Shrewsbury and Telford Hospital NHS Trust has been told “further improvement” is needed in the safety of its maternity units, as well as ensuring sufficient nursing staff are on duty generally.
Following its latest visit to the Midlands trust at the end of last year, the Care Quality Commission concluded some areas had got better since its last inspection in 2014, but more work was required.
“More action is needed to ensure these changes are fully embedded and sustained”
Inspectors highlighted that “safety needed further improvement” in maternity services. For example, learning from safety incidents was not always being shared with all staff, said the CQC in its report.
“The maternity specific safety thermometer was not being used to measure compliance with safe quality care,” stated the CQC’s report, which was published earlier this week.
It added that a lack of regular post-natal ward rounds meant high risk women were not regularly reviewed and medicines management was also flagged as a concern in the Wrekin midwife-led unit.
The trust’s main maternity unit at the Princess Royal Hospital was rated as “requires improvement” overall and “requires improvement” for being safe and well led.
The CQC also warned that the organisation’s two emergency departments were “experiencing continued pressure” and some patients had to wait too long for initial assessment.
“The inspectors had some concerns regarding embedded safety and culture”
In addition, the trust was told that all patients brought in by ambulance must be promptly assessed and triaged by a registered nurse.
Sufficient nursing staff must also be on duty to provide safe care for patients, warned the CQC, stating that an acuity tool should be used to match staffing requirements with patient dependency.
“Nursing staff vacancies were affecting continuity of care and an acuity tool was not used to assess staffing requirements,” said the CQC report. “The triage process for patients brought in by ambulance was inconsistent and unstructured.”
All staff must also have up to date mandatory training and an understanding of how to assess mental capacity under the Mental Capacity Act 2005, noted the regulator.
Meanwhile, in surgery, the trust was told it must ensure it met the referral to treatment time for admission pathways and improve use of the World Health Organization’s ‘safer surgery’ checklist.
Trust told to improve staffing and safety in maternity units
In addition, the CQC called for better infection prevention and control associated with the mortuary department. This “must be ensured through the decontamination of surgical instruments and making sure arrangements are in place for regular deep cleaning”, it said.
However, the CQC noted that progress had taken place in several areas, including end of life care, where concerns were highlighted following the regulator’s previous inspection in October 2014.
The trust’s rating for providing effective services had also improved and was upgraded from “requires improvement” to “good”. Its overall rating remains as “requires improvement”.
The CQC said there was evidence of strong multi-disciplinary team working on all wards and clinical staff were involved in handover meetings to ensure patients received co-ordinated care.
The inspectors also highlighted some areas of “outstanding” practice, including that the trust was working with the Virginia Mason Institute to improve care for patients, for example, on sepsis.
In addition, the CQC noted that the palliative care team had developed a fast-track checklist to provide guidance to ward staff on what to consider when discharging an end of life patient.
The trust was also praised for introducing the ‘Swan Scheme’, which provides resources for staff and practical measures for patients at the end of their lives and their families – including Swan boxes, bags and end of life information files for staff, as well as a Swan bereavement suite.
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Professor Ted Baker, the CQC’s chief inspector of hospitals, “commended” staff for the range of improvements observed at the trust.
“End of life care services had made significant progress and we noted a positive change in culture among staff and leaders at the trust,” he said.
However, Professor Baker noted that the trust “still has some way to go on its improvement journey”.
He specifically highlighted “maintaining appropriate staffing levels in the emergency department and ensuring a strong safety and learning culture within maternity services”.
“At the time of our inspection, new senior leaders had started to make positive changes in the trust’s maternity service, but more action is needed to ensure these changes are fully embedded and sustained,” he added.
Shrewsbury and Telford Hospital provides district general hospital services for almost half a million people across Shropshire, Telford and Wrekin.
It runs two main locations, Royal Shrewsbury Hospital in Shrewsbury and Princess Royal Hospital in Telford. The trust also provides services at Ludlow, Bridgnorth and Oswestry Community Hospitals.
The CQC visited the Princess Royal, the Royal Shrewsbury and its five mid-wife-led maternity units during 12-15 December 2016. Subsequent unannounced visits also took place on 30 December and 3 January 2017.
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In response, Deirdre Fowler, the trust’s director of nursing, midwifery and quality, said: “Clearly, our overall rating of ‘requires improvement’ tells us we are still on a journey and that there are areas where we can and must make improvements.
“The report states that our maternity service is in a transitional period and although new senior leaders have started to make positive changes, the inspectors had some concerns regarding embedded safety and culture,” she noted in a statement.
Ms Fowler said the trust had commissioned the Royal College of Obstetricians and Gynaecologists to “help in this regard” and internally taken action to improve patient safety, as part of its work with Virginia Mason.
But she added that she was pleased that the CQC had noted improvements in end of life care and an “increasing atmosphere of openness, honesty and candour” at the trust.