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Yorkshire trust improves but critical care nurse shortage remains

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Nurse staffing levels in critical care services at Airedale NHS Foundation Trust have improved but there are still shortages, a spot check by the Care Quality Commission has revealed.

Inspectors made an unannounced visit to the critical care unit and some of the medical wards at Airedale General Hospital in September last year to look at specific areas of concern that emerged during and after a full inspection in March 2016.

“Inspectors reviewed staffing data …there was a general improvement in nurse staffing levels. However, there still remained shortfalls on some shifts”

CQC

These included concerns about nurse staffing and the risk of patients deteriorating without adequate monitoring or action.

At the most recent check the regulator found a raft of improvements had been made in critical care but also identified areas where there was still work to be done.

Since the March 2016 inspection the trust had drawn up a critical care action plan and achieved the majority of key goals.

Changes in senior leadership and support for staff had also been made, with a dedicated lead nurse, matron and nurse consultant working on the unit.

Meanwhile the clinical nurse educator had been given more time to carry out their role and was working alongside staff or releasing them to attend training.

Some beds on the unit had been closed to help maintain safe staffing levels although it was still at “maximum capacity”, according to staff.

“Inspectors reviewed staffing data for three months and saw there was a general improvement in nurse staffing levels. However, there still remained shortfalls on some shifts,” said the latest inspection report on the trust, published this month.

“We found in six patient records that clinical observations had not always been completed in the specified timeframe”

CQC

In July 2016, the actual number of registered nurses was below the planned number on 23 day shifts and 17 night shifts, it said.

Inspectors also flagged up the fact the unit only had 12 staff out of 42 available for duty at the time of the inspection, which showed staffing “continued to be a challenge”.

Other developments included the introduction of two-person equipment checks after a serious incident occurred in April 2016.

Under the new system staff should check “high risk” equipment with another nurse at the start of each shift or for every new admission – and this should be recorded on bedside observation charts. However, inspectors found this did not always happen.

Issues in medical care were also identified, including records not being stored securely on one ward and nursing notes left in cardboard boxes on the nurses’ station.

“[Staff] have embraced the action plan and the position now, six months later, is very different…However, there is never room for complacency”

Karl Mainprize 

Inspectors also looked at the process for monitoring patients and deciding whether to escalate treatment.

“All staff we spoke with were able to describe the process they would follow,” said the report.

“However we found in six patient records that clinical observations had not always been completed in the specified timeframe,” it added.

The trust’s medical director Karl Mainprize said the organisation had already addressed or was working on many of the issues raised by the CQC.

“The report highlighted some areas for improvement, particularly around documentation, equipment checks and the completion of patient records,” he said.

“These areas are included in an action plan that we developed last autumn and we are already making good progress to ensure that we meet all the requirements for improvement,” headed.

He praised critical care staff “who work extremely hard to care for our most seriously ill patients”.

“I know that they have embraced the action plan and that the position now, six months later, is very different.

“However, there is never room for complacency, and as a trust we always work on continuously improving our services so that we can give our patients the best care possible,” he said.

A trust spokeswomkan added: “On behalf of our interim director of nursing, Jill Asbury, I can confirm that the trust has fully recruited to all the nursing posts in critical care.”

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