George Eliot NHS Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was a positive learning culture with staff managing incidents well. Learning from incidents was evident. Staff knew what incidents required reporting and how to report them. When things went wrong, staff were aware of the principles of being open and honest and where required, implemented the duty of candour. The processes in place supported staff to report and learning from incidents. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. There were processes in place to ensure the service had enough staff with the right training, skills and qualifications to keep patients safe from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All staff knew what incidents to report and how to report them via the online reporting system. Staff raised concerns and were encouraged to report incidents by their managers. There was evidence that changes had been made because of feedback. For example, a few ward areas had an increase in falls. There had been 77 falls between January and March 2024. The wards increased the training for staff on falls, cohorted patients into groups if they were at risk of falls and ensured a staff member was always in that bay, ordered falls sensor pads and linked in with the falls co-ordinator. Managers told us they had seen a reduction in falls since the implementation of these changes. There was a falls prevention nurse who was very present on the wards and a monthly falls strategy meeting where themes and actions were discussed. The service had no never events on any wards. Managers investigated incidents thoroughly. Managers debriefed and supported staff after any serious incident. We were told about a serious incident and the staff were supported by clinical psychology, the well-being team, and the chaplain. Staff were very positive about the support they received post incidents. Staff understood the policy on complaints and how to handle them. Managers investigated complaints and identified themes. Managers shared feedback from complaints with staff and learning was used to improve the service. Staff could give examples of how they used patient feedback to improve daily practice.

The trust had a clear safeguarding policy and pathway which was up-to-date and accessible to staff through the trust’s intranet. Staff had access to the trust’s safeguarding lead for advice. We saw the mental capacity act policy was followed on the wards we visited. Patient notes we reviewed showed MCA forms and DoLS forms were completed appropriately. We saw appropriate consent forms were used for patients who were undergoing procedures, such as endoscopy, who lacked capacity.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff knew how to make a safeguarding referral and who to inform if they had concerns. All staff we spoke to had a good understanding of the safeguarding policy. Staff received training specific for their role on how to recognise and report abuse. Training levels were above the trust target of 85% for Safeguarding adults and children’s level 1 and 2. However, it was 79.5% for safeguarding adults’ level 3 and 75% for safeguarding children level 3. Staff could give examples of how to protect patients at risk of, or suffering, significant harm. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and completed assessments in line with policy. We saw these were completed appropriately. Staff got advice from their mental health colleagues as required.

The trust had a clear safeguarding policy and pathway which was up-to-date and accessible to staff through the trust’s intranet. Staff had access to the trust’s safeguarding lead for advice. We saw the mental capacity act policy was followed on the wards we visited. Patient notes we reviewed showed MCA forms and DoLS forms were completed appropriately. We saw appropriate consent forms were used for patients who were undergoing procedures, such as endoscopy, who lacked capacity.

Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration. Staff used the national early warning scores (NEWS2) to identify deteriorating patients and escalated increasing scores appropriately. We reviewed 32 records and found NEWS2 was acted upon by staff and patients were reviewed promptly when needed. Staff were mostly aware of specific risk issues for patients, and these were reduced where possible. There was a standard risk assessment booklet for all staff to follow when a patient was admitted. These risk assessments were completed for most patients in the notes we reviewed. Staff told us these were updated when a condition changed or at least on a weekly basis; we saw this happened most of the time. However, in some of the notes we saw whilst the risk assessments were completed, they lacked detail. Wards cohorted patients who were at risk of falls or required extra support into bays. This meant a staff member was allocated to the bay to provide continuous supervision and reduce the risk of falls and injury. Where patients needed further support, 1-to-1 enhanced care was arranged; a risk assessment was completed for this. We overheard staff discussing their needs within staffing calls with managers and further support being arranged. Staff completed mandatory training which included sepsis and blood transfusion. Training for these were all above the trust target of 85%. Wards also arranged training which was specific to their speciality. Patients on the Cardiac Care Unit required continuous monitoring and we found this was not always happening. Patients attached to monitors unplugged themselves when they went to the bathroom and were not always plugged back in promptly. Staff did not always attend to monitors that alarmed due to out-of-range results. There were no incidents where this had caused patients harm.

Staff used the NEWS2 to identify deteriorating patients and escalated increasing scores appropriately. NEWS2 observations were taken on an electronic device which calculated scores automatically for them and created alerts where scores were above 4. In the notes we reviewed, sepsis screening tools were completed where required. Each ward had a clinical dashboard where all staff could monitor NEWS2 and easily see high scores. Critical care outreach service were also able to see high NEWS2 and contacted the wards to find out further information or review patients when they saw escalating NEWS2. The service used ‘situation, background, assessment, recommendation’ handover which meant staff were well informed about patients when they were handed over. We observed 2 handovers and found they were very detailed. Most wards had a huddle at the beginning of each shift where they discussed all patients who were at risk of falls, had high NEWS2, any safeguarding issues, mental health issues and any other concerns. We also observed 3 board rounds and the nurses handed over this information to the multidisciplinary team. This meant all staff were aware of the patient risks on the wards. There was a policy in place for enhanced care on the ward. Staff used the risk assessment within this to determine which level of enhanced care the patient needed and allocated staff accordingly. This had an associated risk assessment which we saw was completed for patients who needed enhanced care. However, this policy was 5 years out of date. Patients were assessed for Venous Thromboembolism (VTE) risks using an online form. If a VTE was not completed, the VTE prevention nurse emailed the staff and copied in the consultant to remind them to complete it. There was a sepsis working group which had a working action plan. We reviewed this and saw that most actions were completed on time and improvements were being made.

