Lack of specialist substance misuse training for nursing staff at the Nightingale Hospital in London is putting patients at risk of “serious harm”, according to the Care Quality Commission.
This was among key safety issues raised by inspections who visited the independent mental health hospital in January this year, which once again rated it as “requires improvement” overall.
“Five registered nurses had not received sufficient specialist training concerning substance misuse”
Other issues highlighted in their report, published on Thursday, include concern about ligature and fire risks, medicines management, infection control and sharing learning from incidents.
However, inspectors also found patients were “very positive” about nursing staff and rated the hospital “good” for being caring.
While inspectors found some improvements had been made since the hospital was last inspected in February 2017, they concluded many basic issues had not been properly addressed.
In particular, they highlighted lack of training for nurses working in the hospital’s substance misuse and detoxification ward.
“At our previous inspection in February 2017, we found that staff working on the substance misuse and detoxification ward were not provided with formal specialist training to work in this service,” said the report.
“At the current inspection, five registered nurses had not received sufficient specialist training concerning substance misuse,” it said. “This placed patients at risk of harm, as interventions to protect patients from harm were not consistently carried out.”
“When asked, most ward staff were unable to describe the incidents which had occurred”
Inspectors said they spoke to five registered nurses, including three that worked regularly on the substance misuse and detox ward, and found none of them could describe the purpose of naloxone – a potentially life-saving medicine used to treat opiate misuse and overdose.
“Patients who periodically left the hospital during opiate detoxification treatment were not prescribed or supplied with naloxone in case of emergency,” said the CQC in its report.
“It may not be suitable for all patients, but the reason for not offering it was not recorded either. Failure to prescribe or supply it to patients who might benefit from it and to train family members and staff to use it placed some patients at serious risk of harm,” the report said.
Inspectors also found a lack of knowledge when it came to treating dangerous alcohol withdrawal symptoms.
“Two registered nurses were unclear about the action they should take in the event that a patient experienced an alcohol withdrawal seizure. This placed some patients at risk of serious harm,” said the report.
They found staff “were not clear about the validated tools to use for patients on detoxification from different substances” and did not have regular appraisals.
“Patients undertaking detoxification were not sufficiently protected from harm, restrictions on leave from the hospital were not always implemented, physical health monitoring was not always followed through and early exit from treatment plans were not in place,” the report added.
“Patients we spoke with were very happy with the nursing support they received”
There were also concerns about insufficient training when it came to supporting patients with eating disorders.
“Although the staff who worked on the ward displayed a knowledge and understanding of providing treatment to a patient with an eating disorder and had experience of working in this type of service, they were not supported by a formal core competency framework, regular specialist training or a specialist induction to the ward,” said the report.
It added: “A comprehensive training programme was not yet in place, although some specific training had been delivered on nasogastric feeding.”
Meanwhile, inspectors found charge nurses in specialist eating disorder services “had limited information to support them with their management role”, such as audits to reflect the performance of the service, staffing and patient care”.
But they found a “positive reporting culture for incidents”, with about 40 incidents reported each month by hospital staff across the hospital most commonly relating to the use of illicit substances and self-harm.
However, they said it was clear key information was still not filtering down to frontline nursing staff.
Previously, they found most staff “could not describe any learning from incidents”. Incidents were meant to be discussed at ward team meetings, but these did not happen very often.
“At this inspection, we found that the compliance manager shared the analysis of incidents with the charge nurses on each ward,” said inspectors from the regulator.
“However, when asked, most ward staff were unable to describe the incidents which had occurred and the changes that had been made as a result,” said the CQC.
While work was under way at the hospital to reduce potential ligature points, such as replacing taps and bathroom doors, inspectors found staff were not able to clearly explain how patients were protected from ongoing risks.
“At our previous inspection in February 2017, we found there were ligature risks throughout the wards and staff were unable to explain how these would be mitigated,” said the report.
“Maintenance work was being undertaken to reduce ligature risks, however, staff were still unable to explain where some of the remaining ligature risks were located,” it said.
Dr Paul Lelliott
But the inspection team did find plenty of examples of excellent nursing care across the hospital, including on the detox unit.
“Patients we spoke with were very happy with the nursing support they received. They described nurses as kind, considerate, compassionate and interested in them,” said the report.
Nevertheless, CQC deputy chief inspector and mental health lead, Dr Paul Lelliott, said there had been “no overall improvement” at the hospital since inspectors last visited.
“It is of particular concern that our most recent inspection identified so many basic problems that affect patient safety,” said Dr Lelliott.
“It is not acceptable that managers do not work to minimise fire risks, ensure that infection control procedures are followed or that medicines are managed safely,” he said.
“However, we did rate the caring key question as good at Nightingale Hospital. In keeping with this, patients gave very positive feedback about staff there,” he added.
Nursing Times has contacted the mental health provider for comment.