Calderdale Royal 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

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

At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant patients were not always safe and protected from avoidable harm. The department needed to improve in some quality statements within the Safe Assessment Service Group (ASG). 

We assessed all quality statements for this key question.

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.

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 scored the service as 3. 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.

The department had clear processes to report incidents and learn from incidents and near misses. We reviewed patient safety incidents reported by the urgent and emergency care department (ED) between July 2025 and January 2026. Staff had reported 440 incidents, of which 4 were reported as moderate harm and none were reported as either severe harm or fatal. The trust told us that each patient safety event was reviewed using an MDT approach with senior nursing and medical leadership involvement.

The Trust had a ‘Learning from Deaths’ Policy. The purpose of this policy was to describe the process for learning from mortality reviews, how the Trust Board was assured and to identify areas for improvements in patient care and experience. The aim was to reduce mortality rates and make sure that patients received the best care possible when death was unavoidable.

Patient safety events were discussed at safety huddles and incidents reported. Staff told us they had received training to use the incident reporting system. All staff recognised the importance of reporting however, some said it was sometimes difficult to report incidents in a timely way because they were busy providing care and treatment, and the reporting process felt lengthy.

Staff told us they were informed about patient safety events and were able to access information about lessons learned and training. They also received regular emails with specific information or reminders about changes to standard operating procedures, including when procedures were not being followed correctly. These reminders supported learning.

Staff told us safety huddles happened at least once a day however the trust informed us that huddles took place approximately every 3 hours. They discussed the department’s status, risks and shared learning from incidents and any feedback received. During our inspection we observed safety huddles and saw feedback being passed to staff.

Staff told us support was available to them after a difficult event or incident, and they felt supported by their colleagues and leaders. We saw this in action after a member of staff was assaulted by a patient whilst delivering care.

We reviewed the trust’s Duty of Candour policy and saw it clearly explained the roles and responsibilities of staff in the process. Staff could access the policy easily if they needed to do so. Staff told us they understood their responsibilities under Duty of Candour, including being open and honest and offering an explanation when something went wrong.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

When patients arrived at the emergency department, reception staff booked in people who self‑attended and passed their details to a senior nurse. The nurse reviewed patients and allocated them to the most appropriate area.

Patients who were directed or “streamed” to the emergency department were triaged by trained staff using the Manchester Triage System (MTS). Sometimes the department used the ‘RAT’ (rapid inspection and treatment) process whereby a senior doctor or clinician was available to assess patients quickly and refer them directly to clinical specialties or for tests and investigations. Staff told us there were pathways to stream patients straight to specialty inspection areas in the hospital. As part of triage, initial tests, such as blood tests and ECGs were carried out in preparation for medical review.

The national target for triage was 15 minutes. Calderdale Royal Hospital (CRH) recorded an average triage time of 15m33s in December 2025 for adults and 12m29s for children. Between July 2025 and December 2025, the average across both varied between 13m59s and 16m54s. During this same period, the department met the 15 minute standard for children each month however did not always meet the standard for adults. This compared favourably with the National average.

The ambulance handover area had 3 bays with patient trolleys. Nurses and health care support workers oversaw both areas. After handover and initial review, staff could request and carry out tests such as blood tests and ECGs in preparation for review by a doctor.

The department also had an SDEC (same day emergency care) area where people with certain conditions were sent to receive treatment. Staff told us it helped reduce pressure on the main department and supported timely care. Patients gave positive feedback about the environment and shorter waiting times. Staff could also book follow‑up SDEC appointments directly.

The department was included in the new National Transfer of Care standard operating procedure (SOP). This required ambulance crews to hand over patients after a 45‑minute wait and leave the department, to improve ambulance availability and response to 999 calls. Ambulance crews gave positive feedback about staff support and the time taken to hand over patients.

Although the department was busy during our inspection, we did not see patients cared for in the corridor. Staff told us corridor care was never acceptable and only very rarely happened at this site.

Leaders met throughout the day to discuss patient flow, including risks related to waiting times including ambulance waits. These systems ensured leaders at all levels were aware of performance and risk. We observed one of these meetings and saw teams working together to free beds and anticipate upcoming discharges and potential bottlenecks. Teams worked in unison to improve patient flow. However, patients often experienced long waits before being moved to wards. During our inspection we saw patients waiting in ED for over 24 hours. We also saw examples of patients completing their treatment in ED and being discharged home from the department because they had not been moved to a ward. Hospital‑wide discharge delays affected the flow of patients through the ED. Poor patient flow impacted patient experience and safety.

