Berwick Infirmary

⚠ Across the trust compliance with mandatory training rates were not met, action on this was inconsistent across core services. Although the service made plans for staff to complete mandatory training, training compliance rates failed to meet the trust target.

⚠ We did not see evidence of learning from incidents was consistent throughout the organisation and over 50% of action plans for SIs and SLEs were overdue.

⚠ We did not see that all relevant risks were monitored, escalated and mitigated.

⚠ We did not see evidence of learning from incidents was consistent throughout the organisation and over 50% of action plans for SIs and SLEs were overdue.

⚠ Although the electronic track and trigger system indicated when patients should be observed, we found that patient observations were not consistently monitored according to the flag alert on the system. The trust did not have oversight of certain assurances around staffing for level 2 patients and the frequency of observations …

⚠ The trust did not have oversight of certain assurances around staffing for level 2 patients and the frequency of observations on the electronic track and trigger system.

⚠ Mortality reviews did not provide a large enough sample to be assured that all learning would be captured.

⚠ Complaints were not investigated within timescales set by the trust.

⚠ We found incidences where oxygen for patients had not been prescribed. This is against trust policy and British Thoracic Society (BTS) best practice guidelines.

⚠ Review dates for Patient Group Directions (PGDs) had been exceeded. This meant that medicines were being administered or supplied without an appropriately reviewed authority document. This was not in line with regulation or NICE guidance.

⚠ Although patient records contained comprehensive information, patient identifiers were not consistently used, entries were not always signed and dated, alterations to records were not appropriately made with a single line, countersigned, timed or dated.

⚠ Overall mandatory training compliance, including safeguarding training, Mental Capacity and Deprivation of Liberty Safeguards training did not meet the trust target. Staff were not given protected time to complete mandatory and safeguard training.

⚠ Oxygen was not prescribed or recorded in line with national guidance on all wards that we inspected.

⚠ Patient group directions had not been reviewed in line with the review date set by the trust.

⚠ Although the electronic track and trigger system indicated when patients should be observed, we found that patient observations were not consistently monitored according to the flag alert on the system.

⚠ Mandatory training levels were not being met by medical or nursing staff with nursing staff compliant in 12 out of 30 modules and medical staff compliant with five out of 23 modules.

⚠ The department was using both paper and electronic records when we carried out our inspection. We found gaps in clinical records and places where information in the paper records did not match information in the electronic record.

⚠ The department was not prescribing oxygen for patients in A&E. This is against trust policy and British Thoracic Society (BTS) best practice guidelines.

⚠ Patient group directions (PGDs), documents that allow competent nursing staff to administer a limited group of medicines to patients without them who meets specific criteria without them being prescribed by a doctor, had not been reviewed by their review date and there was no evidence of a process in place …

⚠ National audit results were poor and the department was not meeting most of the standards and were in the lower quartile compared to national performance. There was little evidence of further local audit work underway to ensure that audit compliance improved.

⚠ During our inspection, the emergency department had surges of ambulances arriving together. This posed a challenge for the department to receive handover of patients in a timely way.

⚠ Midwifery and Medical staff failed to meet trust mandatory training and safeguarding training compliance targets of 95% for the majority of modules, although the service had identified this and had plans in place to address compliance.

⚠ The emergency resuscitation trolley had not been checked regularly with several dates missing from checklists.

⚠ Review dates for Patient Group Directions (PGDs) used by midwives had been exceeded. This meant that medicines were being administered or supplied without an appropriately reviewed authority document. This is not in line with regulation or NICE guidance.