health patients depending on in which county they resided. They said there was a lot of “red tape” trying to understand which commissioning organisation was responsible for a particular patient depending on where they lived and where their GP was located, and this both delayed their treatment and kept them for too long in the department.

However, staff did assess patients for any mental health needs as part of triage processes. If needed, staff referred patients to a team from the local NHS mental health provider which was available 24 hours a day. Many staff told us this team was responsive and worked well with them. Similarly, staff from the mental health trust were complimentary of the department’s mental health triage processes. However, on some occasions, staff felt the response was not quick enough when a patient was severely injured or very ill.

The hospital had agreed standards that required specialist teams to assess patients and arrange admission promptly. Staff said they generally worked well with these teams. However, some specialist teams were not always able to meet the agreed standards. As a result, some patients spent a long time in the Emergency Department after referral and assessment.

Staff, managers and ambulance crews told us that sometimes, due to the number of patients that arrived by ambulance, it was not always possible to ‘offload’ patients immediately. While this meant some sick and frail patients had to wait on the back of an ambulance until there was space in the department, the department used a recognised risk assessment tool to clinically assess and prioritise those patients.

Children referred by GPs were sent directly to the Paediatric Assessment Unit (PAU) which was open from 9:30am until 10pm 7 days a week. Out of those hours, patients were then directed to the ED at Queen’s Hospital Burton or the Children’s Emergency Department at the Derby Royal Hospital. Children who self-presented to the department were referred to the most appropriate area including PAU, the UTC or primary care centre both of which were within the ED. To support this there was in-reach cover by 2 paediatric nurses from 09:30am until 10pm. Children who were considered a risk to themselves or others would be risk assessed and if necessary, cared for in the main ED with the support of appropriately trained professionals.

The service had a permanent ambulance divert in place. This meant ambulances took most children and young people to the Children’s Emergency Department at the Royal Derby Hospital. The exception to this was for children in cardiac arrest or peri-arrest and these would be cared for in the paediatric resuscitation bay located in the majors area of the department.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately, however mandatory training for children’s safeguarding did not meet national guidance.

Not all staff were trained to the level recommended by national guidance. In addition, not all staff groups were compliant with the trust target around safeguarding training, particularly medical staff. Not all staff were trained to the levels of safeguarding as outlined by national best practice documents. In particular, nonclinical staff who had contact with adults and children were only trained to level 1. The document, “Safeguarding children and young people & children and young people in care, Competencies for health care staff Intercollegiate document (2025)” state these staff should be trained to level 2. However, all newly recruited staff completed safeguarding training.

Staff were aware of the department’s and trust’s safeguarding processes and could talk confidently about how to recognise abuse and what to do. Many staff gave recent examples of either having made a safeguarding referral themselves or being aware of a safeguarding referral having been made on their shift.

All patients were assessed for safeguarding needs while in the department. By the interceptor/navigators for self-presenting patients and by the staff in pitstop for patients arriving by ambulance. We were sent a record review for 41 patients who had stayed in the department, and we noted that all had been assessed as to whether they needed a safeguarding review.

Safeguarding information was recorded on the Electronic Patient Record (EPR) and if appropriate raised a warning flag for subsequent presentations.

Staff completed Mental Capacity Act (MCA) 2005 training, which included the Deprivation of Liberty Safeguards (DoLS), and this supported the staff in safeguarding decisions.

Staff completed mental capacity assessments using a “mental health act toolkit”. This was a site-specific document and was to be replaced by the one used on the Derby site later in the year which the staff to whom we spoke, considered much better.

Because of workload and crowding, staff did not always identify patients at risk and so treatment was not always started in a timely manner. However, staff worked with patients to understand and manage risks by thinking holistically. Staff mostly provided care to meet patients’ needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff worked to assess risk quickly so they could direct patients to the safest area of ED. Self presenting patients, in other words those who arrived by their own means rather than by ambulance, were initially seen by a receptionist who would take their details and direct them to sit in either the adult or the children’s waiting area.

They were then seen by a nurse known as an “interceptor/navigator” who assessed them using an established triage tool. As well as their clinical presentation, patients were also assessed as to their mental capacity, pain, and any time-critical medicines they needed.

The interceptor/navigators’ desks were located close to the reception desk so they could see the patients queuing and listen to their conversations with the receptionist and thus “intercept” any patient whose condition caused immediate concern. In one instance while we were observing the waiting room a patient walked in with a significant injury and they were seen by the nurse immediately.