Some specialty doctors attended the department less frequently to review patients which contributed to poor flow. Professional standards state that specialty doctors should review patients within 60 minutes of a request. This was not always the case which resulted in delays to patient reviews, potential delays to treatment and care planning, and overcrowding in ED. Staff told us they were frustrated because of the impact this had on patients and the department flow.

Allied health professionals (AHPs), including physiotherapists and occupational therapists, supported patients in the department and carried out pre-discharge inspections when needed. We saw this in action during our onsite inspection.

The department had a standard operating procedure (SOP) for Electronic discharge summaries which was shared with two other trusts to make sure there was shared access to information about patients. Discharge letters were then shared with a patient’s GP when the patient was discharged home and contained all relevant information from their stay in the department. The trust also had a Discharge for Adults Group Policy which clearly outlines the responsibilities staff had in relation to discharging patients who were medically optimised.

Safeguarding training compliance of staff within the department did not meet the Trust’s own 90% standard. However, the service worked with people and healthcare partners to understand what being safe meant to them and how to achieve that. They concentrated on improving people’s lives and protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They shared concerns quickly and appropriately.

The trust provided safeguarding adults and safeguarding children training to all staff working in the emergency department (ED), including reception staff. Safeguarding training was part of mandatory training with refresher training required every 3 years. The trust standard of compliance was 90%.

Training compliance did not meet the required percentage across all levels of training. For example, 0% (zero) of medical and dental staff in ED had completed level 3 safeguarding adults training and only 69% had completed level 2. Additionally, medical staff were only 68% compliant with level 2 safeguarding children and 50% compliant for level 3 safeguarding children training. Furthermore, nursing staff were not meeting the compliance standard for level 3 safeguarding children training. The trust was aware of the areas of low compliance and told us there was targeted work ongoing with the non compliant groups to meet an 80% target by February 2026 and 90 by March 2026. This was a breach of Regulation 13 Safeguarding.

We saw staff assessing and documenting patients’ capacity in their notes. Clinicians were able to explain how they assessed people with poor mental health needs, including completing appropriate risk assessments. Mental Capacity Act (MCA) training formed part of the mandatory training modules and staff were required to carry out refresher training every three years. Staff had undertaken deprivation of liberty safeguards training, however compliance with the 90% standard was not being met by medical staff. Therefore, we were not assured that current best practice was being followed at all times.

The trust had a safeguarding policy and there were processes in place to report any safeguarding concerns for adults and children in normal working hours and outside of hours. Staff could also speak to senior staff within the department if they needed extra support.

The trust provided us with information about the most common themes identified as reasons for referrals to safeguarding for both adults and children. In the three month period from October 2025 to December 2025, 109 paediatric and 42 adult referrals had been made with the main themes for adults being neglect and organisational abuse and for children, Injury and burns. The trust had a BLOSM service which supported vulnerable young people up to age 25 to help them make better life decisions. BLOSM stands for Bridging the gap, Leading a change in culture, Overcoming adversity, Supporting vulnerable people and Motivating independence and confidence.

Staff in the paediatric ED knew how to identify children at risk of, or experiencing, significant harm and worked in partnership with other agencies. Staff were also aware of the risks and presentations of child sexual exploitation (CSE) and remained alert to who accompanied young people. All cases were reviewed retrospectively to make sure no safeguarding opportunities had been missed. Staff described the actions they would take when concerned about a child. Staff also explained that all non‑mobile children who attended with injuries such as unexplained bruising were reviewed by a senior clinician however since training compliance was low, this did offer a strong level of assurance.

The electronic record system contained safeguarding information for patients of all ages who were at known risk of harm, had experienced abuse or were linked to someone who had been abused. Alerts helped staff recognise risks and take appropriate precautions.

