An out-of-hours care centre in Peterborough has been placed into special measures by the Care Quality Commission after inspectors found problems, including nurses triaging patients without appropriate training.
The centre, run by Cambridgeshire Community Services NHS Trust, was rated “inadequate” overall following an inspection in November.
”The provider must ensure that all staff who triage patients have been adequately trained to make clinical decisions by telephone and have been assessed”
In its report on the service – which is based at the City Care Centre – the regulator said “patients were at risk of harm because systems and processes were not always in place to keep them safe”.
There was no evidence nurses carrying out telephone triage had been trained in extended skills such as history taking and minor illness, said the CQC’s report.
In addition, these nurses did not have access to telephone-assisted software or readily available guidelines to ensure the safety of the assessment process, it added.
There was also no evidence of them having been assessed through examination or supervised practice following a specialist course in the use of telephone-assisted software, said inspectors.
Meanwhile, the system for assessing the competency of nurses who administered medicines under patient group directions (PGDs) – which allow specified staff members to administer to a patient with an identified clinical condition without the need for a prescription – was “not effective”, according to the CQC.
“We saw evidence that nurses had been signed off as competent to administer the medicines referred to under a PGD. However, for one member of staff, this was signed as recently as the day of our inspection, despite this member having worked at the service for two years,” said the report.
”For one member of staff, [the PGD] was signed as recently as the day of our inspection”
Following the inspection, the service confirmed to the CQC that staff not signed off on PGDs did not administer medication that were regulated by them until PGDs were signed and competency assessed.
Meanwhile, inspectors raised concerns around safeguarding, noting that following a period of 72 hours after a referral had been made and there had been no update, these were not being followed up.
Inspectors said the centre must make a range of improvements including ensuring staff are adequately trained and assessed to make clinical decisions by telephone, that medication administration protocols are recorded and that safeguarding referrals are followed up.
In its assessment of how caring the service was, the CQC rated it as “good” noting all patients said they were treated with compassion, dignity and respect.
However, due it its overall rating the service has been placed in special measures for six months, after which it will be re-inspected. It will be at risk of being de-registered if it is still providing “inadequate” care at this time.
Janet Williamson, deputy chief Inspector of general practice and dentistry in CQC’s central region, said: “We found that patients were at risk because systems were not always in place to keep them safe. The provider must ensure that all staff who triage patients have been adequately trained to make clinical decisions by telephone and have been assessed.
“Additional actions continue to be taken forward and the vast majority of these will be fully implemented by the end of February 2016”
“We will continue to monitor this service and we will inspect again in six months to check whether improvements have been made,” she added.
In a statement, Matthew Winn, chief executive of Cambridgeshire Community Services Trust, said it had taken “immediate actions” in response to CQC concerns about evidencing safe practice.
This included the introduction of new clinical protocols for nurse consultations over the telephone and re-establishing monthly clinical supervision for every employed nurse.
“Additional actions continue to be taken forward and the vast majority of these will be fully implemented by the end of February 2016,” he said.
“We have every intention of ensuring the service achieves a ‘good’ rating from the CQC at its re-inspection of the GP out-of-hours service in six months,” he added.