Lincolnshire Community Health Services NHS Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective commentary

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
At our last assessment we rated this key question good. At this assessment the rating has remained the same.
 

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always ensure the effectiveness of people’s care.

We saw staff used a variety of assessment and patient monitoring forms. The type and number and quality of recording was inconsistent. On one ward we saw fluid balance charts that were incomplete and no evidence of escalation when the records showed a very poor intake for a patient with complex medical issues. Two more clinical records we checked had incomplete fluid balance charts.One senior member of staff told us it’s something we don’t do properly.

We saw food monitoring charts that had gaps and did not include portion sizes or whether poor dietary intake should be reported.

On the same ward we also looked at 5 specific records regarding rounding and repositioning. Rounding is a structured approach to proactively check on patient needs, this included whether repositioning is indicated. Staff had also implemented turn charts in the 5 instances to monitor specific actions regarding relieving pressure. We asked staff to clarify what regime of pressure area care and prevention was indicated in 5 cases based upon the patients care plan, repositioning form and turn chart, they were unable to give us this information. The records we reviewed showed considerable gaps of up to 6 hours in patients being repositioned. This meant patients were at significant risk of tissue breakdown.

We have been informed following the assessment that the turn chart had been discontinued, and work is to be undertaken to standardise the rounding and repositioning form.

We looked at 25 care records during the assessment; staff completed a comprehensive assessment of the patient in a timely manner.

Staff developed care plans that met the needs identified during assessment.

Care plans were personalised, holistic and recovery oriented.

Staff updated care plans when necessary.

Staff followed up-to-date policies to plan and deliver care according to best practice and national guidance.

Staff protected the rights of patients subject to the Mental Capacity Act.

We observed one daily board round where each patient was discussed including therapy input and discharge plans. However, we saw a lack of consistency in the forms in use, one form had more detail and included mobility and hydration status.

Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. Mandatory training rates were 90% across the wards.

Managers gave all new staff a full induction tailored to their role before they started work.

Managers supported staff to develop through yearly, constructive appraisals of their work, compliance rates were 98%.

Managers supported nursing staff to develop through regular, constructive clinical supervision of their work, compliance rates were 81%.

Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge.

Managers made sure staff received any specialist training for their role including stroke and wound care.

Community hospital wards operated a nurse led model. Wards were led by senior nurses, matrons, or advanced clinical practitioners (ACPs) who managed patient pathways, diagnoses, and discharges. We were told that issues had arisen when support was required out of normal working hours, this was provided by the clinical access service. If the person on call was not trained or had permissions to use the electronic prescribing system used on all the wards this could lead to delays in prescribing and administration of essential medicines including pain relief.

Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care.

Staff referred patients for mental health assessments where appropriate, however we were told that local mental health teams only saw patients when they had been discharged and not whilst they were on the ward, this meant there could be delays in getting the appropriate support in place for patients and their carers upon discharge.

Staff supported patients to live healthier lives, through promoting smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

Patients we spoke with said they had enough to eat and drink and sometimes the portions were too big.

Staff did not always accurately complete fluid and nutrition charts where needed.

Staff used the Malnutritional Universal Screening Tool (MUST) to monitor patients at risk of malnutrition.

Staff we spoke with said there were often delays in accessing specialist support from specialist staff such as dietitians and speech and language therapists.

We saw multiple notice boards with information promoting healthy lifestyles and wellbeing.

Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle, this included nutritional advice for patients who were overweight.

Senior staff completed a monthly community hospitals quality assurance audit, a structured and standardised approach to ward-level quality oversight. The audit functioned as both an assurance mechanism and an improvement tool, enabling identification of risks,trendsand areas of good practice.The audit included direct observation of practice and the environment, review of the electronic patient record (EPR) along with other relevant documentation and structured patient and staff feedback. However, on one ward, we found issues with the monitoring of diet and fluid intake and pressure area care that had not been identified in the audits.

One ward had achieved accreditation in the Gold Standards Framework (GSF) which aimed to improve care quality and coordination for people in their last year of life, allowing them to live well and die in their preferred place. Staff on the remaining four wards said they were working towards achieving accreditation.

We looked at 25 care records; staff took all practical steps to enable patients to make their own decisions and recorded capacity to consent appropriately. they did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history and recorded this appropriately.

Staff gained consent from patients for their care and treatment in line with legislation and guidance.

Staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Training compliance rates were 90%.

Staff implemented Deprivation of Liberty Safeguards in line with approved documentation. Managers monitored the use of Deprivation of Liberty Safeguards and made sure staff knew how to complete them.