Hereford A&E needs improvements after CQC inspection

In a report released today (February 27), inspectors said the emergency medical services provided by Hereford County Hospital’s emergency department were: “Improvement is necessary,” he said.

The hospital is run by Wye Valley NHS Trust, which spoke out following the inspection.

Read more: Hereford Hospital issues statement after harsh criticism from inspectors

The inspection assessed five key areas of the service, with a rating of ‘good’ in the ‘caring’ category, ‘responsiveness’, ‘good guidance’, ‘requires improvement’ in the ‘effective’ category and ‘requires improvement’ in the ‘effective’ category. It was rated as “inadequate”. Safety” category.

what needs to change

Inspectors should be aware of any issues within the department, such as the layout of the department, where some patients may not be visible to staff, overcrowding, which may result in patients being cared for in corridors or remaining in ambulances, or the mental health environment. discovered many problems. It was “inadequate” for patient safety.

The report highlighted problems with departments being left in clutter while staff did not have ready access to equipment in case of an emergency. In one instance, examiners said there was no bleeding or trauma packs in the resuscitation room, but the chest drain drawer contained primarily bandages.

“Staff stated that equipment was removed when the area was ‘cleared out’ and not replaced,” the report states.

Some staff working in pediatric departments had not completed pediatric lifesaving training, pediatric competency, and child safety training, while non-clinical staff, if not trained in clinical decision-making, was expected to escort the patient to the minor injury waiting room. The overall training completion rate for nursing staff in the department was 80.3%, the report said.

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The report also said there was a shortage of consultant-level medical and nursing staff to care for patients and keep them safe without mobilizing large numbers of bank, agency and local government staff. The number of consultants was significantly below the recommendations of the Royal College of Emergency Medicine and there were no pediatric emergency consultants in line with the requirements of the Royal College of Paediatrics and Child Health.

Additionally, issues were found in record-keeping and medication management, making it difficult for staff to identify and quickly respond to patients at risk of worsening symptoms, maintain appropriate treatment records, and monitor patient routines in line with local guidelines. It was not possible to observe it directly. Not all patients are guaranteed to receive their medications on time, including time-sensitive medications, and patients are not always provided with regular meals and drinks was.

Three of the 12 patient records examined showed that triage was not completed, all 12 showed that hourly observations were not performed as required, and some staff were concerned about sepsis. They lacked sufficient awareness of assessment and treatment and did not always act quickly. to reduce risk.

“Staff said they did not have time to complete observations and management was aware of this,” the report said.

According to the report, capacity issues have worsened hospital flow and delays in discharging patients who are safely discharged, resulting in many patients remaining in accident and emergency situations for extended periods of time, and overcapacity leading to patient declines. They said they couldn’t always access services when they needed them.

Inspectors said staff had been increased to address these issues by the time of the second visit at the end of the month.

A lack of regular and consistent audits, risk management and learning from incidents was also criticized, with no action taken to drive improvements when audits were conducted.

“With no formal learning taking place from incidents that occurred within the department, staff could miss out on important learning and improvements needed from incidents. They did not tell us about the changes that had been made,”’ the report said, adding that inspectors shared learnings in shift “safety meetings” and encrypted social messaging groups.

“There was no mechanism to notify staff who did not attend meetings or use the messaging group, so it was not clear whether all staff were included, updated, or engaged. ” said the inspectors.

good point

Despite the problems found, some good points were also found during the inspection, with inspectors saying staff worked as a team for patients, supported each other and primarily treated patients with compassion and kindness. , said they were helpful and considerate of individual needs. They understand their situation. They provided emotional support to patients, families, and caregivers.

The report said staff were under pressure due to high patient numbers and departments unable to cope with demand and capacity, and staff did their best to provide compassionate care to these patients in difficult circumstances. .

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The report said infection risks were largely well controlled and equipment and facilities were visibly clean, although hand washing was not always done when required.

Leaders are visible and approachable to patients and staff, while staff who define their roles and responsibilities and are committed to improving services feel respected, supported and valued. A good teamwork-based culture existed within the department.

“Following feedback to the senior leadership team following the initial site visit, improvements were underway to seriously address many of the concerns we raised,” the report said.

What a trust must do

Risks to health and safety are exacerbated by documented regular observations, clinically led patient navigation within the department by trained and experienced staff, and on-time management of patient medications. It must be evaluated through patient assessment and response, and response to risks such as sepsis. Patients with pressure ulcers, falls, and pain.

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The Trust also ensures that it has sufficient trained, suitably qualified, competent, skilled and experienced staff to carry out its duties, and that they have adequate competence in safeguarding and life support. It was also said that there was a need to ensure that medical personnel were properly trained and had adequate medical staff. Operates the department safely and effectively, including Pediatric Emergency Medicine Consultants.

We also need to ensure that we do everything reasonably practicable to reduce risk through effective and safe care for patients who require ongoing treatment but do not have timely access to hospital beds. there is.

Finally, inspectors said they must ensure systems and processes are in place to assess, monitor and improve the quality and safety of services provided as regulated activities continue. Risks related to the health, safety and welfare of patients and those who may be exposed to risks arising from the continuation of regulated activities must be assessed, monitored and mitigated, and effective governance systems, risk profiles and audits are required. Must have a program. We provide safe, high-quality care and ensure that areas for improvement are identified and addressed.