Care Quality Commission says that doctors must comply with policies on patient consent at York Teaching Hospital NHS Foundation Trust

26 October 2011

The Care Quality Commission has told York Teaching Hospital NHS Foundation Trust that it must take action to ensure that it complies with its own policies on patients' consent to care and treatment.

CQC inspectors found that the trust was failing to meet essential standards of care at both the York Hospital and St Helen's Rehabilitation Hospital in relation to the use of DNAR (do not attempt resuscitation) forms.   

Inspectors visited the York Hospital, St Helen's Rehabilitation Hospital and White Cross Court Rehabilitation Hospital in July this year as part of the routine schedule of planned reviews of NHS organisations.  

At the York Hospital and St Helen's Rehabilitation Hospital the trust was not compliant with the standard covering consent to care and treatment: While patients said that they had been consulted about their treatment, inspectors found that care records were not always completed.

Documentation relating to whether a patient should be resuscitated or not, was not being completed correctly, or reviewed as required by the hospital's own guidelines. This meant that some patients may have had an instruction in place which was out of date, incorrect or no longer in their best interests. The trust’s policy also required that decisions about resuscitation should be reviewed regularly. There was no evidence that relatives had been consulted where appropriate. There had been no second opinion, in some instances and no specific date when the decision should be reviewed.

CQC has given the trust 28 days to provide a report that says what action they are going to take to achieve compliance with the essential standards.

Jo Dent, Regional Director of CQC for Yorkshire and Humber, said: "Very often these forms are completed when a patient is admitted to hospital, perhaps in a critical condition - but the decisions which are made then must be reviewed as a priority if a person's condition improves or stabilises.

"We found DNAR forms which had been completed by a doctor but that there was no evidence to say that patients had been involved in the decision, or evidence that relatives, even where they were taking an active role in the patient's progress, had been consulted.

"Doctors we spoke to agreed it was best practice to discuss these decisions with the family or next of kin and the patient themselves, where possible.  But one doctor also told us that it was a difficult topic to raise with relatives and patients and that these decisions were often made when relatives were not around.

"The trust's own policy makes it perfectly clear how these decisions are to be reached, who to consult and how it should be recorded to make sure the right decision is made.  The records seen by us did not follow these guidelines.

"We have asked the trust to provide a report that says what action they are going to take to comply with this standard and we will return unannounced to check that this is being done in the near future."

Inspectors found that the trust was not compliant with a number of other standards listed below. The trust is required to provide a report showing how it will achieve compliance:

The York Hospital

• Meeting nutritional needs: Inspectors said that while  there was good practice across most of the hospital, they were concerned that this was not the case on one ward, particularly as the patients being cared for there were vulnerable and unable to assist themselves.
• Management of medicines:  While the management of routine medication was well organised, incomplete documentation, and the lack of regular auditing, meant that controlled medication may not be properly accounted for and records may not accurately reflect the medication administered.

St Helen's Rehabilitation Hospital

• Management of medicines: Incomplete documentation and poor practice with regard to controlled medication meant that medication cannot be properly accounted for and some patients may not be given their medication at the time it was prescribed.

White Cross Court Rehabilitation Hospital

• Cleanliness and infection control: Inspectors found that people using the service were not always fully protected from risk of harm because of poor practices relating to infection control and cleanliness and the failure to lock away hazardous materials.

Ends

For further information please contact the CQC press office on 0207 448 9239 or out of hours on 07917 232 143.