Pilgrim 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

We rated safe as good. We assessed 4 quality statements. The service worked with people to understand what being safe means to them as well as with their partners on the best way to achieve this. The service detected and controlled potential risks in the care environment. They made sure that the equipment, facilities and technology supported the delivery of safe care. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared any concerns with appropriate agencies promptly.

However, the service did not always work with people and partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured.

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.

We did not look at Learning culture during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

People’s information and support needs were effectively communicated to other care services and health professionals. This meant people would receive the care and support in line with their medical and nursing needs.

However, there were times of extreme pressure on the service, which often led to delays in people being admitted to the wards or being discharged from hospital.

People told us that communication between staff was sometimes lacking in consistency, which meant that one staff member would advise of one issue and another staff member would advise differently. This led to confusion for patients and relatives. For example, when moving wards or arranging discharge plans.

Staff worked with health and social care partners to establish and maintain safe systems of treatment, nursing care, discharge planning and care after leaving hospital.

Staff we spoke with told us the number of people in accident and emergency waiting to be admitted to hospital had added significant pressure on the service and other local health and social care agencies.

This had resulted in ongoing pressure within the medicine department. Staff we spoke with explained how in times of pressure and increased patient capacity a policy was invoked to help maintain patient movement from the emergency department and through the hospital.

Staff told us patients were risk assessed prior to being moved into temporary escalation spaces. For example, an equipped day room area on ward 5a.

There were systems and processes in place to safely move patients through the hospital and onto medical or speciality wards. Medical consultants were available to ensure patients arrived on outlying surgical wards with an active plan of care. However, staff on ward 5b told us this was often bypassed, and the ward would take medical admissions directly from accident and emergency.

Care needs and basic tests could be actioned on the ward. However, if any further treatment was needed the staff had to contact the relevant medical team as there was no cross-cover arrangements with the surgical team. This had the potential to delay care and treatment.

The hospital had a discharge lounge for patients who were medically fit for discharge and were experiencing delays. For example, delays in setting up a care package for people when they returned home.

To ensure the safety of patients there was a clear set of inclusion / exclusion criteria for the discharge lounge.

The person had to be medically fit for discharge and have a confirmed discharge plan in place. However, staff we spoke with told us that this criterion was often not followed. A recent example was shared with us which had resulted in a vulnerable patient requiring support from the social work team. This delayed the discharge and would have been potentially managed better in a ward setting. Other delays to timely discharges were related to patient transport services delays and residential or nursing homes with specific cut off times for new or complex admissions being discharged to them.

Staff we spoke with identified the key points within the safeguarding policy and how to recognise and respond to safeguarding cases and concerns.

The trust had safeguarding policies in place for both adults and children. Staff understood how to protect people from abuse and the service worked well with other agencies to do so.

Staff we spoke with understood how to identify any concerns about harassment and discrimination and were able to describe the process of escalation. Staff we spoke with were confident in using whistleblowing processes if they felt concerns were not being responded to.

Staff received mandatory safeguarding training specific for their role on how to recognise and report abuse. This also included training on equality, diversity, and human rights, mental capacity, and deprivation of liberty safeguards.

Staff had a good understanding of safeguarding and understood their responsibilities and actions required in identifying patients at risk of deterioration, harm and abuse, and associated reporting.

The service had processes in place with other agencies to share and report relevant safeguarding information.

At the time of our assessment safeguarding adults training was 96% and safeguarding children training was 95%, against the trust target of 90%.

We did not look at Involving people to manage risks during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

Staff we spoke with told us they worked with people to ensure they had the right equipment to safely care for them and maximise their abilities and maintain their independence. For example, the occupational therapy and physiotherapy teams would work with people to increase their independence before being discharged from hospital into the community.

The onsite social workers would then assess people’s needs when they were medically fit for discharge and evaluate them for the appropriate care package at home. Staff knew how to observe the safety of the ward environment, and where to report any concerns, or raise an incident form.

During our assessment, we observed there were appropriate risk assessments in place for the storage of cleaning products and medication.

We observed equipment being used to support patients achieve their mobility goals. All equipment was checked for safety and staff were trained in its safe use.

The Trust had clear processes in place which included, audits and equipment check lists which were consistently completed.

Equipment checks were in place and staff knew how to report concerns regarding faulty or damaged equipment.

We did not look at Safe and effective staffing during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

Staff we spoke with during our assessment understood the principles of infection control. They were aware of the trust policy and procedures and knew how to access supplies of personal protective equipment (PPE).

Staff explained the requirements for isolation of patients with certain conditions and knew how to alert the IPC team should there be any concerns re specific management of certain infections or diseases.

Leaders were aware of antimicrobial prescribing concerns and the need to ensure treatment schedules were adhered to. These included relevant treatment decisions being discussed with pharmacy and microbiology. All staff we spoke with were clear on their individual roles and responsibilities concerning infection prevention and control.

During our assessment we observed all staff had access to PPE as needed, such as disposable gloves and aprons, and they wore these when appropriate. We observed clinical staff were bare below the elbow, in line with trust policy to help prevent the spread of infection.

Hand cleansing gels were available in dispensers and used in all the areas that we visited. We observed staff using hand gels to clean their hands at regular intervals. We also observed staff using hand washing facilities according to local and national policy.

Ward areas we assessed had suitable furnishings however not all areas were clean and well maintained. We fed this back to the ward team on the day of the assessment so that the concerns could be addressed.

In one sluice room a box of absorbent gel granules was observed in an unsecured area. These were subject to a National Patient Safety Alert in 2019 due to the risk associated with swallowing the product. Staff were aware of the alert and a risk assessment was subsequently completed. On our return to the area both concerns had been acted upon. The trust also provided further assurance; the ward was placed on an enhanced monitoring process improvement action plan to undertake snapshot audits of compliance with secure storage arrangements.

Other areas we assessed were clean and well maintained by the hospitals domestic cleaning and maintenance teams.

The Trust had clear processes in place which included, audits and cleaning checklists which were consistently available and completed in all areas we visited. There were processes for managing infections and isolation of patients. Staff were consistent in isolating patients at risk of spreading infection to others. Infection control policies were written in line with national guidelines. Staff we spoke with were aware of these policies and knew how to access them on the trust’s intranet.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.