Senior medical staff told us the introduction of this system had reduced the risk of not recognising deteriorating patients in the waiting area. However, some nurses who carried out the role said when the waiting room was crowded it was difficult to be assured of the safety of all patients, especially when some chose to wait outside of the waiting room. This meant staff could not always see all patients who may be waiting a long time and start to deteriorate in their health.

If patients left the department without being seen or treated there was a safety netting procedure where their notes were reviewed and, if possible, contact was made by telephone to ensure they were safe.

We saw staff made an effort to find patients when it was their turn to be assessed. For example, on one occasion staff went to find a patient who had not replied to their name being called. Staff found the patient elsewhere in the department.

Staff also said they worried about the time to triage patients and ambulance offload times when the department was busy. Senior staff told us they had addressed concerns about safety by getting patients to see a clinician as early as possible. While average triage times were 33 minutes, the introduction of the interceptor/navigator role meant patients saw a clinician much earlier than this.

Staff in the nearby primary care centre worked with the ED staff if they had any patients that became seriously ill or collapsed. An alarm was triggered that alerted the main ED area who would send a team directly there, as happened in the rest of the ED rather than alert the hospital’s general emergency response team.

The department was relatively small, and we saw it could become busy quickly. There were processes to deal with this, including the opening of escalation spaces and the rapid decanting of patients out of the department into assessment units or wards. We saw when the 3 resuscitation beds were filled, and one of those patients was very poorly, there were arrangements for staff from the trust’s resuscitation team to support the department. However, staff told us this situation was one of their biggest worries.

Safety “huddles” took place every 3 hours. These were multi-disciplinary discussions involving nurses, doctors and managers where risks affecting the department and individual patients were discussed and plans drawn up. For more significant concerns there were “stop moments” where managers, site practitioners and consultants came together to formulate a plan.

When we asked nursing staff about their greatest worry, they often said that it was what would happen when the department was busy, all the resuscitation beds were full, and a very sick patient arrived. However, the Trust escalation policy allowed for the immediate offload of these category 1 cases and movements of others between cubicles and escalation spaces.

Most patients told us they had been kept informed during their stay in the department and this enabled them to be involved in planning their care.

Staff asked about allergies to medicines, and because of the time often spent in the department these questions also addressed food allergies.

There was a recognition that for many patients, their stay in the department was much longer than should be the case. To mitigate the risks associated with this there was a long stay checklist which was triggered and brought to staff’s attention, when the patient had spent 6 hours in the department. Among other things this ensured the patient was made aware of the circumstances, they got regular as well as time critical medicines, they had skin integrity assessments, were moved from a trolley to a hospital bed and, if indicated, they got deep vein thrombosis (DVT) prophylaxis. When we reviewed patient notes, we saw this was done.

Staff from other areas of the hospital supported ED to assess patients. For example, there was an initiative to place a senior doctor from internal medicine into the ED during weekdays over the winter months to support those patients waiting for admission into medical beds. This was to reduce risk as those patients would have their management provided by a more appropriate physician who would keep them under review, prescribe medicines and ensure their plan was followed

We saw staff using nationally recognised tools to help monitor risk. For example, they used the National Early Warning Score (NEWS2) for adult patients in the ED, the Paediatric Early Warning Score (PEWS) for children and young people, and the Modified Early Obstetric Warning Score (MEOWS) for pregnant and postpartum women. Staff assessed the risk of falls for patients who had been in the department for a long time. The warning scores were easy to see on the patients’ records and alerts were generated by the system for those patients whose scores gave concern. We were sent a record review for 41 patients who had stayed for a time in the department, and we noted that for almost every patient, their observations had been carried out at the times required. This aligned with our own examination of patients notes where we saw that observations were carried out for adults and also for a child.

Alongside the regular observation staff completed TRIPP assessment which stood for toilet, refreshments, information, reposition and pain. This was a formal process which was recorded as part of the patient’s notes. When we looked at a record review for 41 patients who had stayed for a time in the department, we saw that while all had numerous TRIPP assessments recorded, only around 30% had them hourly as required. We also noted that while every patient had their pain assessed and recorded on admission only around 60% had a record of pain reassessment during their stay.

Staff used a falls risk assessment to protect patients in the ED without delaying assessment or treatment. Previously this would not have been done until admitted patients reached a ward. However, learning from incidents had identified a need to complete these in ED due to patients spending longer there. Audits showed this had reduced the number of falls in the ED.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was an ambulance entrance that led directly to 3 suitably equipped resuscitation bays. 1 of these bays had the appropriate equipment to care for a child and there was a separate dedicated paediatric resuscitation bay in the majors area. Other patients brought in by ambulance went into a “pitstop” area where they were assessed and moved on to the most appropriate place in the department. The majors area consisted of 22 cubicles with 7 monitored beds, a 6 bedded pitstop with 3 monitored beds, 3 resus beds, 4 treatment rooms and 9 UTC cubicles. Staff told us that the number of monitored bays was sufficient as there was portable monitoring to be brought in as necessary.

