North Tyneside General Hospital

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

⚠ 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 didn't have oversight of certain assurances around staffing for level 2 patients and the frequency of observations on …

⚠ The trust didn't 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.

⚠ Review dates for Patient Group Directions (PGDs) had been exceeded. We found incidences where oxygen for patients had not been prescribed. Medicines had been administered to patients in an emergency without a clear or retrospective record.

⚠ 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. In the four weeks prior to inspection, out of 77,350 observations recorded only 44,610 had been completed within 15 minutes …

⚠ Mandatory training was not always completed by medical or nursing staff in a timely manner and we lacked assurance how the hospital would improve compliance rates. Mandatory training levels were not being met by medical or nursing staff with nursing staff compliant in 12 out of 30 modules and medical …

⚠ Paper records were not always securely bound within notes folders and we found some pages or parts became detached. Patient identifiers were not consistently used, for example entries were not always signed and dated, alterations to records were not appropriately made with a single line, countersigned, timed or dated.

⚠ Oxygen prescribing did not follow trust policy, best practice and national guidance in the ED. 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) were past their review date and there was no clear governance process in place to ensure they were reviewed and updated before they expired.

⚠ 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. NSECH ED did not meet RCEM audit standards including …

⚠ 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. The access and flow through the emergency department was a challenge.

⚠ Midwifery and Medical staff failed to meet trust mandatory training and safeguarding training compliance targets of 95% for the majority of modules. Nursing staff training compliance failed to meet the trust target for 95% for 23 out of 25 modules and medical staff failed to meet the target for 18 …

⚠ Not all staff received appraisals to assess their work performance and promote their professional development. Appraisal compliance did not meet the trust target.

⚠ 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 was not in line with regulation or NICE guidance.