Healthcare Improvement Scotland highlights concerns over safe delivery of care to patients at Western Isles Hospital.
It also flags up “many challenges” currently facing staff at the hospital such as training as well as challenges in relation to recruitment and retention of staff.
Three inspectors made an unannounced visit to the hospital over two days - on Tuesday
3 September and the following day.
Healthcare Improvement Scotland has drawn up 22 requirements, stressing NHS Western Isles must make sure these are all met.
The health board has produced a comprehensive improvement action plan in order to comply.
Routinely health boards are expected to provide an action plan at 18 weeks but due to the level of concerns raised the island health board has been asked to provide updates for shorter periods of six, 10, 14 as well as 18 weeks.
The inspection found children are cared for in a dedicated bay or within single rooms in an adult ward but on occasions adult patients within the ward became distressed, confused and aggressive. Managers at the Stornoway hospital told inspectors they would look to moved any adult patient becoming confused and showing signs of aggression to another ward.
But, currently there is no risk assessment in place to support the movement of patients displaying signs of confusion and aggression. The report points out further movement around the hospital may cause increased confusion for the patient.
Inspectors observed staff working hard to provide compassionate and responsive care with all patients being complimentary about the care provided. The hospital environment was clean and well maintained. Additionally, mealtimes were calm and well led with patients receiving assistance with hand hygiene prior to meals and with eating and drinking where required.
However, “significant concerns” arose regarding the availability of children’s nurses, staff trained in paediatric immediate life support and systems and processes for the safe care of acutely unwell, deteriorating patients.
Inspectors also brought up concerns about staff training in child and adult support and protection, regarding fire training compliance and maintenance for firefighting equipment in Western Isles Hospital.
Their report said: “Other areas for improvement include governance processes around the development and review of policies and procedures, safe storage of medication and cleaning products and the completion of patient documentation.”
Conflicting information has been provided in relation to the number of suitably trained staff in paediatric immediate life support and immediate life support and there remains a lack of assurance in this area.
At the time of inspection, no-one in the clinical support nurse team held an up to
date paediatric immediate life support certificate and only 15% of the team hold
a European paediatric advanced life support certificate.
The inspection team flagged up issues with servicing of fire extinguishers, emergency lighting testing as well as storing oxygen and electrical equipment in the same cupboard. Low rates of fire safety training did not comply with NHS Western Isles own fire safety policy.
Fire walkarounds within clinical areas had not been carried out. There were also two storage areas where oxygen cylinders and other flammable items were stored alongside electrical items which were charging within a room with no fire detection.
Only 37% of staff were up to date with annual training and 14% up to date with three yearly fire training.
Fire safety assessments carried out a year ago highlight similar issues such as low staff training compliance, lack of fire drills and walkthroughs and storage of some equipment in areas without appropriate fire detection.
Despite being busy, staff were working hard to deliver care but some reported they often do not receive scheduled breaks on time or even not at all. Staff were often late leaving shift due to pressures and staff shortages. Senior managers told inspectors they were unaware.
The report highlights staff in the Covid ward were under significant pressure and felt increased levels of stress due to the level of severity of patients condition and staffing skill mix. Staff in this ward regularly do not leave on time after their shift is supposed to finish and frequently do not get scheduled breaks. Additionally, staff describe morale being low, with a lack of senior management oversight and a culture of staff not feeling listened to or supported by senior managers.
Donna Maclean, chief inspector, Healthcare Improvement Scotland, said: “As a result of issues identified during our inspection, we wrote to NHS Western Isles twice during our inspection to raise significant concerns.
“NHS Western Isles responded to our requests for further information however the information provided in relation to the number of trained staff in paediatric immediate life support, and immediate life support, did not provide sufficient assurance.”
Some of the areas visited were calm and well organised with visible leaders. However, within one ward there were no visible leadership and staff reported feeling stressed.
Like most Scottish health boards NHS Western Isles have to use additional beds in
non-standard care areas at times of increased pressure. In the emergency department
there was an additional bed within the corridor which was used with temporary screens
to maintain some privacy for patients.