All staff told us they had access to suitable amounts of equipment to enable them to complete their role. Equipment was well maintained and regularly serviced to ensure patients were kept safe. Staff carried out daily checks of specialist equipment. The service mostly had suitable facilities to meet the needs of patients’ families. However, we saw a patient’s family had to leave the ward to speak to staff on CCU as there was no relatives room or other appropriate space. Staff told us there was a lack of storage on some of the wards, such as Melly ward and Alexandra Ward. This meant items were stored in corridors and patient bathrooms.

The design of the environment mostly followed national guidance. Some wards required improvements. For example, Arbury Lodge ward was undergoing upgrades to their patient room doors as patient beds could not fit out of their current doors. Staff evacuated patients out of rooms on a trolley in an emergency and risk assessments were in place for this. However, it was not on the service’s risk register. There was also only 1 shower on the ward for 25 beds. Equipment was observed to have been serviced, electrically tested, and had details of when next checks were due. We saw on Alexandra ward 2 of the side rooms did not have an ensuite bathroom. This meant if a patient developed an infection, a bathroom would be blocked off for their access which reduced the accessibility for other patients. The manager told us this was due to be added to their risk register.

The service had enough nursing, medical and support staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers calculated and reviewed the number and grade of nurse and health-care assistants (HCAs) needed for each shift in accordance with national guidance. The ward manager could adjust staffing levels daily according to the needs of the patients. The service had low vacancy rates. The trust had completed an international recruitment programme which had significantly reduced their vacancies for nursing staff. This meant that whilst there were low vacancy rates, the nursing teams on most wards were quite junior and required extra support. There were no junior doctor vacancies. There were 3 consultant vacancies within frailty but 2 of these were covered by long term locum staff booked via the bank to reduce costs. The service had sickness levels in line with the trust target of 4% between November 2023 and April 2024. Staff absences were mostly covered with existing staff, staff from other wards or bank staff. The service had low rates of bank and agency nurses. Managers limited their use of bank and agency staff and requested staff familiar with their service. Managers made sure all bank and agency staff had a full induction and understood the service. The vacancy rate for medical staff was low. The gaps in the rota were covered by locum shifts, usually by doctors who worked within the hospital. The service always had a consultant on call during evenings and weekends and medical patients had a review by a consultant daily. Staff said they had always been able to reach a consultant for advice or they had attended the ward if needed. Managers told us they had recently increased the number of medical registrars rota’ed on at night and the number of doctors at the weekends following feedback from junior doctors that they required further support.

There were processes in place for bank and agency staff to undergo a local induction. This ensured information about ward specific needs and policies were discussed. The managers completed a staffing acuity tool 3 times a day to ensure their staffing matched the needs of the patients. This was discussed twice a day with the manager on call for the medical service. Staff were moved where required to ensure safe staffing levels were met across the organisation considering ward comments and patient acuity. However, we saw student nurses were used as extra staff instead of shadowing teaching opportunities. For example, on Acute Medical Unit the nurses were completing the medication rounds, and a student nurse was providing enhanced 1-to-1 care to a patient. We discussed this with the matron who felt that students were used in this manner. They said staffing levels were being reviewed on a few wards and adjusted to reflect the increasing needs of the patients. For example, they had recently increased the staffing levels on Melly Ward following feedback from staff. Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of patients. Managers supported staff to develop through yearly, constructive appraisals of their work. Data showed 85% of staff had an appraisal which was in line with the trust target of 85%. Managers made sure staff received any specialist training for their role. The clinical educators supported the learning and development needs of staff. There was a strong education and development culture at the service with a range of development courses available for staff. We saw a few staff who had progressed from HCA through to nurses or nurses to advanced care practitioners through the support of the managers. We found there were opportunities for staff to develop.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean. Data provided showed 91.6% of clinical staff were trained in infection prevention level 2 and 100% of non-clinical staff were trained in infection prevention level 1. Cleaning records were up-to-date and demonstrated all areas were cleaned regularly. We saw mostly actions were taken to make improvements. For example, on Bob Jakin ward, they had seen an increase in the number of patients who developed Clostridium Difficile (C Diff). They implemented a cleaning co-ordinator role 3 times a day to make sure areas were clean. They had seen a reduction in infection since they had brought this role in. However, we were also told on Arbury Lodge at times they struggled to get rooms cleaned at night. Staff said that they have patients admitted to the rooms which had not been effectively cleaned after patients who had an infection. We were also told that the dishwasher was broken for a year and no action had been taken to fix it even though it had been raised several times. This meant staff were cleaning all dishes by hand, including dishes of patients who had infections. We raised this with management who arranged for the dishwasher to be fixed whilst we were on site. Data showed between November 2023 and April 2024 there had been no cases of MRSA within the medicine service, 6 cases of Methicillin-susceptible Staphylococcus aureus and 18 cases of C Diff. There was an onsite infection prevention and control team who gave advice, carried out walk around audits with the cleaning teams and hand hygiene audits. They gave feedback from the audits to the managers who created actions plans to make improvements.