The design of the ED was largely in line with national standards. The department had a single entrance for self-presenting patients attending the main ED which led to the main waiting room in which there was a reception desk. There was no separate entrance for children.

The waiting room had been recently upgraded to provide a separate children’s area with a toilet, a feeding room and a dedicated children’s triage room. However, both the main waiting room and the children’s area were small and quickly became crowded when the department experienced a surge of patients.

Because of the physical layout of the hospital, which was built into the side of a hill, the ED had the main hospital to the rear and the ambulance bays to the front with a drop below onto a car park and other buildings. This meant it was not possible to expand the footprint of the ED and senior managers told us the ED estate was effectively “maxed out”. Although recent changes to the ED increased capacity, the benefits were limited because the space simply filled up.

There was a separate entrance which led into the UTC and the Primary Care Centre. This was marked as the “Green Entrance” so patients sent there by their GP could find it without going to the main waiting room and reception.

The SDEC was open from 8am to 10pm. SDEC had bays for 9 trolleys and 9 seated bays. Staff told us there was sufficient monitoring equipment for their needs.

There was a mental health room which met national guidance and could accommodate one patient. However, because there was frequently more than one patient needing this facility in the department it meant sometimes patients were accommodated under supervision in normal cubicles. This was not ideal for the patient.

There were adjacent facilities for diagnostic imaging and aside from plain x-ray there was computerised tomography (CT) and magnetic resonance imaging (MRI). The CT was available at all times and the MRI from 9am to 5pm, Monday to Friday. Nursing staff told us there was not usually a problem accessing imaging for their patients and emergencies were always accommodated. However, senior medical staff said that at times of peak demand in the ED assessment and treatment times could be delayed because of inpatient demand for the imaging services and this was an issue we noted as being recorded on the department’s risk register.

There was a decontamination cabin outside of the main building which was well signposted for any patients self-presenting following a major incident. There were designated and signposted pathways from the decontamination facility to the main building. The decontamination cabin was suitably equipped with a shower and personal protective equipment (PPE). Action cards and other supporting documents were located in the decontamination cabin, and these directed the establishment of a bronze command in the ED with silver or gold commands in the operations room. The processes were compatible with the two NHS ambulance services that brought patients to the ED.

We noted behind the nursing station in the majors area the door to the sluice was unlocked and wedged open. This area contained readily accessible chemicals and while a patient would have to walk behind the nursing station to access them, it represented a risk.

The service did not make sure there were enough qualified, skilled, and experienced staff on duty to safely care for patients. On many shifts the staffing was significantly below what was planned. However, there was mitigation through the deployment of other staff. Staff did receive effective support, supervision, and development, although there were shortfalls in mandatory training for medical staff. Staff worked together well to provide safe care that met people’s individual needs.

There were not enough nursing or healthcare assistant staff to keep patients safe. Managers calculated the number of nursing staff needed based on national guidance. However, over a period of 84 days, the ED almost never had the number of nurses it was planned to have. The full planned number of registered nurses was only available on one day. On many days there were significantly fewer nurses than expected, with staffing dropping below 80% of the planned level on 32 days. Healthcare assistant staffing was slightly better, but it was still often below the expected level. While staffing was close to the planned level on 46 days, there were still 30 days when fewer than 80% of the required healthcare assistants were available. Overall, this meant the department was regularly understaffed, particularly when it came to registered nurses. To mitigate staff were transferred from other areas, and there was support from managers and clinical educators. However, this meant that those supernumerary staff were not able to carry out their own planned duties during that shift.

Nurse staffing at night was better, but did not always provide adequate cover. During night shifts, there were some occasions when more registered nurses were on duty than the planned staffing levels required. Staffing levels for registered nurses reached at least 90% of the planned level on 46 nights, although there were still 30 occasions when staffing fell below 80% of what was expected. Healthcare assistant staffing was generally much better, with planned staffing levels usually being met, and there was only one occasion when staffing dropped below 80% of the required level.

In all our conversations with nursing staff, at all grades, there was a constant theme of concern that staffing levels in the department were not adequate for the number of patients that came through the doors, and it did not feel safe. We were told it felt particularly worrying at night and that influenced staff morale with them being anxious about doing night shifts. Staff told us this had been raised but they had been told by board level managers that no harm to patients had been identified in the ED because of staffing and we saw this recorded in the notes of governance meetings.