Additionally, in the emergency department inspectors saw no patients have access to a call bell and in the side rooms there was only an emergency buzzer. There are times where the door may be closed, and it may be more difficult for patients to get help they said.
Within one ward medicine had been left on the patients’ bedside tables which could increase the risk of errors such as medicine being missed or being taken by the wrong person, said inspector. In addition, medicine cupboards and preparation rooms were unlocked with some medicine left unattended.
Most of mealtimes observed by inspectors were “well organised with patients receiving their meals quickly and with assistance if needed, with staff were aware of patients’ dietary requirements, helping patients to carry out hand hygiene prior to meals and giving them assistance to eat and drink if needed.
In one ward there was just one shower and no bath for 22 patients, managers advised that there are plans to upgrade the facilities within this ward. All patients were offered assistance with personal hygiene and if required were provided with a basin to wash at their bedside.
All patients the inspection team talked to spoke highly of the care received, staff were seen to be responsive to patients’ care needs. All patients stated they had received care quickly with no long waits for assistance and would be happy if a loved one had to access care at Western Isles Hospital.
NHS Western Isles chief executive Gordon Jamieson said it is the health board “priority” to address the concerns “as quickly and comprehensively as possible.”
“Ensuring all relevant staff are up to date with their annual paediatric immediate and advanced life support training is a priority for us, and ensuring that staff continue to be supported in terms of their wellbeing is key, in particular during these challenging times when hospital occupancy is so high and as recruitment remains one of the Board’s main challenges.”
Requirements for NHS Western Isles
- Ensure as a matter of urgency all staff are provided with and complete the necessary paediatric and adult immediate life support training to safely carry out their roles
- Ensure improvement actions within fire risk assessments are carried out, fire safety equipment is tested and maintained to ensure safe working and staff have complete mandatory fire training
- All staff to complete appropriate levels of adult support and protection and child support and protection training relevant to their roles
- Ensure senior management and leadership oversight and support is effective, to reduce the risks for staff and patients and support staff wellbeing
- Improve feedback to staff on incidents raised through the incident reporting system and ensure learning from incidents is used to improve safety and outcomes for patients and staff
- Have effective processes in place for communication and dissemination of information from hospital wide huddles
- Ensure staff are supported within their role and that concerns raised by staff are acted upon
- Ensure effective and appropriate governance approval and oversight of policies and procedures are in place
- Ensure use of a selection criteria within risk assessments to support placement of patients within additional beds that are used during periods of extreme system pressure
- Ensure all patients have access to call bells NHS Western Isles must ensure that all patient care documentation is accurately and consistently completed
- Ensure the safe storage and administration of medicines at all times
- Ensure that all staff carry out hand hygiene at appropriate moments and use personal protective equipment in line with current guidance
- Ensure all staff comply with the safe management of waste including sharps
- Ensure cleaning products are stored safely and securely NHS Western Isles must ensure that decision making regarding staffing risks and mitigations are open and transparent and aligned with patient acuity
- Consider skill mix, dependency and complexity of patients to support staff to apply professional judgement when declaring safe to start
- Ensure a robust system in place consistently to assess and capture real time staffing across all professions to ensure clear management oversight
- Ensure clear real time staffing data is consistently recorded and communicated and clear escalation processes and any mitigations/inability to mitigate are recorded clearly and accurately
- Ensure that there are processes in place to support the consistent application of the common staffing method, demonstrating triangulation of quality, safety and workforce data to inform staffing requirements and, where appropriate, service improvement. This includes that the principles of the common staffing method are applied, including having a robust mechanism for feedback to be provided to staff about the use of the common staffing method, and staffing decisions made as a result.
- NHS Western Isles must ensure patient dignity is maintained at all times. This includes but is not limited to access to shower facilities for all patients
- NHS Western Isles must ensure safe and effective policies and procedures are in place for all CCTV cameras in use. CCTV cameras must be operated in line with national regulation, guidance and local policy and staff are aware of and apply correct procedures
NHS watchdog raises concerns over Western Isles Hospital
13 December 2024
