Colchester General Hospital has been told it must make rapid improvements on its surgery and medical care inpatient wards after the Care Quality Commission found a series of problems including staffing shortages and poor record completion.
The regulator used its urgent enforcement powers to place conditions on the trust’s registration following an unannounced inspection in July prompted by concerns around staffing, performance and quality of care.
The hospital is run by Colchester Hospital University Foundation Trust, which has been in the CQC’s special measures regime since 2013.
“Administration of medicines on rounds was delayed and this was linked to the staffing levels not being sufficient on the wards”
CQC report on Colchester General Hospital
During this most recent inspection of seven wards at Colchester General, the CQC found staffing levels were not routinely determined by taking into account acuity and dependency of patients.
Instead, staffing ratios were decided on numbers of nurses per patients.
Inspectors warned that while planned nurse staffing levels were met - with the support of agency and bank staff due to low numbers of permanent workers - it found wards with too few staff to meet the needs of patients.
It noted a high use of temporary staff, with some shifts comprising 80% to 100% bank or agency workers.
Meanwhile, the trust failed to show it had an effective system to ensure bank, agency and redeployed staff were inducted and assessed as suitably competent, skilled and experienced to work on the wards, according to inspectors.
Other problems included “poorly completed, disorganised and difficult to navigate” records which “did not provide a clear picture of the care patients required”.
“Agency staff brought in did not always have an effective induction”
Delays in undertaking patient observations, medicines rounds including providing IV fluids, antibiotics and IV care, were also all noted.
Records for one patient on the emergency assessment unit showed a three-hour delay for receiving medication.
“We observed that the administration of medicines on rounds was delayed and this was linked to the staffing levels not being sufficient on the wards,” said the CQC in its report on the hospital.
“Five nurses we spoke with raised concerns about the completion of records by agency staff. They stated that coming on duty following a shift with agency staff was challenging as the records were not well completed,” the report added later.
CQC chief inspector of hospitals Sir Mike Richards said: “Staffing continues to be a problem. There was not enough staff on the inpatient wards to meet the needs of patients.
“Agency staff brought in did not always have an effective induction and we found that important competency and induction checklists were not available on the wards. In addition, patients at risk of deterioration were not monitored in accordance with trust policy.”
“If, despite all these measures the trust fails to make sufficient progress I have no doubt that we will take further enforcement action to protect the interests of the people who rely on this service,” he added.
Lucy Moore, the trust’s chief executive, said the examples of poor care found by inspectors were “unacceptable” and said the organisation had taken immediate action to address the issues.
She said this included a new ward induction programme for agency and locum staff and a further review of the acuity and dependency needs of patients – resulting in an increase in the number of nursing staff on a number of wards.
“I am confident of the huge effort from all staff to drive improvement, their strong desire and determination to change, and their awareness of the issues and challenges. However, there is more to do to tackle the inconsistency of care that we provide,” said Ms Moore.
The trust was last visited by the CQC in 2014, when inspectors found insufficient staffing levels, poor hygiene and infection control procedures, and nursing staff not always treating patients in a caring way.