Royal United Hospital Bath

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

For the effective domain, we looked at the quality statement, ‘delivering evidence-based care and treatment’. We rated this good. The service worked in line with legislation and current evidence-based good practice and standards. The service was performing well against many performance indicators such as compliance with the World Health Organization Pain checklist but there were also areas where the service could improve such as around venous thromboembolism assessments being completed within 6 hours on the ward as well as completing the fluid balance charts.

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 Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients were happy with the care they received during their stay. Matrons carried out an oversight audit, which checked patient feedback against certain criterion. We saw results from February 2024 which stated 100% of patients were happy with the care they received during their stay, 75% of patients knew why they were admitted to hospital and 75% of patients knew what their next care steps were and whether discharge plans had been discussed.

Staff worked in line with legislation and current evidence-based good practice and standards. Staff said audits were discussed regularly in clinical governance meetings. We reviewed meeting minutes and saw evidence that learning from audits was shared. The majority of the audits carried out by the service showed a good level of compliance against standards. For example, in February 2024 the audit that covered aspects of the Mental Capacity act and Deprivation of Liberty Safeguards was at 96% and the hand hygiene audits were positive at 98%. However the trust had room for improvement with regards to venous thromboembolism assessments being completed within 6 hours on the ward. This was at 60.28% compliance across the wards as of March 2024. Completion of fluid balances was between 38% and 59% during the period October 2023 to February 2024. We have asked the trust to produce an action plan. Processes around identifying patients who required additional help with nutrition was not always clear. On the date of our site visit we observed patients asleep with hot food trays placed in front of them. We saw that there was plenty of staff serving the meals but not as many staff visible when patients were eating. When patients required additional help with eating food, or needed foods that had a modified texture (such as mashed or pureed foods), this was highlighted to staff using a red tray. We were not assured the system always worked because staff had to look at patients' care plan to obtain this information and it wasn’t readily available. We informed the trust of our concerns and observed that on the second day of the site visit, on 1 ward, this information along with the malnutrition universal screening tool scores was visible on the organisation's white board. This meant it was easier for staff to know which patients required assistance at mealtimes.

The service had clear processes to obtain evidence-based information to inform best practice. The service had an audit programme which was reviewed regularly. The trust had a tool where wards could view their overall compliance with the audit programme within a chosen 6-month period and a full break down of their results for each audit standard. Audit results were discussed at divisional clinical governance meetings and the trust quality and safety group. We were told themes from audits and areas of concern were discussed at the weekly matrons’ meeting.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.