Wythenshawe Hospital

⚠ However, there was no standardised process to confirm missing equipment had been replaced and we found some equipment in opened packages or in no packaging at all. We reviewed equipment checklists which staff said were completed daily but found nine out of 27 dates were missing in the resuscitation area.

⚠ Appraisal rates for ED staff did not meet the trust target of 85%. Between April and October 2015, the trust reported that only 68% of administrative and clerical staff, 40% of nursing staff and 80% of medical staff had received their appraisal.

⚠ Reception staff were based at desks which were open to the public. Whilst they rarely experienced problems, staff told us that one incident had occurred whereby a visitor jumped over the reception desk. Staff were unsure whether panic buttons that had once been active, still worked. Additionally, security staff were …

⚠ Fridges storing medicines at low temperature were within the correct temperature range but the trust was unable to provide us with comprehensive records of temperature range checks. We asked staff to provide records for dates prior to this and received one document recording dates for an unidentified area in December …

⚠ There were air vents in the ceiling which we were concerned could be a ligature risk. We asked a consultant and matron about this, who confirmed that this room had been risk assessed for ligature points and that this had not been identified as an issue. Despite this staff acknowledged …

⚠ The Department of Health target for emergency departments is to admit, transfer or discharge 95% of patients within four hours of arrival. The trust failed to meet this target between November 2014 and November 2015. The highest percentage of patients admitted, transferred or discharged within four hours was 94% in …

⚠ Nursing staffing levels across the medical wards was variable. All wards we visited had vacancies that were being filled by either staff working extra hours, or bank and agency workers. Staff were regularly moved to cover other wards leaving their own ward short of staff. All staff we spoke with …

⚠ Records were paper based and stored on the wards. We found that, on most wards we visited, records were not stored securely. On AMU records were kept on the ward in unlockable trolleys, which potentially risked that patient records could be accessed by unauthorised people. We were informed that lockable …

⚠ Between January 2015 and December 2015, bed occupancy rates for medical services were over 100%, ranging from 101% to 104%. This meant there were more patients needing medical beds than they actually had. Evidence has shown that when bed occupancy rises above 85% then it can start to affect the …

⚠ There had been a longstanding concern within maternity services in terms of safeguarding children’s level three training. At the time of the inspection average compliance for the service was 79%, with obstetric medical staff at 55% compliance. The action plan indicated that there would be a continued push to increase …

⚠ However, many of the trust’s maternity service guidelines were out of date. We looked at 53 guidelines and found 28 of them were out of date. Examples of out of date guidelines included: Guideline for Care of the Rhesus Negative Pregnant Patient, which was due for review in 2011. A …

⚠ A risk identified on the risk register, reviewed on 23 October 2015, highlighted the failure to manage incidents in a timely manner. This identified that 50% of incident investigations and reports were incomplete from January to September 2015 which ‘may lead to incidents not being adequately investigated’. The cause was …

⚠ The neonatal unit did not always meet standards of staffing recommended by the British Association of Perinatal Medicine (BAPM). Nurse staffing levels on starlight ward did not reflect Royal College of Nursing (RCN) standards; an acuity tool on the starlight ward was not in use at the time of the …

⚠ Staff were aware how to report incidents on the Hospitals Electronic Reporting System (HER’s); however it was not evident that staff were knowledgeable about the types of incidents to report. While on inspection we observed incidents that were not reported. An example of this was 24 hours after a child …

⚠ Documentation on the paediatric ward was poor. We also raised concerns about the transfer of nursing notes from the nurse led book. This book contained patient information and was used by nursing staff as a daily task list. After cross referencing the book with 16 medical and nursing case notes …

⚠ Transition arrangements for children between 16 and 18 years were found to be rigid with all children over 16 years admitted to the adult services. This included children and young people admitted with mental health or self-harm concerns and also included young people with learning disabilities. The adult service used …