St Peter's Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Our rating for this key question remains good. We found staff involved people in decisions about their care and treatment and provided them advice and support.

Patients and relatives told us they had explanations and their questions answered by staff before any procedure. We saw instances where patients were asked for their verbal consent before taking observations and we observed occasions where staff were effectively communicating with relatives and patients about care or treatment options.

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.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Clinical staff and leaders were able to give examples of how they involved patients and their relatives assessment of their needs, including communication support.

People’ needs were reviewed using a range of assessment tools and we saw examples such as sepsis screening and management in line with national guidance. The division participated in clinical audit programmes to help to support and monitor implementation of guidance and treatment pathways.

Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. However, nutritional records were not always completed correctly.

Policies and processes guided staff to ensure patients were comfortable and ready to have their meals at a protected time. Staff had identified patients who needed assistance with eating their meals and processes were ongoing to support this.

Malnutrition risk assessments and fluid balance audits were completed on each medical ward. Some medical wards did not complete the required patient records in line with trust policy. While audits had been completed, actions had not been fully taken to improve standards.

The needs of carers for people using the medical service were assessed and met. This supported the patients and carers health and wellbeing. For patients in need of extra assistance, families and carers were encouraged to come in to help. The trust raised awareness of mental health by signposting families and carers to sources of practical help.

People’s ability to get relief from pain was supported by staff using tools to assess their pain levels without the need for the person to be able to communicate that need directly. This helped staff ensure that effective and timely pain relief could be given if needed.

The hospital had a secure online platform, which enabled users to view their hospital appointments and other information from their hospital record.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients and their relatives gave some examples which indicated a limited understanding of how multidisciplinary teams, services and organisations were involved in planning, delivering and reviewing care and treatment. We concluded this was not unusual given the acute care environment we were assessing.

Clinical staff were able to give examples of how multidisciplinary teams, services and organisations were involved in planning, delivering and reviewing care and treatment. We saw specialist practitioners visiting and interacting with patients during our assessment.

The division participated in clinical audit programmes to help to support and monitor implementation of treatment pathways across specialist teams involved in acute medical care.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care.

There was a discharge team who had links with local services, local authorities, and care providers. The hospital had capacity and flow problems due to the high number of patients with no care package immediately available, for discharge to be carried out safely. The division monitored the number of delayed discharges and reviewed how to manage these effectively.

Patients and relatives told us in positive terms about the explanations they had and how their questions were resolved: “staff clearly tried to do this and give attention to individual patients needs as much as possible”.

We observed occasions where staff were effectively communicating with relatives and patients about care plans, including one example where staff were explaining how to manage own medication on discharge for the hospital.

We saw a wide range of health promotion and advice posters and leaflets on display in ward corridors and other public areas, including signposting to local resources and support groups.

Staff signposted us to a wide range of health promotion and advice posters and leaflets on display in ward corridors and other public areas, including signposting to local resources and support groups.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients and relatives told us they had explanations and their questions answered by staff before any procedure. We saw instances where patients were asked for their verbal consent before taking observations and we observed occasions where staff were effectively communicating with relatives and patients about care or treatment options.

All Deprivation of Liberty Safeguards (DoLS) applications received were logged on a central spreadsheet that enabled the trust to monitor applications. There was a divisional spreadsheet available to the senior nursing team. This meant patients in each ward or unit were identifiable.

Copies of DoLS applications were stored in shared drives allocated to the division. These were password-protected. We noted that not all DoLS, mental capacity act (MCA) and best interest forms had been completed in line with policy and guidance prior to submission.

The trust had adopted the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) document. The policy stated this document should be completed for all patients within a maximum time of 24 hours after admission. However, following documentation audits, this was found not to be the case. Within a 6-month period, 12% of patients had died without a ReSPECT form in place. The medical division was currently reviewing dashboard information and ReSPECT audits to review the data and implement learning and actions.