The department was staffed below the planned establishment by 25 registered nurses and 8 healthcare support workers. This situation had not been resolved because of a trust wide recruitment “freeze” that meant the posts could not be advertised. At the time of our inspection the freeze had just been lifted, and managers were making plans to recruit new staff. However, because this was a large number to recruit at one time, the recruitment was to be staggered to allow new staff to be inducted and mentored with minimum disruption.

There was mostly sufficient medical cover in the main ED to keep patients safe. Consultants were present in the main department from 8am to 10pm each day with on call cover outside of those times. The consultant doing the day shift provided out of hours cover. However, nursing staff told us the lack of consultant presence in SDEC meant some clinical decisions were delayed, despite sufficient staff in terms of nurses and lower grade doctors. Senior medical staff told us when they came on shift, the concerns in their mind would be whether there was staff sickness and, linked with this, whether there would be sufficient resident grade doctors on duty.

There was an effective system in place to manage the medical staff rota, and we saw copies of recent rotas that demonstrated that any gaps in cover were managed. However, there was a shortfall in the numbers of middle grade staff, and it was noted in the business unit risk register that there were difficulties in recruiting substantive middle grade doctors and locum doctors were being used. While there was an initiative to make the roles more attractive, this was against a background of a national shortage of such doctors.

There was a paediatric emergency medicine (PEM) consultant who had dedicated time allocated to paediatric emergency care. There were 2 children’s inreach nurses rostered in the department from 9:30am to 10pm but staff told us this was not often achieved because of sickness. Outside of these times there was always a band 7 nurse with advanced children’s life support training and all staff in the ambulance pitstop area were trained in children’s life support. This did not meet the Royal College of Paediatrics and Child Health (RCPCH) standards that required there to always be 2 trained children’s nurses in an emergency department that treats children. However, there were always clinical staff on duty with the necessary paediatric competences for the safe immediate assessment and management of critically ill and injured children and young people and out of the hours where the inreach nurses were present in the department, there were arrangements for support by children’s nurses from the children’s ward.

Not all staff were up to date with mandatory training. Overall completion rates for individual modules across all staff groups did not meet the trust target of 95% except for the infection prevention and control level 1 and safeguarding level 1 which were courses for administrative and other non-clinical staff.

Staff were given time for their continuous professional development as well as their mandatory training.

Within the different staff groups there was a clear trend that non-nursing and other professional staff groups were almost always exceeding the trust target, nursing staff groups were meeting the target, and medical staff groups were falling short of the target with scores around 70%. We saw this shortfall was noted and discussed in the departmental governance meetings and action was being taken. These completion levels for medical staff were described in the business unit risk register as being “considerably low”. There was a specific risk noted in the risk register, of the senior medical bleep holders having out of date advanced life support or children’s life support qualifications.

Managers ensured some staff were able to complete training for professional development and to increase competency levels. We saw considerable variation in completion rates, and staff having outstanding training needs. However, this did not necessarily represent a safety concern as staff might not be carrying out those procedures or tasks.

Staff were scheduled to receive regular appraisals and to have 1 to 1 supervision meetings with their managers every other month. Staff appraisal rates for the acute medicine were difficult to understand from the information sent by the trust in response to our information request but appeared low, at between 70 to 90%. However, the most recent staff survey response showed staff did generally have appraisals and staff felt supported in their career progression. All medical staff were in date with their General Medical Council (GMC) validation.

There were nurse educators in the ED and nursing staff told us they were supported by the nurse educators when their mandatory training was due. We were also told the educators were “very active” and they were essential for the support of new staff coming into the department.

We saw themed education boards in the department. One current themed board was a comprehensive overview of pressure area care and had been done in response to the increased risk of pressure sores because patients were spending longer in the department.

Managers gave newly recruited staff 6 weeks of supernumerary status as part of an induction process. They had a learning passport in place, alongside a well-structured training and induction programme, and were assigned a mentor for support.

The service mostly assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service mostly managed the risk of infection well. However, we saw some areas that required improvement. Overall, the department was clean and tidy. Furnishings, including seating were made from suitable materials and we saw domestic staff cleaning during the day. However, as the day progressed, those areas that were crowded with patients became untidy and were sometimes littered with food packaging and other waste despite there being wastebins provided. Staff kept toilets and commodes clean.

Staff told us they had access to PPE when needed and we saw them using gloves and aprons appropriately.

Staff followed the trust’s uniform policy. There was no jewellery, they were bare below the elbow when interacting with patients, there were no false nails and hair was off the collar. Staff looked notably smart and professional.

