21-23 November 2022
During a routine inspection
Alexandra Hospital
Medical Care (including older people's care):
Our rating of this location stayed the same. We rated it as requires improvement because:
- Staff did not always have training in key skills. Mandatory training levels for medical staff did not meet the trust target of 90%.
- The service did not always have effective processes in place to protect patients from harm during the discharge process. Patients were regularly admitted onto discharge units against standard operating procedure criteria.
- The service did not always have safe process and systems in place to manage the prescribing, storage and monitoring of medications.
- Not all staff felt respected, supported and valued.
- Leaders at the service did not always have oversight of the risks to patients or take action to reduce the risks.
- Staff did not always share key information to keep patients safe when handing over their care to others.
- The service did not have dedicated Medical staffing for discharge lounge, causing delays in discharge and risks to deteriorating patients.
- Medical staff did not keep up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards.
However:
- The service had enough staff to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
How we carried out the inspection
We inspected this service on 21, 22 and 23 November 2022. This was an unannounced full core service inspection looking at medical care. We visited all medical wards and speciality services. Areas we visited during our inspection included:
- Ward 1 (Discharge Lounge)
- Ward 2
- Ward 3
- Acute Medical Unit
- Acute Emergency Care
- Medical Short Stay Unit
- Endoscopy
- Cardiology
- Ward 11 – Frailty Ward and General medicine
- Ward 12-– Frailty Ward and General medicine
- Ward 18 – Pathway Discharge Unit
The team that inspected the service comprised of 1 CQC inspector, 2 Inspection Managers, 1 Assistant inspector and a specialist advisor with expertise in medical care.
During our inspection we spoke with 15 staff members including nursing staff, healthcare assistants, medical staff and managers. We spoke to 8 patients and we reviewed 10 sets of patient records.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
Urgent and Emergency Care:
Our rating of urgent and emergency care improved. We rated it as requires improvement because:
- Staff did not always have training in key skills. Mandatory training levels for medical staff did not meet the trust target of 90%.
- Staff did not always have the training in safeguarding at the appropriate level.
- Patients were being cared for in the corridor which was not always dignified.
- The service did not have paediatric nurses and not all nurses were trained in paediatric competencies.
- Staff did not always assess the risks to patients in a timely manner.
- The service had systems and processes to prescribe and administer medicines safely, however, it did not always meet the needs of the patient.
- There was a good relationship with the pharmacy service to ensure medicines were available, however, there was no clinical pharmacy service within the emergency department.
- Medicines were not always stored safely or appropriately to reduce the risk of errors.
- Staff did not always give pain relief to patients when they needed it.
- The service planning did not meet the needs of the patients.
- There were delays in moving patients off ambulances into the department. This resulted in delays in assessment and treatment for some patients.
- Staff did not understand the service’s vision and values, and how to apply them in their work.
- Managers did not always have oversight for some of the issues within the department including lack of paediatric nurses, duplicating of medicine charts and lack of strategy for managing the poor flow.
However:
- The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. The service managed safety incidents well and learned lessons from them.
- Managers monitored the effectiveness of the service and made sure staff were competent. Key services were available seven days a week.
- Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
How we carried out the inspection
We inspected this service on 21 and 23 November 2022. This was an unannounced full core service inspection looking at urgent and emergency care. We visited all areas of the emergency department including the waiting rooms, resuscitation, minors, majors and early decisions unit.
The team that inspected the service comprised 3 CQC inspectors and 2 specialist advisors with expertise in emergency medicine.
During our inspection we spoke with 44 staff members including nursing staff, healthcare assistants, ambulance staff, cleaners, doctors and managers. We spoke to 15 patients and we reviewed 18 patient records.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.