We scored the service as 2 The evidence showed some shortfalls. The service did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff did not always assess and manage risks consistently, including risks related to both mental and physical health. Falls risk assessments and bed rail assessments were not always completed for patients who were at risk of falls, and we observed patients with bed rails raised without risk assessments. Inappropriate use of bed rails can increase harm if patients become entangled or attempt to climb over them. We asked the department to send us information about previous risk inspection audits, such as those relating to pressure damage, falls, pain and documentation completion. The trust informed us it had recently introduced a new daily retrospective audit.

The department used an intentional rounding tool called the EDEN (Emergency Department Essential Nursing) tool which prompted staff to carry out specific care tasks at least ever four hours. We reviewed the tool and when we looked at clinical records, we found that it was not always completed for patients. When we looked at the electronic records we saw even when interventions had been carried out, these had not been recorded in the EDEN tool.

The trust had a policy in place for managing patients with mental health disorders incorporating the Mental Health Act 1983. This provided staff with guidance about how to manage all patients including children and young people, attending the department with poor mental. Staff understood who to contact to support patients and make appropriate referrals when necessary.

At department level, 84% of patients with symptoms of sepsis received antibiotics within an hour in January 2025. This met the trust target of 80%. We saw discussions recorded that the trust should increase the target to 90% but which also acknowledged that departmental flow impacted timeliness of receiving antibiotics.

Staff assessed patients’ holistic health needs at triage, but they did not always develop and record a clear risk management plan, including required levels of observation or where the person should be placed within the department. This was done using the NEWS2 (National Early Warning Score version 2) tool. There was 1 mental health room, this was often used for physically unwell patients, meaning patients with poor mental health were placed in general waiting areas or general cubicles.

The department identified patients who required additional input from specialist teams. Staff told us that some specialties, such as care of the elderly and medicine, worked closely with ED staff and attended promptly. However, some staff also told us this was not always the case.

During our inspection, we saw patients had long waits in the department after a decision had been made that they needed to be admitted. Some patients waited over 24 hours in the department and at the time of our inspection we saw some patients had spent more than 19 hours in the department. Patients living with poor mental health had the longest waits for beds in other hospitals and staff told us it was often difficult to meet their personal hygiene needs. Many patients could not move to the AMU (acute medical unit) or wards because very few beds were available across the hospital.

The department had identified a need to strengthen how it reacted to deteriorating patients and was working on implementing a new electronic system which will remind staff when observations are required and deliver better real time information to support clinical decision making. Staff told us they were also allocated roles in the department in case of rapid deterioration such as cardiac arrest.

We saw patient information leaflets available in the department for people being discharged with certain conditions. These leaflets were available using QR codes which patients could scan. They explained their condition, symptoms to look out for and when to seek further help. Patients could also download the leaflets in different languages.

The evidence showed significant shortfalls in maintaining a safe environment. The service did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

During our inspection, we identified concerns about the safety of the environment. We escalated these concerns to leaders in the department and action was taken to address the risks. However, we still found a breach of Regulation 15.

Patients presenting with poor mental health or experiencing a mental health crisis were allocated to specific rooms when these were available. We reviewed these rooms against the recognised PLAN (Psychiatric Liaison Accreditation Network) standards and found they did not meet the recommended requirements. For example, they contained several ligature risks, meaning there were fixtures or items that a person could use to harm themselves. The furniture was neither weighted nor fixed to the floor, so it could potentially be used as a weapon. This increased the risk of harm to patients in mental health crisis because the environment was not suitable for safe care. This was a breach of Regulations 12 and 15. This risk was not recorded on the trust risk register.

We saw open or unlocked cupboard doors exposed consumables that patients could use to harm themselves or others. We also observed oxygen cylinders that were not chained to the wall as required and were left loose on the floor. These issues posed avoidable safety risks. We raised these to the leadership team who acted to rectify them.

We visited the SDEC (same day emergency care) several times during our inspection. It was a very busy area. We spoke with staff working there. They told us that the area felt isolated and away from the main department. Several expressed concerns about the remoteness in case of an emergency because there was no emergency or crash call bell. They were concerned about how they could quickly and effectively request help in these situations. We raised this with the management team who acknowledged the concerns and told us they would explore ways to make staff feel better connected to the main department in the case of emergency such as a deteriorating patient.

We reviewed the resuscitation trolleys in the department. Records showed that daily checks were not always completed. The provider could not evidence that the trolleys were stocked correctly with in‑date consumables and medicines, that oxygen cylinders were full or that electrical equipment such as defibrillators was working as intended. This increased the risk of harm from equipment failure, missing stock or expired consumables.