We observed staff washing their hands and taking other hand hygiene precautions. However, the department had introduced an interceptor/navigator role and the area used was a short corridor in a corner at the end of the waiting room. There were no sinks here and instead staff made use of hand gel instead of handwashing which is less effective.

Staff carried out procedures to protect patients who were particularly vulnerable to infection through reverse barrier nursing techniques. When this was needed the room was labelled and a trolley of equipment was placed outside. During our inspection visit one such patient was being nursed in this manner, and we saw staff adhered to the infection prevention and control measures.

While we saw most staff disposing of sharps correctly, including the use of mobile sharps bins. However, on one day, next to the sluice was a sharps bin that was overflowing with consumable items that included lines contaminated with blood. The bin was overflowing to the extent it had been used by several members of staff with it in that state without the matter being addressed. We pointed this out to the nurse in charge who arranged for it to be emptied and the door to be closed.

Managers did not always complete infection prevention and control audits. For example, we requested data to show the results of the audits. Data was missing for November 2025 and January 2026. For December 2025, the trust sent limited data which showed a compliance rate of 94%. This meant we were not assured leaders monitored IPC enough to keep patients safe.

Not all staff received training in infection prevention and control through their induction and as part of their mandatory refresher training. Overall compliance figures showed 92% completion against the trust target of 95%. However more detailed figures revealed that within the different staff groups, medical staff were falling short of the target with aggregated scores for the different grades of around 60%.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Staff did not follow a set process for storing medical gases such as oxygen. However, we found a full oxygen tank stored with empty ones due to be collected. We also found an empty tank in a resuscitation bay which had been marked as prepared and ready for the next patient. When we pointed this out it was immediately changed and did not pose an immediate risk to patients as there was another in the bay, and all bays had piped oxygen outlets. However, it did raise concern there was not a process for dealing with oxygen tank replacement and staff confirmed this was the case.

There was no regular pharmacy presence in these areas, which is recommended by national guidance from Royal College of Emergency Medicine (RCEM). Staff could still follow a set process to get medicines and clinical advice when the pharmacist was not on site. A clinical pharmacist was available by phone (“bleep system”) every day to give advice across the ED.

We saw staff used the same electronic systems throughout the patient journey. This helped everyone share patient information more accurately and quickly. However, we identified a patient who was admitted through the ED and later transferred to a short stay ward. Although the patient's regular critical medicines were clearly documented in their records and this information was handed over during the transfer, the medicines were not prescribed on admission to the ward. As a result, doses of these critical medicines were omitted.

We found when a patient needed a medicine that was not on the trust’s approved list (the formulary), staff did not always give an alternative or record the reason for not giving it on the medication chart. This increased the risk that medicines could be accidentally missed, especially when patients were discharged.

Staff did not always store medicines safely. Some cupboards contained expired medicines, and medicines that have a reduced expiry when opened were not consistently labelled with their date of opening to ensure they were used appropriately. Staff did not always store or correctly complete prescription pads (FP10s) or their records. Staff did not report discrepancies within the prescription pads as required. Staff did not always correctly complete the records for checking controlled drugs (CDs). In one inspected area, medicines trolleys were locked but not fixed securely to the wall, as written in the trust policy.

We also found problems with safety checks on resuscitation (resus) trolleys. Staff did not always complete emergency medicines expiry checks every day, even though the trust policy required it. Although some checks were being done, we found an empty oxygen tank on one resus trolley, despite both an audit and daily check being completed on the same day.

Staff were monitoring medicine storage temperatures, but they were not always acting on problems when temperatures went outside the safe range. Medicines fridges are required to maintain temperatures between 2°C and 8°C. The monitoring form only highlighted fridge temperatures above 9°C, which meant staff missed temperature issues between 8°C and 9°C.

Staff did not consistently record when they used liquid thickener products for patients who had swallowing difficulties. This can reduce assurance for other people involved in their care that this has been used safely, and prevents people knowing it has been given if an issue were to arise later. For patients receiving medicines via enteral feeding routes, information on administering medicines safely was not always available, including how crush or disperse some medicines.

Staff mostly gave time critical medicines on time. All patients were asked about time critical medicines as part of their initial assessment by the nurse interceptor/navigators. This was recorded on the EPR system and reminders were set when the medicines were due. It was not possible to close this part of the assessment unless the critical medicine question had been answered and if appropriate, the medicine prescribed. If a time critical medicine was missed the patient’s record was “red flagged” to draw it to the attention of staff. We were sent a record review for patients who had stayed for a long time in the department. Of these 8 needed time critical medicines to be prescribed and of them 7 got it in a timely fashion.