The Care Quality Commission (CQC) has told East Kent Hospitals University NHS Foundation Trust that it must make significant improvements to its emergency department and medical care services.
CQC carried out an announced focused inspection of the emergency department and medical wards at William Harvey Hospital on 11 August 2020. Following previous engagement with the trust and other concerns raised, the inspection team visited the following areas.
- a ward where patients had COVID-19 symptoms and were awaiting their test results
- a ward caring for patients who had COVID-19
- a ward caring for patients who do not have COVID-19
- a ward where there was an outbreak of COVID-19 and was subsequently closed to new admissions.
Following the inspection, CQC took urgent enforcement action, telling the trust it must ensure there is an effective system to manage the health and safety of people using the hospital. The trust has also been told it must ensure that all areas in the emergency department are risk assessed for social distancing and risks related to the spread of COVID-19 are mitigated.
Inspectors found that staff did not always wear PPE correctly in medical wards. Nursing staff were observed wearing face masks incorrectly on the COVID-19 ward. A member of the nursing team was also seen wearing their face mask incorrectly in the ward where there had been an outbreak of Covd-19.
Inspectors found staff did not always use alcohol hand gel on entering and leaving wards. At least seven members of staff were seen entering and leaving the ward caring for people who were suspected of having COVID-19 without adhering to hand hygiene practices.
Staff did not always wear PPE correctly in the emergency department. For example, they did not always remove it upon entering a new clinical area and did not always put on or take off their PPE when entering and leaving patient bays. Staff did not always wear the correct PPE for the patient care they were delivering.
While equipment was found to have been cleaned on the day, inspectors found this was not always recorded. Environment cleaning schedules had only partially been completed in the two weeks prior to CQC's inspection. This meant the trust did not have assurance that all aspects of the environment were cleaned during this period..
Not all rooms had signs to indicate how many people were permitted to be in that area while being able to socially distance. Managers told inspectors that every room should have these signs. Five members of staff were seen in one room which was too small to enable the practiced social distancing in that space.
Inspectors found there was an inconsistent approach to triaging patients with COVID-19 symptoms in the emergency department.
Staff and patients did not always have access to hand gel or hand washing facilities in the emergency department. There were two entrances to the assessment area. However, hand sanitiser at both entrances were found to be empty. Despite raising this with the department, on their return, in the afternoon, hand sanitisers were still empty.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“It is extremely disappointing to find that despite being warned about their hygiene, not enough work had been carried out to address infection control issues within the trust. It is particularly concerning during a time when infection control could never have been more important.
“We had reviewed the work carried out by East Kent Hospitals University NHS Foundation Trust around infection prevention and control practices and issued a warning notice to them on 3 August. However, the scale of the concerns were so great that we carried out a focussed inspection on 11 August.
“Following the inspection, we reported our findings to the trust so its leaders know what they must address. We used our enforcement powers by imposing conditions on the trust’s registration, to ensure people are safe.
“We have assurance by our weekly engagement from the trust leadership that these issues are being addressed. We continue to monitor the trust closely. We will return to inspect it, to determine whether significant improvements have been made and embedded.”