We observed visitors being allowed into the paediatric ED through locked doors without security checks or questions about their reason for attending. This meant people could enter the department inappropriately, increasing the risk to children and their families.

Description: We do not always make sure there are enough qualified, skilled and experienced people, to provide safe care that meets people’s individual needs.

The evidence showed shortfalls in safe and effective staffing. The service did not make sure there were enough qualified, skilled and experienced staff on duty to meet the needs of patients.

The department had an induction process for all new staff, which included orientation to the emergency department, such as the location of crash trolleys, fire alarms and sharps bins. The induction also covered handover and escalation processes, health and safety, infection prevention and control, medicines management and uniform requirements. Bank staff and staff from other departments were given a picture map showing key areas in the department to help them navigate the environment. Staff working in the ED had the appropriate qualifications for their roles.

Staff told us the department was a good place to learn and that colleagues were supportive. None of the resident doctors reported difficulties in asking for help, including overnight to on call consultants.

We reviewed the level of training compliance for staff in the ED. The trust had a compliance target of 90% for all subjects and excluded staff on long term sick or maternity leave from training figures. The trust told us they had an overall training compliance of over 92% in December 2025. However, There were several training modules where compliance was below the 90% trust compliance rate, including end of life care level 2 (71%) and nasogastric tube insertion and management (73%). Low training compliance puts patients at increased risk as staff may not have the skills and competencies to respond to emergency situations. This was a breach of Regulation 18

Medical staffing were worse than the trust target of 90% for all mandatory training. For example, the lowest level of compliance was 52% for infection prevention and control.

Trust compliance with the mandatory training requirement in learning disability and autism was poor. Whilst over 90% of staff had completed eLearning, there were no areas of the division where compliance with the training requirement was above 20%. This meant there was a risk that staff were not equipped with the necessary skills to meet the specific needs of patients with a learning disability or those who were autistic. We spoke with staff who told us that they worried they didn’t always feel they had the skills, confidence or capacity to work to meet the specific needs of patients with a learning disability or those who were autistic. The trust had a plan for increasing compliance in the coming year, however at the point of our inspection, we could not be assured that staff were trained and therefore able to meet the specific needs of this patient group.

Staff told us that training was available, but it was sometimes difficult to access because of how busy the department was and the pressure on staffing. We were concerned that this limited some staff members’ ability to develop their knowledge and experience, which could affect their ability to improve the quality of care they provided.

We reviewed staff appraisal compliance. Staff told us appraisals were supportive and offered opportunities for feedback and for raising concerns. The trust’s data showed appraisal compliance for nursing staff in the adult ED was 97% and 94% in the paediatric ED. Medical staff compliance across the department was 65% in January 2026, with plans in place to improve this. They also told us that staff had to have 100% compliance to progress through the pay gateways and receive pay increases.

We were concerned about staffing levels in the department and identified a breach of staffing regulations (Regulation 18) because the provider did not deploy enough suitably qualified staff to meet patients’ needs.

The trust employed a range of staff disciplines across the ED, including nurses, health care support workers (HCSWs), resident, middle‑grade and consultant‑grade doctors, as well as emergency and advanced care practitioners (ECPs and ACPs).

The service had a 4.6% vacancy rate for nursing staff and a 5% vacancy rate for medical staff. We also reviewed sickness rates which showed a level of 5% in nursing, a 7% level in ECPs and a 12% rate in the resuscitation team. This compared to a national average of 6% across the NHS in October 2025.

We reviewed the number of hours of bank and agency staff used by the department. Bank staff are existing staff who pick up vacant shifts, agency staff are employed by an external employer. We found for qualified nursing staff, the department used between 0.14% and 4% agency staff between October 2025 and December 2025. They also used between 8% and 14% bank staff across the same period. In December 2025 almost 20% of shifts were covered by bank or agency staff. For unregistered staff such as HCSWs, the department used between 11% and 15% bank staff between October 2025 and December 2025 and zero agency staff.

We also reviewed the use of locum medical staff of all grades in the department. The information showed agency and locum use was between 29% and 32%. Almost one third of all medical staffing was provided by locum doctors.

