Nurse shortages that in some cases meant staffing numbers fell below safe levels were found at South Tyneside NHS Foundation Trust by the hospital regulator, which said the organisation “requires improvement” overall.
Although agency staff were being used and the trust had recently invested in increasing its number of nurses, inspectors saw one ward with a ratio of one qualified nurse to 15 patients at night when it visited the trust in May.
The Care Quality Commission said it was told by the trust’s chief nurse that a tool was used to determine safe staffing levels and there were, at the time, 58 whole-time equivalent vacancies across the organisation.
“The pressure on beds has been affecting the quality of care. I am concerned that at times patients needing intensive care were being cared for in other areas”
A lack of beds in the intensive care unit was also noted by inspectors, who found patients being cared for in the theatre recovery unit instead on a number of occasions.
However, theatre and recovery nurses working in the area told inspectors they did not have the skills or experience to look after critical care patients and they had not been trained to do so.
But this was desputed by the chief nurse, who said he felt staff were competent to care for critical patients in the theatre recovery unit.
Other issues found by the CQC included a lack of routine photographing of pressure ulcers due to insufficient equipment and lack of understanding of the reasoning for taking pictures.
“Wards had been provided with cameras, but flat batteries and lack of understanding of the reasons for taking the photographs meant the tissue viability nurses could not always attribute the origin of pressure ulcers,” said the CQC in its report on the trust.
Meanwhile, the trust’s special care baby unit – which has six cot spaces – also had staffing problems.
Guidance from the British Association of Perinatal Medicine recommends the ratio of nurses looking after special care babies should be at least one nurse to four babies. But inspectors found rotas that showed between January and April there was “consistently” only one nurse on duty for night shifts
“This meant if the unit was full, there was one qualified nurse to six patients which did not meet the recommendations of the BAPM guidance,” the CQC said in its report.
“In addition we saw between 27 January 2015 and 6 February 2015, there had been between seven and nine babies on the unit. When we checked the off-duty [rota] we saw there was one qualified nurse on a night shift between 27 January 2015 and 6 February 2015,” added the CQC.
The regulator called for a range of actions including appropriate staffing on all children’s inpatient areas, particularly the special care baby unit, and an escalation plan to support caring for critically ill patients in the recovery room.
Despite the problems found in the trust’s South Tyneside District Hospital, inspectors rated its community services as “good” or “outstanding” across all areas. Across the whole trust, staff were rated “good” for being caring, particularly for end of life services.
Mike Richards, CQC chief inspector of hospitals, said: “When we inspected the services run by South Tyneside Foundation Trust, we found that staff were universally committed to delivering compassionate person centered care to patients.
Sir Mike Richards
“However, the pressure on beds has been affecting the quality of care. I am concerned that at times patients needing intensive care were being cared for in other areas,” he said.
“Patients have had to wait too long in accident and emergency before they are admitted to the wards. These are areas which must be addressed to ensure that patients’ needs are met at all times,” he added.
In response, trust chief executive Steve Williamson said the organisation had had action plans in place “for some time” to improve areas identified by the CQC.
He said the trust was nearing the completion of a local, national and international nursing recruitment programme, which should result in a “significant” increase in registered nurses.