25 August 2011
The Care Quality Commission (CQC) has told Northern Devon Healthcare NHS Trust that it must improve its systems for managing woundcare and for dealing with patients who are at risk of developing pressure sores.
Inspectors who visited North Devon District Hospital in Barnstaple found that care plans and other patient records were not always completed. While they did not find individual cases of poor care, they did find a failure to fully assess and plan all aspects of patient care which could mean that some people might not get the care they needed.
The report of that inspection is published today.
The inspection process looked at areas of possible concerns relating to patient care which are currently being investigated through safeguarding procedures involving NHS Devon, Devon County Council, Devon and Cornwall police and the CQC.
The inspection focused on the hospital's current compliance in four related areas.
- How pressure area care is managed.
- How well the hospital works with patients with complex needs or with communications difficulties
- Consent and assessing mental capacity for patients.
- Meeting nutritional and hydration needs.
Inspectors spent three days at the hospital in July, meeting patients and staff, checking records and visiting medical and surgical wards. They found that the trust was compliant with three of the four standards which were reviewed.
Respecting and involving people
Inspectors found that people's independence, privacy and dignity were respected and they were able to make informed choices and express their views. Improvements were needed to ensure that where possible individuals' needs and preferences were fully documented. For people with dementia this includes consulting with their carers and ensuring they are always treated with dignity and respect.
Consent to care and treatment
The report concludes that there were processes to ensure that people, including those who lacked capacity, could give informed consent to their care and treatment. While the hospital met the requirements of the Mental Capacity Act, some improvements were needed to ensure consent was fully documented for all areas of treatment and care, such as the use of bed rails.
Meeting nutritional needs
Records showed that risk assessments were recorded properly, and where needed, referrals were made to dieticians and speech and language therapists for swallowing assessments. Assessments had been made and reviewed in respect of people who may be at risk of malnourishment. Inspectors concluded that people's dietary and nutritional needs were being met.
Care and welfare of patients
The trust was not compliant with this standard.
Inspectors found examples where patients' care plans, wound care plans and pressure area assessments were not recorded properly. They found eight examples of wound care plans where the records were unclear about when treatment started or whether improvements were being properly monitored. Inspectors concluded that people were at risk of receiving inappropriate care because care plans and monitoring records were incomplete. Failure to fully assess and plan the delivery of all aspects of care and treatment meant that their needs might not be met properly.
Ian Biggs, Regional Director of CQC in the South West, said that the trust must now provide its plans to show how it will achieve full compliance.
He said: "In a busy hospital, good patient records are essential. Doctors and nurses depend on them to ensure that their patients are getting the right care throughout the day and night when shifts change and different staff come on duty or take over responsibility for a particular person’s care.
"Patients we met on the wards had no complaints about their care, although we have identified some key areas of concern, mainly around pressure damage and wound care, where lack of assessment and care planning could place people at risk.
"When we raised the issue of records at North Devon Hospital earlier in the year, the trust gave us a detailed action plan which included some key changes to the documentation being used to ensure good care and treatment. They told us they would be fully compliant by the end of September.
“We are satisfied that the trust is already taking action. If we had any further concerns for people’s safety, we would take action straight away. In the meantime we will continue to monitor the hospital – and we will check to see that all the improvements have been made in further unannounced inspections.”
For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.