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Chesterfield hospital criticised by CQC for 1:15 nurse staffing ratio

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Concerns have been raised by the Care Quality Commission about low nurse staffing levels at night at Chesterfield Royal Hospital Foundation Trust, following an inspection.

Overall the trust was rated “requires improvement” by the regulator’s team of inspectors, which  spent four days at the hospital in April.

Following the visit – which found some medical wards operating at night with up to 15 patients to just one registered nurse –  the trust took immediate action to review staffing levels, said the CQC in its report on the trust.

“Staff told us they thought their response to call bells was lengthier, especially during the first part of the night shift, and patient falls were more prevalent”

CQC report on Chesterfield Royal Hospital

The inspectors noted this ratio was in breach of safe staffing guidance from the National Institute for Health and Care Excellence for adult inpatient wards.

“Staff told us they thought their response to call bells was lengthier, especially during the first part of the night shift, and patient falls were more prevalent although data recorded in the trust incident system did not support this perception,” said inspectors in their report on the trust.

“Night staff also told us that antibiotic and other medicines were frequently given late. On the night we visited the nurse was still administering evening medications at 11.30pm when they were due to finish at 9pm,” they added.

“Night staff also told us that antibiotic and other medicines were frequently given late”

CQC report on Chesterfield Royal Hospital

Since raising concerns with the trust, the CQC  has received regular updates from the director of nursing. The trust also pledged to look at skill mix on the wards and launch a “red flag system” so staff could escalate concerns about staffing levels.

Other concerns about staffing raised by the CQC included the fact the trust did not have a senior children’s nurse on duty at all times to support the nursing team, having struggled to recruit suitably experienced candidates.

The trust was also told to improve the monitoring of seriously ill patients in its high dependency unit and support for staff to identify and manage very sick patients on the wards, and improve assessments of patient’s mental capacity to make decisions about care.

“We need to build on all the positives [from the inspection] but our focus at present is on the areas where we need to make improvements”

Lynn Andrews

However, inspectors also noted much good practice and the trust was rated “good” overall for both caring and the effectiveness of services.

Inspectors praised efforts to make the hospital environment for being “dementia-friendly”. Meanwhile another example of “outstanding” practice was the fact each clinical area had its own improvement plan.

Director of nursing and patient care Lynn Andrews said she was “delighted” at the areas of positive practice highlighted in the report.

“We need to maintain and build on all these positives but our focus at present is on the areas where we need to make improvements,” she added.

The trust has put an action plan in place to address the key areas for improvement identified by the CQC within three to six months.

“The inspection has brought a ‘fresh pair of eyes’ examining what we do and suggesting ways to make the care we provide even better. The report will enable us to do just that, highlighting a range of improvements we are already on track to deliver,” said trust chief executive Gavin Boyle.

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Readers' comments (2)

  • milton pena

    The solution to eliminate under-staffing - a daily occurrence during an average of 10% of shifts - in NHS hospitals, is to introduce mandatory minimum nurse-to-patient ratios through legislation. This is not unrealistic and has been introduced in various developed countries and various USA states. I have campaigned for this and hopefully will publish a book soon of my experience at Tameside Hospital.

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  • I used to work in a hospital (in Scotland) where it was normal to have 1:15 ratio on the night shift and this still happens. All the wards in the hospital were the same. So why isn't something being done? There needs to be proper minimum levels put in place.

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