We reviewed the staffing rota which showed the paediatric department was not always staffed in line with best practice or as recommended by the Royal College of Paediatrics and Child Acute services Health (RCPCH). We raised this during the inspection and the trust provided evidence of measures in place to manage departmental staffing risk.

We spoke with staff about working in the PED. Some told us that although they were not RSCNs they worked shifts in that department but always with an RSCN to support them. Staff who were not RSCNs were given additional training called Paediatric Positive to equip them with the skills to care for and treat babies and children. Staff training compliance was at 88% at the time of our inspection with priority given to those who had not yet attended the course. Most staff told us they were comfortable working in PED however some staff told us they did not feel confident working in this area because it wasn’t their specific area of training and qualification.

We asked the department for training rates for immediate and advanced life support training for paediatrics and adults split by doctors and nurses however this was not provided. The trust did however provide information about the total number of staff who had attended each type of training. We were not assured that all staff working in the PED had undergone paediatric immediate life support (PILS) or advanced paediatric life support (APLS) training. This was a breach of Regulation 12.

During our inspection, the department was busy We observed the department and how staffing levels impacted care and treatment. In the Majors department we saw 2 nurses and 2 HCSWs were responsible for the care of 12 patients including accompanying them on transfers to other departments. We witnessed remaining staff having difficulty meeting the needs of patients including those with poor mental health. We witnessed one patient with poor mental health continually trying to leave the department because there were insufficient staff to monitor them. We spoke with staff working in this area over the time of our inspection. They told us that it was difficult to look after and support all their patients because some patients needed a lot of support such as with personal care. Managers told us an additional ‘floater’ had been funded to support the department over the winter however we saw this person was also helping other areas when there was short staffing. Further, this was not a long term solution to staffing levels in majors. Staff were not always able to meet the needs of patients an additional breach of Regulation 18.

We wanted to check whether staffing levels caused delays to how long patients waited to be seen by a health care professional when they first arrived at the department. We reviewed triage times in the department for adults and children from July 2025 to December 2025. The national standard is 15 minutes. This standard was met each month for children however for adults, it was only met in July and August with patient attending from September to December on average waiting slightly longer, up to 17 minutes. There was no significant delay to patients waiting to be triaged.

We reviewed medical cover and spoke with staff at different levels of experience and qualification. The department had 24‑hour medical cover, with overnight cover provided by staff of the correct seniority (Specialist Trainee, ST Tier 4), in line with RCEM guidance. Senior clinical leaders confirmed this. However, some medical and senior nursing staff raised concerns to us about the level of overnight cover at Calderdale hospital such as staff being moved from the Calderdale site to Huddersfield leaving Calderdale medical staffing short. Staff also raised concerns about the number of senior staff present in the department and the impact and pressure this placed on the most senior clinician. For example, when there was only one Tier 4 doctor this impacted on the length of time patients had to wait to be seen and was a risk to them. One clinician told us this made the department feel unsafe at times because the waiting room patients needed medical review and patients already reviewed needed ongoing treatment.

We raised these concerns with the clinical leadership in the department when we met with them. They told us they were aware of the issue, recognised the risk and had put some mitigation in place however they also told us this was not consistent. Senior leaders also told us that staff were also transferred to Calderdale to provide support. Further, leaders told us that the biggest medical staffing risk to the department was in the Tier 4+ medical staffing where there were 10 vacancies across the Trust at the time of the inspection.

When we spoke with staff about their workload and staffing levels, they told us the department needed more staff. They said patients often waited a long time to be seen and to receive care and treatment. Staff told us they sometimes missed breaks and that patient care was affected. Some said their workloads were heavy and they struggled to deliver the standard of care they aimed to provide. Although managers were aware of the concerns, the risks remained, showing the department did not have enough suitably trained and qualified staff to consistently meet patients’ needs.

We scored the service as 2. The evidence showed shortfalls in infection prevention and control. The service did not assess or manage the risk of infection well. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

We observed unsafe practice in infection prevention and control. For example, during our observations throughout the department, we saw that a patient with a potentially infectious condition was not barrier nursed and there was no signage to inform staff, volunteers and visitors of the patient’s condition. This put people at risk of not only contracting the condition but also spreading it. We brought this to the attention of the nurse in charge who acted to remedy this.

