Trust given warning notice over rapid tranquillisation

The Care Quality Commission said the trust needed to ensure all staff at Kent and Medway NHS and Social Care Partnership Trust followed local and national recommendations to monitor and record a patient’s physical health when rapid tranquillisation was administered. Inspectors were concerned staff were not always aware of the potential impact of these medications.

Following the inspection in May, the overall ratings for the trust’s acute wards for adults and psychiatric intensive care wards have dropped from “good” to “requires improvement”. The units were also rated “requires improvement” for well-led and “inadequate” for safety.

The trust’s overall rating – which has been “good” since 2021 – has not changed. 

Serena Coleman, CQC deputy director of operations in the south, said: “We found some staff weren’t always using the least restrictive options to make sure that people’s behaviour wasn’t controlled by an excessive use of medicines.

“As required medication, such as lorazepam and promethazine, was being used quite frequently but we couldn’t always find records to explain why these medications were necessary. There were examples where reviews hadn’t happened for long periods, meaning staff couldn’t be sure it was still appropriate to administer to people.

“We also found that staff didn’t always follow the trust’s guidelines on documenting the monitoring of people’s physical health after administering medicines for rapid tranquillisation. This made it difficult for the trust to review these and ensure they were appropriate.”

The CQC also raised concerns about “restrictive practices” such as patients not having access to gardens or cups for drinking water in parts of the hospitals and poor availability of showers at St Martin’s Hospital in Canterbury.

However, most people the inspectors spoke to said they felt safe and staff treated them with kindness and respect, and inspectors saw staff working hard to meet people’s needs.

Andy Cruickshank, KMPT’s chief nurse, said: “The safety and wellbeing of our service users are at the heart of everything we do and so we are committed to continuously improving the care and services we provide. The findings of these inspections provide valuable feedback to help us do that.

“We acted swiftly in response to the CQC’s warning notice on rapid tranquillisation to immediately address their concerns. One of many measures we put in place was the introduction of new bespoke training, which over 93 per cent of staff have already completed.

“Many of the systemic areas identified for improvement were issues we were already working to resolve, and we will continue this work at pace. However, it is encouraging the CQC found our staff are caring and hard-working and service users told the CQC they felt safe, staff treated them with kindness and respect, and their family members provided positive feedback.”

The inspection covered three sites: St Martin’s Hospital in Canterbury; Littlebrook Hospital in Dartford; and Priority House in Maidstone.