Winfield Hospital

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• 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

We reviewed safe environments; safe and effective staffing; infection prevention and control; for the safe key question. Staff followed corporate policies and processes to provide safe care for patients. Staff reported concerns regarding patient or environmental safety. Managers took action to reduce risk of harm to patients and staff. Managers arranged staffing numbers to maintain patient safety in theatres and staff supported each other to provide safe care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Managers and staff followed Winfield Hospital policies and procedures to maintain safe environments. Maintenance schedules and repairs were completed and logged. Staff reported, and managers reviewed incidents, including any machine breakdowns or missing equipment. Emerging risks were raised for senior management review. Audit processes monitored staff compliance with safety activities such as using the World Health Organisation check list ‘5 steps to safer surgery’ before during and after surgery.

Concerns had been raised with CQC regarding some processes between the sterilising unit (TSSU) and theatres. Staff in each area showed us they were knowledgeable about Winfield policies and processes to maintain safety. Staff showed us the electronic tracking system for surgical instruments and described actions they would take if anything was missing. Staff told us engineers maintained and repaired machines which cleaned endoscopes. An endoscope is an instrument used to view gastrointestinal structures and require detailed specialist cleaning between procedures.

We observed staff using equipment in a way that provided safe care. Staff used processes to maintain safety. Traceability stickers on surgical equipment had their numbers logged to identify equipment used for each patient; swab numbers were constantly monitored in theatres using a swab count board. Managers monitored staff compliance with Winfield Hospital policies and took action if staff did not comply.

We observed staff completing processes for patient safety before any surgical procedures were undertaken. We saw staff completing their allocated roles and taking part in the WHO check list ‘5 steps to safer surgery’. We saw staffing rotas which detailed planned skill mix in each theatre area which was in line with hospital policy.

Managers and staff used systems to provide enough staff with appropriate skills to maintain patient safety. Staff undertook skills training for their roles and managers monitored compliance. Staff were reminded when training was due to be completed or updated including bank and agency staff. There was always an experienced Winfield Hospital staff member in each theatre who had the role of team leader. Recruiting staff had been a challenge and gaps in staffing numbers were filled by bank and agency staff. Managers told us 9 staff were in the process of completing induction programmes. Staff told us they received support and training to undertake their roles and were familiar with the area in which they worked.

Managers used systems to ensure staffing numbers and skill mix were in line with Association for Perioperative Practice guidelines. Electronic safe staffing tools were completed to plan staffing. The tool identified where more staff would be needed and gave a commentary on planned demand. Bank or agency staff were booked to work for a block of time in theatres until permanent roles were recruited to. A hospital wide, daily safety huddle shared where staffing challenges were and what actions would reduce the risk.

We observed staff following procedures to maintain infection prevention and control standards. For example, staff cleaning equipment between surgical cases, staff wearing personal protective equipment within the theatre and not moving out of theatre in theatre scrubs.

Staff reported infection incidences and compared outcomes with hospitals across Ramsay Health Care. Managers reported surgical site infections to Public Health England surveillance scheme. Most procedures were within expected rates. However, some orthopaedic procedures had a slightly higher number of infections. The information had been shared with surgeons and discussions had prompted actions to reduce the risk.

Processes provided a structure to reduce risks of infection and cross infection between patients and staff. The service was supported by a microbiologist. The director of infection prevention and control maintained responsibility for oversight and senior leadership team reported to Ramsay Health Care infection prevention and control leads. Infection control link nurses supported staff with processes. An overarching strategy for the hospital identified infection prevention and control responsibilities for each staff role. Audit processes monitored staff compliance with policies and effectiveness of processes. The infection prevention and control committee collected data and provided reports and improvement actions for more senior review. We saw clinical governance meetings had reviewed changes to practice such as using a different skin preparation solution. We saw documentation recording trends in surgical site infections and actions senior managers had taken in response.

Managers described infection prevention and control processes used to reduce patient risk. A 50 step check list provided a cleanliness of the environment audit. A section of flooring had been replaced in response to the audit. Staff were aware of infection rates and actions they needed to take. Managers monitored staff compliance with training in procedures for infection prevention and control and most staff were up to date with this.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.