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Grantham and District Hospital Good

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Inspection report

Date of Inspection: 24, 25 February 2014
Date of Publication: 2 April 2014
Inspection Report published 02 April 2014 PDF | 94.14 KB

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 24 February 2014 and 25 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

Patients gave both positive and negative feedback about their experiences at the hospital whilst being in-patients. All patients were either happy or very happy with the care they had received but some told us about some experiences they were not totally satisfied about. Two patients told us they felt they would have liked more help in managing their pain and another patient said they felt staff had not helped them with their physiotherapy exercises over a weekend period. In both cases they had not passed on this information to nursing or medical staff and would not allow their names to be shared.

Patients on the day ward and outpatient department were generally more satisfied with their experiences in those departments. One patient said, "Staff are very nice and attentive." Another patient told us, "Staff are fantastic."

We observed staff interacting with patients throughout our visit. They did this quietly and where possible pulled curtains around the bed area or asked people to move to a quieter area of the ward or department. Staff introduced themselves and ensured each patient understood their care and treatment. Patients told us staff spoke with them using a language they understood and ensured they understood their treatment and care.

We spoke with relatives who were managing the affairs of four patients, due to the patients' poor memory. Relatives we spoke with told us they had to seek out staff members to ask for an update on their family member's condition. They told us staff were pleasant when they telephoned into the hospital to ask for an update. The provider may wish to note this was causing some anxiety with some relatives as the patients could not tell them what had happened each day and staff did not automatically approach them. One relative said, "I don't like to worry staff as they seem so busy, but neither do I want to spend the whole of my visit trying to chase staff for updates." We asked the relative's permission to approach staff about their needs. They allowed us to do so and later we saw staff sat with the relative and patient, going over the recent details about their care needs and treatment options.

We looked at nine sets of patients' notes who were receiving on going treatment for pressure damage to their skin and specific invasive treatments. In each case, staff had recorded each patient's needs, the outcome of assessments and a plan for future care. Notes were kept in secure trolleys and put away when not in use. Where other health professionals such as occupational therapists and physiotherapists had been involved in a patients' care this was well documented. Staff told us they usually had time to ensure the patients' notes were up to date.

In one ward the number of patient days spent on the ward had increased. Senior nursing staff told us they had instigated more training with staff on documentation to ensure all sections were completed before they were moved to a different area. A staff member said, "We aren't used to completing updates on risk assessments as usually patients have moved on before they require review. It's been a learning curve."

The risk management results of checks on documentation around pressure damage varied on different wards. Nursing staff were able to explain the results in their areas and show us what measures they were putting in place to ensure the results improved in the following month. Staff told us results were on display and better ways of working had been discussed with them to improve the outcomes for patients.

Staff told us information was available on the trust intranet system. We saw a set of information on one computer entitled "Care Bundles". These gave details to staff about certain aspects of care. For example about the track and trigger system if someone was likely to be at certain risks because of complex needs and required close monitoring. This was an effective use of the system to identify risk to a patient who required a tissue viability