CQC reveals catalogue of failings in “unsafe” A&E

A CQC inspection of emergency services at The Dudley Group Foundation Trust has revealed serious concerns over staffing levels and multiple failures to spot deteriorating patients. 

On 15 March 2018 the CQC carried out an unannounced inspection into the emergency department, short stay ward and immediate medical assessment unit at the trust’s main Russell Hall hospital site.

This followed an inspection in December 2017, after which the trust was rated “requires improvement” overall, but “inadequate” for urgent and emergency services.

According to the latest inspection report, published last week, the CQC’s inspection was prompted by concerns it received about a patient’s death and over the management of patients within A&E. 

The report revealed that staff in the trust’s short stay ward told inspectors they were stressed over the high levels of agency staff in use; felt the environments was not safe; and were concerned for patients’ safety.

CQC inspectors also had to intervene when staff failed to spot the deterioration of two patients and had to alert staff to a patient who was taking medication without their knowledge.

Other concerns raised in the report included:

• “Medical and nursing cover across all areas was not sufficient to meet the needs of patients”
• The emergency department was “predominantly” staffed by agency or bank workers with both staff and patients raising concerns over the level of care
• Some patients felt “uncomfortable” staying in short stay and IMMA wards for longer periods due to the design and number of temporary staff
• Patient records were not always written and managed in a way that keep patients safe
• Patients not wearing allergy wristbands were not easily identified by records
• A review of nine sets of medical notes found all were inconsistent and one example of a patient’s record which included another patient’s information
• Not all staff were “bare below the elbows” and some medical staff did not wash their hands

Despite the failings the CQC did find some improvements including that patients were allocated a timely bed space; no over-crowding and no patients recieving care in corridors.

In January and February 2018, the CQC took enforcement action against the trust over its emergency services, placing conditions on the trust’s registration over fears that “a person will or may be exposed to the risk of harm if [they] do not do so.”

Conditions which have been placed on the trust’s registration mean the provider must send the CQC weekly reports “until futher notice.” This includes detail on how it is ensuring effective deteriorating patient and sepsis management is in place and that its ED and waiting area have suitable numbers of qualified staff. 

Professor Ted Baker, chief inspector of hospitals for the CQC, said: “We have reported all our findings from this inspection back to the trust and the trust board knows what it must do to bring about sustainable change to its services so that people receive the care they should be able to expect, particularly within the urgent and emergency department.”

In a statement Diane Wake, chief executive for The Dudley Group FT said: “There are four key areas for improvement these are, care of the deteriorating patient, use of agency and bank staff and skills mix and use of allergy wristbands…We have support from the Emergency Care Intensive Support Team (ECIST) and additional director level capacity to work solely with ED on quality improvement.

She added the trust has a “clear action plan”, have increased senior nurse support, retrained staff in triage processes and focussed the teams on caring for deteriorating patients.

Addressing workforce challenges Ms Wakefield said six newly qualified nurses will be joining the trust’s ED, 11 consultants in post from August and that 75 per cent of nursing hours in the department are substantive staff.