The Care Quality Commission (CQC) has told The Hillingdon Hospitals NHS Foundation Trust it must make further improvements to the emergency department at Hillingdon Hospital following an inspection in September. This unannounced, focused inspection was carried out to follow up on a previous inspection which took place in August when CQC imposed urgent conditions on the trust.
During this latest inspection, CQC has found improvements to address some the concerns previously identified but has told the trust that further work is needed. CQC has also issued a warning notice to address additional risks that were identified, and to ensure improvements continue and are thoroughly embedded.
CQC’s Deputy Chief Inspector of Hospitals, Nigel Acheson, said:
“On our return to The Hillingdon Hospital’s emergency department, we were encouraged to see some of the improvements we had already identified now in place. However, inspectors also found a number of new risks where improvements were required.
“In August we took action to drive improvement in infection control practices in the emergency department and the wider trust, by imposing urgent conditions. The trust leadership have provided an action plan and regular updates on how this is progressing.
“We did however identify new risks at this inspection and as a result we issued the trust with a further warning notice. This is to ensure they continue to concentrate on the improvements needed and ensure they are thoroughly embedded and able to be sustained.
“The leadership team are aware of the actions they need to take, and we will continue to monitor progress closely, and inspect again to check the necessary improvements have been made.”
Inspectors found the emergency department now had number of steps in place to improve their infection prevention and control practice. Since the August inspection Personal Protective Equipment (PPE) equipment was more effectively used throughout the department and all staff washed their hands between patient contact.
CQC found that staff wearing clean and dirty scrubs were sharing two small toilet cubicles at the start and end of shifts, and these were not cleaned with an enhanced cleaning schedule. This lack of separate changing areas caused a risk of cross contamination. Senior leaders were aware of this risk and the trust were looking at ways to improve access to changing areas for staff. This was not documented as a risk on the department’s risk register but this was later added as a result of the inspection. The trust also confirmed with CQC a plan for ‘changing pods’ to be introduced to the emergency department.
Staff were fit tested for masks and some staff were using respirator masks. These masks required filters to be changed on a monthly basis and staff were required to sign to confirm they are responsible for changing the filter on their masks. However, there were no processes in place for filter changes and no assurance staff followed the recommended maintenance. This was not in line with the Health and Safety Executive (HSE) guidelines.
Staff were knowledgeable about patient pathways, however, they reported that some bed placements made by the bed management team were sometimes unclear. For example, a non-COVID-19 patient was admitted overnight for surgery in a ward for respiratory or COVID-19 positive patients.
Inspectors found that nurses and consultants on Bevan ward and the acute medical unit had variable knowledge around the steps involved in the putting on and taking off PPE. There were some posters showing how to do this, however, they were placed in areas where staff could not read them easily, for example, outside a bay or patient room.
There were now weekly PPE checks as part of the matron audit, weekly lead nurse walk arounds and a Quick Question Assessment (QQA) review where any issues around PPE and infection, prevention and control could be identified and challenged. Information from these audits were submitted to CQC on a weekly basis as part of the trust’s ongoing monitoring.
All Black, Asian and Minority Ethnic (BAME) staff within the department had undergone a risk assessment to identify any needs and manage any concerns. The trust had decided to widen this to all staff. This was to ensure risks were identified and managed effectively.
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