The Care Quality Commission (CQC) has warned the Isle of Wight NHS Trust that services provided in the emergency department at St Mary’s Hospital in Newport must improve as a matter of urgency.
CQC carried out a focused inspection in the emergency department at the hospital in January 2019, as part of a programme to assess safety during the winter period.
After the inspection CQC issued a Warning Notice requiring the trust to take immediate action to address concerns about the safety and quality of patients’ care in surgery. At times care and treatment was not always provided in a way that reduced risks to patients. The warning notice highlights:
Patients were cared for and treated in non-designated areas for care in the emergency department, which increased the risk of them not having the right assessments, care and treatment.
Patients were not always assessed in a timely or safe manner, or assessed by staff who were suitably qualified.
There were not enough staff on duty to deliver safe care and treatment to patients.
Dr Nigel Acheson, CQC’s Deputy Chief Inspector of Hospitals for the South, said: “While we can acknowledge winter is a busy time for hospitals this should never impede on patient care. Our inspectors visited the emergency department of St Marys Hospital at the end of January and were not assured that patients were not being treated promptly enough and in areas which were not designated as care areas.
“Handovers from ambulance teams to the hospital were done in a timely manner but there was again concern that the initial assessment for patient treatment was not always seen by a nurse in the first instance. This is unacceptable and we have warned the trust that we want immediate improvements within the emergency department to ensure people receive the high-quality care they deserve.
“We will continue to monitor the trust extremely closely and will return to inspect services again on an unannounced basis in the near future.”
Inspectors found that despite recent recruitment there remained a noticeable shortage of qualified nurses. In the month prior to the inspection there was heavy reliance on agency nurses. Although agency nurses are fully qualified they do not always have the specialist experience of working in that particular emergency department before.
Staffing information displayed in the department during the inspection showed that eight nurses were expected to be on duty but only six were present. As a result of this, the nurse in charge was having to assess newly arrived ambulance patients, look after patients requiring care in the corridor, assist in the resuscitation room, take over from nurses on meal breaks as well as co-ordinate the care of all the patients in the department. It was not possible for one nurse to do all of this and inspectors found several aspects of patient care had not been completed.
There were periods during the inspection when there were no nurses in the major treatment area, the minor treatment area or the rapid assessment area. There had been a review of nursing levels in September 2018, but it was not clear whether the increase in nursing numbers would be implemented.
The first assessment of ambulance patients did not take place according to national guidance. Although a handover generally took place within 15 minutes of arrival, there was no face-to-face assessment of these patients by an experienced nurse. Subsequent observations and assessments were often undertaken by a healthcare assistant.
The department was crowded throughout the inspection with patients receiving care and treatment in corridors. One patient had been in the department for 15 hours and had been nursed in the corridor for three hours.
During a review of the records of patients four out of six patient safety checklists were incomplete.
Isle of Wight NHS Trust is currently rated as Inadequate and is in special measures. This inspection was not rated and does not change the overall rating for the trust.