Royal Albert Edward Infirmary

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• 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

Staff planned and delivered care according to best practice and national guidance. Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. The service participated in a range of local and national clinical audits. Staff made sure patients had enough to eat and drink including those with specialist nutrition and hydration needs. Fluid balance charts were not always completed consistently and accurately, but the service had taken actions to improve this.

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 told us staff had informed them about their plan of care. Patients told us their nutrition and hydration needs had been met. Patients and their loved ones who were waiting for treatment in the waiting area had access to jugs of juice and water and hot drinks. They also had vending machines they could access. Corridor patients had access to hot food at dinner time following the division introducing meal trays to accommodate this.

Staff told us they followed care pathways based on national guidelines and knew how to access clinical pathways and guidance when needed. Senior managers told us they participated in local and national clinical audits and audit findings were reviewed as part of monthly departmental governance meetings and as part of trust-wide clinical audit and effectiveness meetings, that were held every 3 months. The lead nurse for the emergency department told us they were aware of shortfalls in fluid balance document completion and had identified this as a training issue for bank, agency and newly appointed nurses. The lead nurse told us the practice educator had been providing additional training and support for individual staff in order to improve compliance.

Staff followed up-to-date policies to plan and deliver care according to best practice and national guidance, such as from the National Institute for Health and Care Excellence (NICE) and Royal College of Emergency Medicine (RCEM) clinical guidelines. Staff used a range of care pathways for adults and children, in line with national guidance, such as for sepsis, asthma, diabetes, head or cervical spinal injuries, severe headaches, frail and elderly trauma, major trauma and upper gastrointestinal haemorrhage. We reviewed a selection of care pathways and found they were up to date and reflected national guidelines. Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. Patients presenting in the emergency department with mental health needs could access specialist support. The service participated in a range of local and national clinical audits. Audit findings were reviewed to monitor compliance against local and national standards and action plans and planned re-audits were in place where further improvement was identified. Staff made sure patients had enough to eat and drink including those with specialist nutrition and hydration needs. Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition. Where patients were identified as at risk, staff completed patients’ fluid and nutrition charts. We found information such as fluid input and output was not completed consistently and accurately in patient records. A fluid balance action plan was in place to improve compliance. The weekly fluid balance chart audit results showed staff compliance in the completion of fluid balance records was below expected levels but this had improved recently.

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.