The trust had an Infection Prevention and Control (IPC) policy which staff were expected to follow. However, infection prevention and control (IPC) standards were not always maintained in the department, and not all staff were up to date with IPC training. Across all staff, training compliance for IPC level 2 was 79%, below the 90% expected compliance level.

We found the majors department to be cluttered with unnecessary items not disposed of. We raised this with the Trust, and they acted straight away to tidy up the areas identified.

The seating in the bereavement room was torn, making it non‑compliant with IPC standards. Elsewhere in the department, seating was IPC‑compliant but required cleaning. Staff told us this was difficult due to the constant high demand for seating throughout the day. The waiting room was visibly clean, and hand gel was available. We checked toilet facilities throughout the day. These were cleaned throughout the day.

We reviewed hand hygiene audits which showed and average compliance rate of 99% for the 12 months prior to our inspection. The trust told us that ‘bare below the elbow’ checks were carried out as part of these audits however during our inspection we observed staff not always adhering to this guidance including people wearing watches, a cloth bracelet, rings with stones and nail varnish all of which increased the risk of infection transmission and were against the Trust’s IPC policy.

The trust also provided audit evidence of general IPC checks within the department, including checks of kitchens, isolation of infected patients and patient equipment amongst others. These audits showed a general compliance of above 90% other than for the general environment which was consistently under 90%. The Trust further provided two examples of Infection Prevention and Quality Improvement Audits which were both rated Amber with overall infection control scored under 90%. Particular areas which had low scores were patient care spaces, corridors and thoroughfares, stores and linen room and disposal of sharps.

There was enough personal protective equipment (PPE), including gowns, gloves and masks, to protect staff and patients. Sharps bins and clinical waste bins were managed and disposed of correctly. Equipment such as blood pressure machines and ECG machines was visibly clean, and we saw staff cleaning equipment after use. Corridors and clinical environments were also visibly clean, and we saw staff cleaning cubicles, striping and cleaning mattresses.

When we spoke with patients about the cleanliness of the department, they told us that the department looked generally clean and they had no concerns.

Toys were available in the paediatric waiting area for children to play with. Although they appeared visibly clean, staff were unable to tell us who was responsible for disinfecting toys or how often this should happen. The trust later confirmed that play specialists took responsibility for cleaning toys.

We scored the service as 2. The evidence showed some shortfalls in medicines being optimised. 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.

There were no designated pharmacy team members to support the UEC department. This was not in line with the current guidance recommendations set out by the Royal College of Emergency Medicine.

We saw that comprehensive medicines histories were not always recorded during initial clerking. This resulted in medicines not always being prescribed correctly and in a timely manner. A medicines reconciliation service (the process of accurately listing a person’s current medicines) was not provided within the emergency department. The National Institute for Health and Care Excellence (NICE) recommends that inpatients in an acute healthcare setting have their medicines reconciled within 24 hours of admission. This is to reduce the risk of medicine errors occurring. We were told that medicines reconciliation only happened once a patient was admitted to a ward.

People were not always given their medicines at the right time. This included time critical medicines such as those for the treatment of Parkinson’s Disease. The NICE quality statement QS164 states Adults with Parkinson's disease who are in hospital or a care home take levodopa within 30 minutes of their individually prescribed administration time.’ We saw medicines being given outside the 30-minute time frame on several occasions. There was a risk that people’s Parkinson’s symptoms would not be adequately controlled.

Temperature monitoring was in place for medicines requiring refrigeration. However ambient temperature monitoring was not in place for all areas where medicines were stored.

Where antibiotics had been prescribed, there was not always an indication or a duration of treatment documented to ensure that appropriate treatment was being used for the shortest effective duration. Patient Group Directions (PGDs) were available, signed by the relevant people and in date for staff to use when required. However, PGD usage was not audited to ensure appropriate use. The Trust is now developing a formal audit process in response to this finding.

We reviewed medicines storage areas on wards including treatment rooms and resuscitation trolleys. We also reviewed medicines records for 5 patients and spoke with members of the nursing team including the lead nurse, a physician associate, resident doctor and directorate pharmacist for ED and acute medical care. Details of patient allergies were clearly recorded for all patients reviewed. Medicines were stored safely and securely. Medicines stock was regularly replenished, and critical medicines were stored in the department to avoid delays in administration.