Patients have been put at risk because of staff shortages at one of the busiest accident and emergency departments in the country, according to regulators.
A report from the Care Quality Commission said patients’ safety and health and welfare needs were not being met in the accident and emergency department at Bradford Teaching Hospitals Foundation Trust because of insufficient staffing levels.
The trust has pledged to address “unacceptable” staff shortages in light of the CQC’s warning.
Inspectors also witnessed examples of poor nursing care during unannounced visits to Bradford Royal Infirmary in September and October 2013.
Overall the trust failed to meet four out of six key quality and safety standards reviewed by the CQC, according to a report published on 8 January.
“The issues identified at Bradford are unacceptable and the trust must take further action to ensure national standards are met,” said Malcolm Bower-Brown the CQC’s regional director for the north.
Inspectors identified staff shortages across a number of wards and departments particularly in Accident and Emergency and raised concern about skills-mix in some areas.
When they reviewed the A&E duty rota for nursing staff covering a four-week period they found “shortfalls in nursing staff every day”.
“One week there were 18 shifts not covered by a registered nurse and nine shifts not covered by a healthcare assistant,” said the report.
The report found “people’s dignity and privacy was regularly compromised” in A&E and inspectors recorded several incidents on other wards where nursing staff “did not communicate with patients in an appropriate or respectful way”.
On one occasion a member of staff was observed shouting down a corridor at a confused patient on an elderly care ward.
In another incident on a surgical ward inspectors were forced to intervene when a staff member apparently ignored a patient in distress.
“We heard them groaning and it sounded like they were in pain. During the next 10 minutes the person continued to make the bed and did not attend to the patient,” said the report.
However the report also recorded examples of good nursing care and featured many positive comments from patients.
Chief nurse Juliette Greenwood told Nursing Times immediate action was taken to address specific incidents highlighted in the report.
Meanwhile the trust was undertaking a wide range of quality improvement work from ward to board level – some of which was already under way when the CQC came in.
“Action was taken at the time but we have also started to dig underneath that, working with ward managers and matrons,” she said.
“We have a trust action plan but that’s owned at a local level, which for me is really important especially when it comes to looking at concerns around dignity, privacy and care and breaking that down into really tiny elements.”
The trust was also making a huge effort to address staffing issues, including investing in extra nursing and medical posts and now had “a very strong grip on recruitment”, added Ms Greenwood.
When CQC inspectors visited in the autumn there were 118 vacant nursing posts but the trust has since recruited 58 nurses and A&E was now “fully recruited” when it came to nursing staff.
“We now have about 50 vacant posts - around 4% of our nursing workforce - which is not an adverse position to be in,” said Ms Greenwood.
“However, we are not complacent and our aim is to get up to fill recruitment and then to get ahead of the curve a bit.”
Before the CQC published its report, the trust had already committed to reviewing nursing staff levels three times a year.
Efforts to ensure best practice also included reviewing and re-vitalising key policies around dignity and care, and the introduction of “nursing quality dashboards” to display performance data and staffing information. The trust plans to publish this data online in the future.
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