During our onsite assessment, we found all wards were clean and had suitable furnishings which were clean and well-maintained. We observed staff cleaning equipment after patient contact. However, not all staff labelled the equipment to show when it had been cleaned. We observed staff washing performing hand hygiene before and after contact with patients. We saw patients who had infections were isolated appropriately with appropriate personal protective equipment available at entry to the patient room. However, on cardiac care unit we found within the patient room where a patient was isolating, there was no clinical waste bin.

There was an infection prevention and control policy in place for staff to follow. The service generally performed well for cleanliness. The infection prevention and control team completed hand hygiene audits quarterly on each ward, but it was not clear that actions were taken to improve compliance. We looked at 22 audits between August 2023 and May 2024 and found that mostly the staff adhered to hand hygiene principles. However, we saw where results were below standard, such as when Bob Jakin Ward scored 70% in May 2024, there were no action plans to improve compliance. There was good compliance with infection prevention and control screening. All patients were screened for Methicillin-resistant Staphylococcus aureus in the emergency department prior to their admission to the wards.

Staff told us that they knew how to contact pharmacy for advice and processes were in place for the supply of medicines. Staff knew who the ward pharmacist and pharmacy technicians were. Staff had access to relevant medicine policies, procedures and guidelines. Wards had access to a medicines management pharmacy team who completed a medicines reconciliation (the process of gathering a complete list of people’s prescribed medicines) to ensure people didn’t go without medicines when admitted to the ward. The pharmacy department supported staff with managing medicine processes such as ordering and receiving medicines. For example, staff on Dorothea ward (Oncology/Haematology) had pharmacist specialist support with screening chemotherapy prescriptions and ensuring treatments were available when they needed them. Staff on Dorothea ward had annual refresher training on how to treat extravasation in chemotherapy although they had never had an incident. Staff could access pharmacy advice, emergency medicines and critical medicines out of hours. The medicine safety officer sent out monthly medicine reports to each division highlighting medicine incidents. Staff told us that sometimes patients medicines got lost in the transfer from the acute medical unit (AMU) to other wards mainly because the medicines were not kept in their bedside locker. Different ideas such as the use of identifying stickers on medicine charts were being trialled as an aid to highlight to staff to remember patients’ medicines.

Medicines storage was locked and secure with access only to authorised staff. However, medicines were not always stored safely. We observed some disorganised storage arrangements on AMU with no system in place to easily locate some medicines. There was a lack of individual staff responsibility to ensure that medicines were stored neatly. This increased the potential risk of a medicine error, or a medicine not being located. We observed members of the pharmacy team having discussions with people to check their medicine history was accurate and up to date. We witnessed clinical checks being undertaken by a pharmacist. Any discrepancies or medicine issues were successfully resolved to ensure the effective continuation of treatment. Resuscitation medicines required in an emergency were stored safely in tamper-proof trolleys which followed Resuscitation Council (UK) guidance. We observed that staff recorded safety checks to ensure the medicines were safe to use. Medicines for refrigeration were stored securely with electronic central records available of maximum and minimum temperatures to ensure the medicines were stored safely. Where temperatures went out of range, managers were sent an email to alert them. We saw 1 person with a known antibiotic allergy wearing a red wrist band to highlight their allergy status.

Processes were in place to ensure people received their medicines as prescribed We reviewed multiple people’s medicines administration records. They were well documented with route and time of administration, including recording a reason if a medicine was not given. The information showed people were receiving their medicines as prescribed. Weights of patients were not always recorded on medicine administration records which is important for calculating weight-based medicines prescribing. However, the pharmacy team highlighted any gaps. Processes were in place for reviewing antibiotic prescribing. Controlled drugs (CD’s) were stored safely and securely with access restricted to authorised staff. Checks were undertaken and recorded by 2 staff daily. Checks of CDs showed that they were within date and stock balances were accurate. However, some patient’s personal items were stored in the CD cabinet (CCU) which should not be. CD’s were audited quarterly by the medicines team and a member of ward staff. Results ranged from 84% to 100%. There were actions plans associated with each audit, but the actions were not always clear to ensure compliance improved. There was a clear process in place for managing and reporting any errors or incidents involving medicines. Staff were able to talk through the process that would be followed if this occurred. There is a good safety culture that encouraged staff to report these. We witnessed a nurse informing a member of the pharmacy team about a medicine error they had identified which was documented following trust procedure. Staff told us they had delays in ‘to take out’ (TTO) medication for patients on discharge. They had reduced this by using volunteers to take patients TTO’s to their houses for them.