The Care Quality Commission (CQC) has published two reports following focused inspections of the medical care services (including older people’s care) at William Harvey Hospital and Kent and Canterbury Hospital, following inspections in May. Both hospitals are run by East Kent Hospitals University NHS Foundation Trust.
In October, CQC carried out a focused inspection at William Harvey Hospital to look at how safe the medical care service was, after receiving information of concern from staff, stakeholders and members of the public about poor infection control practices. The service was then rated inadequate for being safe.
Following the latest inspection in May, the rating for safe has improved from inadequate to requires improvement. The overall rating for the medical care services remains requires improvement.
William Harvey Hospital was not re-rated during this inspection so the previous overall rating of requires improvement remains. However, the overall rating for safe for the hospital has improved from inadequate to requires improvement.
Inspectors also looked at the medical care services at Kent and Canterbury Hospital to look at how safe, effective and well-led the service was. Following this inspection, the previous rating of requires improvement overall remains in place. The hospital is rated requires improvement overall.
Amanda Williams, CQC’s head of hospital inspection, said:
“I am pleased to report that since our last inspection, leaders have worked hard to improve infection control practices in the medical care services departments at both hospitals, although some improvements still need to be fully embedded, particularly at William Harvey Hospital.
“We also found that there was a positive culture in the service across both hospitals, and staff felt empowered to report incidents. These were fully investigated by managers and, importantly, learnings were shared with the wider team.
“However, in both hospitals we were concerned to find that patient records were not always up-to-date, and some important risk assessment information was missing, including details about people’s fluid balance. This was despite being told by the coroner in July last year that fluid balance monitoring needed to improve to prevent patient future deaths. This was after fluid overload contributed to the death of a patient in the hospital. Across both hospitals, our inspectors found records relating to people’s fluid balances were consistently incomplete or not completed at all. It is important to check how much fluid patients take on and how much goes out, otherwise people could be at risk of dehydration or becoming overloaded with fluid.
“Trust leaders told us they would address our concerns as a matter of urgency, and we will continue to monitor their progress.”
In both hospitals, inspections found:
- The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave staff a full induction
- The service controlled infection risk well, although further improvements were needed at William Harvey Hospital. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean
- The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well
- The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the team. When things went wrong, staff apologised and gave patients honest information and suitable support
- The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
At William Harvey Hospital, inspectors found:
- The service provided mandatory training in key skills to all staff and there were systems to monitor compliance
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it
- Staff completed risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration
- The service used systems and processes to safely prescribe, administer, record and store medicines. Records were stored securely and easily available to all staff providing care.
However:
- Not all staff had completed their mandatory training
- Not all staff washed their hands before entering wards and social distancing guidance was not always followed
- Risk assessments were not always updated. Staff did not consistently monitor patients for risks related to fluid balance, sepsis or developing venous thromboembolism
- Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear and up to date
- The service did not always monitor the ambient temperature of areas being used to store medicines.
At Kent and Canterbury Hospital, inspectors found:
- Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear
- The trust had effective systems to ensure that standards of cleanliness and hygiene were maintained and offered protection and safety for staff and patients
- Staff knew how to access the policies and how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them
- Staff stored and managed medicines and prescribing documents in line with the provider’s policy. This included patients own drugs, medicines requiring refrigeration and controlled drugs
- Nursing staff told us they were given enough time and support to do their mandatory training.
However:
- Staff did not always complete comprehensive risk assessments upon patient admission
- Staff did not always update risk assessments for each patient and did not always record what actions they had taken to mitigate any risks
- Staff did not always keep detailed records of patients’ care and treatment and records were not always clear. Staff did not always follow the trust’s guidance for dealing with deteriorating patients
- Not all staff had the knowledge around how to escalate concerns about patients with mental health conditions out of hours
- Nursing and medical staff had not met the trust target of 85% for dementia training. Nursing staff had not met the trust target of 85% for hand hygiene and adult basic life support. Medical staff had only met the trust target of 85% for one of the mandatory training topics.
Read the reports published on the CQC website:
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