Inspectors have downgraded the Urgent and Emergency Care Department at Aintree Hospital in Liverpool and ordered it makes improvements.
The unit has lost its "Good overall' rating, and has now has been labeled as "Requires Improvement"
But the Trust says it's already responding to the safety concerns.. and in the meantime the hospital's overall rating remains as "Good":-
We were concerned upon inspection, that the processes in place for recognising and escalating the care of deteriorating patients were not always followed which put people at risk. We reported these urgent concerns to senior staff at the trust at the time of inspection and actions were put in place to address this issue. We have been monitoring these actions regularly to make sure improvements were being made.
We also saw that nurse staffing levels were lower than the safe recommended amount. We do acknowledge that the trust was taking action to address the nurse vacancy rate but it remained evident during our visit that the wards were not always staffed as they should be.
We are aware of the pressures on our nursing staff who look after patients admitted via A&E and, at the time of the inspection, we had some gaps in nursing cover arising from staff sickness and vacancies. However, we have plans in place to do all we can to ensure we continue to provide high quality care – these plans include deploying experienced staff to the areas which need them most and recruiting new nurses to Aintree, both temporary and permanent.
We have focussed on the accurate recording and calculation of MEWS, which determines the degree of illness of a patient, and recent audits have demonstrated improvement. In terms of sepsis management - we are in fact the best performing hospital in the North West for this, despite not meeting our aspirational target. We continue to work on this under the Advancing Quality programme to ensure we improve on this performance.
We have a new approach to mandatory training which includes the use of block training sessions, and this has seen an increase in compliance.
Aintree aims to provide the highest quality health care and this report helps us to achieve that vision.
The key findings included the following:
CQC found that staff were using a national Modified Early Warning Score (MEWS) tool to help monitor a patient's condition and identify signs of deterioration in their condition. However inspectors found that this was not being used correctly in line with the trust’s own procedures and caused concern that this may not appropriately identify patients who were deteriorating.
Nurse staffing levels were not always filled to the safe staffing establishment, and staffing was below this threshold on the surgical assessment unit, ward 31 and in the accident and emergency department at the time of the inspection. There were periods of understaffing over a number of days prior and post inspection and there was evidence that staff had raised staffing concerns using the incident reporting process.
Inspectors found there was poor staff compliance with the trust’s mandatory training target. The trust had a plan in place to reach 85% compliance by March 2017. However, patients could be at risk if staff were not adequately trained in a timely manner.
Patients are being urged to stay away from the Royal Lancaster Infirmary unless they have a serious or life threatening condition.
The A&E department has experienced a significant surge in demand with 163 people attending between 8am on Friday 19th August and 8am Saturday 20th August.
Members of the public with a minor illness or injury are being asked to visit their nearest pharmacist, Primary Care Assessment Centre, or GP.
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The Trust is always keen to learn and to improve care. We commissioned a review by experts from outside the Trust to look at the details of a small number of maternity cases at our hospitals.
We are now considering that report and are developing a number of actions as a result to make some improvements to ensure we continue to provide the best quality of care for our patients.
We deliver 10,000 babies each year and would like to reassure families about the safety of maternity services at our hospitals, but if any expectant mother has a concern they can contact their designated midwife to discuss this.
Seven babies and three mums have died in two Greater Manchester maternity units in just eight months – sparking an independent investigation.
Bosses at Royal Oldham and North Manchester General hospitals called in outside experts to review the departments in light of the 10 tragedies.
It is understood the deaths took place between December 2013 and July last year – with four babies and two mums dying at Oldham, and three babies and one mother dying at North Manchester.
"We are making significant improvements".
That's the message from Karen James, Interim Chief Executive, Tameside General Hospital in response to a critical report by CQC inspectors who found the trust was still failing to meet 8 out of 11 key national standards.
The Trust says it has already started recruiting 60 nurses and compassion is at the heart of what they do.