Ormskirk District General hospital

⚠ The trust had not addressed the Hospital Pharmacy Transformation Plan (HPTP) objectives in a timely way.

⚠ The trust was not compliant with the Falsification of Medicines Directive at the time of our inspection.

⚠ We were concerned regarding medicines, including medicines that were passed their expiry date and in relation to the way that controlled drugs were managed.

⚠ The trust did not have a clear vision for medicines optimisation across the trust. We had immediate concerns regarding medicines optimisation, which we escalated at the time of our inspection.

⚠ At inspection we were concerned that some policies we looked at had not been reviewed in a timely way.

⚠ At our last inspection during our reviews of records we identified that staff had not completed documentation for Mental Capacity Act, Deprivation of Liberty safeguards and do not attempt cardiopulmonary resuscitation plans appropriately. This represented a patient safety risk. We had similar concerns at this inspection.

⚠ At our last inspection we saw patient records were not stored securely. At this inspection we found paper patient records were not stored securely.

⚠ We were concerned regarding staff competencies including how they were evidenced. In relation to equipment, we were not assured that the trust had oversight as to whether staff were competent. We found gaps in records relating to competencies.

⚠ Staff did not always assess the risks to patients appropriately and did not always keep good care records.

⚠ The maintenance and use of equipment did not always keep people safe.

⚠ At this inspection, we saw staff did not consistently use equipment and control measures to protect patients, themselves and others from infection. Staff did not follow best practice to minimise the spread of infection when caring for patients with identified infections inside rooms.

⚠ We found substances hazardous to health stored in unlocked rooms on three wards. This meant there was a risk they could accessed by vulnerable patients and was not in line with health and safety best practice. Managers did not always ensure that actions from patient safety alerts were implemented and …

⚠ The service did not have enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

⚠ At this inspection we found paper patient records were not stored securely on three wards.

⚠ The service did not ensure medicines were always safely prescribed, administered and stored. We found out of date medicines in three wards. Staff did not consistently monitor ambient room temperature where medicines were stored and did not escalate this to estates when room temperatures were out of range. We saw …

⚠ Staff did not follow national guidance to gain patients’ consent. We reviewed 14 completed ‘Do Not Attempt Cardio-pulmonary Resuscitation’ (DNACPR) forms across three wards. Of 14 forms, six were not signed by a senior clinician at the time the DNACPR was initiated. Seven of the 14 patients lacked capacity and …

⚠ Staff did not always agree personalised measures that limited patients' liberty. We found one patient where bed rails were used to restrict their movement but were not indicated in the assessment and a capacity assessment had not been completed.

⚠ Staff were not always able to respect patients privacy and dignity. We saw three occasions on one ward where patients were not afforded privacy and dignity. The shower facilities and lack of rehabilitation space on another ward did not allow staff to always protect patients’ privacy and dignity and there …

⚠ Local governance processes were not effective as we found areas of poor practice which had not been identified through governance processes.

⚠ Though leaders and teams used systems to manage performance, these were not effective. We found areas of poor practice at this inspection which had not been corrected though we had told the service to make improvements previously.

⚠ The service provided mandatory training in key skills to all staff, however; compliance was below trust target for medical and theatre staff.

⚠ Staff did not always understand how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

⚠ processes in place to prescribe, administer, record and store medicines were not safe

⚠ There were issues with the resuscitation trolleys, in that regular and robust checks were not always completed. We found one of the resuscitation trolleys to be inadequate, as staff could not be assured that the equipment they needed in an emergency would be there. Checking processes were not robust.

⚠ On review of two root cause analysis for serious incidents relating to babies, we found evidence that medical staff had not always responded to nursing concerns. Nursing staff told us at the time of the inspection this issue was ongoing.

⚠ The service provided mandatory training in key skills to all staff, however, not all of the staff had completed this. We were particularly concerned regarding completion levels for resuscitation training for medical staff (31.6%).

⚠ The service did not have enough medical staff at consultant level to meet national standards.