Medway Maritime Hospital
NHS / Health Body
Action Taken
Medway Maritime Hospital has implemented electronic observation recording with a red-flagging system, delivered MHLS training to nurses, trained Band 6 nurses in ALERT and Advanced Life Support, established an acute response team, improved shift handovers, increased A&E staffing, reduced reliance on agency nurses, enhanced the nursing team in Pembroke Ward, and invested in an after-hours equipment store. (AI summary)
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Dear Ms Harding,
Regulation 28 Report to Prevent Future Deaths – Rodney Gates
Please find below the Trust’s response to the Regulation 28 Notice issued by the Assistant Coroner Kate Thomas on 8 March 2021.
Coroner’s Concerns:-
(1) The failure to undertake at all the required observations of a patient pursuant to clinical direction and / or the NEWS protocol which was directly attributable to the conditions of the nursing staff on the ward, those being –(2-5)
Response:-
• Since the index events in April 2018, every inpatient ward area at the Trust has moved to electronic observation recording and an effective red flagging system based on NEWS2 via our networked Extramed system
• MHLS [Medway Hospital Life Support] (deteriorating patient training) is now delivered and monitored for all acute ward registered nurses based on NEWS principles
• All Band 6 nurses complete the ALERT course which is an advanced deteriorating patient management training program
• The Trust now has a well-established acute response team (ART) of expert nursing staff who are available 24hrs a day 7 days a week for escalation of any concerns and management of clinical deterioration in patients
• The Trust Band 6 nurses are also trained in Advanced Life Support
Medway Maritime Hospital Windmill Road Gillingham Kent ME7 5NY
• Shift to shift nursing handover has been improved to include bedside discussion involving every patient using a new best practice template to improve the quality and effectiveness of this process.
(2) The overall low number of nursing staff both within the A&E department and on the ward
Response
• In 2019, the Chief Nursing Officer commissioned a safe nursing staffing review which identified and resourced increases in the establishment of nursing staff line in accord with national guidelines
• The Accident and Emergency department has used best practice workforce tools on an annual basis to ensure safe nursing staffing levels are met since
2017.
• The nurse staffing head count in A&E has increased since 2017 threefold with a significant reduction year on year in Bank and Agency staff usage
(3) The reliance on agency nurses
Response
• There is an experienced Ward Manager in post since 2018, who has developed a stable and experienced team with considerable consistent success in recruitment and training reducing agency usage in this area
• There are no current Registered Nurse vacancies in Pembroke Ward
• Agency staff usage overall in the Trust has reduced from 127 Whole Time Equivalent to 69 Whole Time Equivalent in the last three years.
(4) The lack of experience and narrow spectrum of skill set of the nursing staff
Response
• The reviewed establishment for nursing staff in Pembroke ward which now includes 5 x band 6 Registered Nurses, all with experience and training in orthopaedic nursing has significantly improved the specialised care delivery to patients and supervision of junior nursing staff.
• The ward is supported by a professional trauma co-ordinator who delivers advanced clinical skills training to Registered Nurses and medical staff involved in the care of trauma orthopaedic patients informally at the bedside and in regular trauma day training forums.
• The A&E Department has recruited resuscitation practitioners working to identify and escalate trauma designated care.
• The Department conducts regular complex simulation training including trauma scenarios. Monthly trauma meetings are conducted to review complex case management and the sharing of lessons learned with the broader clinical team including our system partners SECAmb.
(5) The lack of equipment available to nursing staff on the ward
Response
• The Trust has invested in an equipment store after-hours, so that if equipment fails or cannot be located there are now resources continually available to ward nursing staff both during the day and after hours
Regulation 28 Report to Prevent Future Deaths – Rodney Gates
Please find below the Trust’s response to the Regulation 28 Notice issued by the Assistant Coroner Kate Thomas on 8 March 2021.
Coroner’s Concerns:-
(1) The failure to undertake at all the required observations of a patient pursuant to clinical direction and / or the NEWS protocol which was directly attributable to the conditions of the nursing staff on the ward, those being –(2-5)
Response:-
• Since the index events in April 2018, every inpatient ward area at the Trust has moved to electronic observation recording and an effective red flagging system based on NEWS2 via our networked Extramed system
• MHLS [Medway Hospital Life Support] (deteriorating patient training) is now delivered and monitored for all acute ward registered nurses based on NEWS principles
• All Band 6 nurses complete the ALERT course which is an advanced deteriorating patient management training program
• The Trust now has a well-established acute response team (ART) of expert nursing staff who are available 24hrs a day 7 days a week for escalation of any concerns and management of clinical deterioration in patients
• The Trust Band 6 nurses are also trained in Advanced Life Support
Medway Maritime Hospital Windmill Road Gillingham Kent ME7 5NY
• Shift to shift nursing handover has been improved to include bedside discussion involving every patient using a new best practice template to improve the quality and effectiveness of this process.
(2) The overall low number of nursing staff both within the A&E department and on the ward
Response
• In 2019, the Chief Nursing Officer commissioned a safe nursing staffing review which identified and resourced increases in the establishment of nursing staff line in accord with national guidelines
• The Accident and Emergency department has used best practice workforce tools on an annual basis to ensure safe nursing staffing levels are met since
2017.
• The nurse staffing head count in A&E has increased since 2017 threefold with a significant reduction year on year in Bank and Agency staff usage
(3) The reliance on agency nurses
Response
• There is an experienced Ward Manager in post since 2018, who has developed a stable and experienced team with considerable consistent success in recruitment and training reducing agency usage in this area
• There are no current Registered Nurse vacancies in Pembroke Ward
• Agency staff usage overall in the Trust has reduced from 127 Whole Time Equivalent to 69 Whole Time Equivalent in the last three years.
(4) The lack of experience and narrow spectrum of skill set of the nursing staff
Response
• The reviewed establishment for nursing staff in Pembroke ward which now includes 5 x band 6 Registered Nurses, all with experience and training in orthopaedic nursing has significantly improved the specialised care delivery to patients and supervision of junior nursing staff.
• The ward is supported by a professional trauma co-ordinator who delivers advanced clinical skills training to Registered Nurses and medical staff involved in the care of trauma orthopaedic patients informally at the bedside and in regular trauma day training forums.
• The A&E Department has recruited resuscitation practitioners working to identify and escalate trauma designated care.
• The Department conducts regular complex simulation training including trauma scenarios. Monthly trauma meetings are conducted to review complex case management and the sharing of lessons learned with the broader clinical team including our system partners SECAmb.
(5) The lack of equipment available to nursing staff on the ward
Response
• The Trust has invested in an equipment store after-hours, so that if equipment fails or cannot be located there are now resources continually available to ward nursing staff both during the day and after hours