Health Service Journal (HSJ)
August 19, 2013
A national health trust in London has been issued with three formal warnings after inspectors found "unsafe" conditions including filthy maternity wards and water placed out of the reach of elderly patients.
Barts Health Trust has "failed to protect the safety and welfare of patients" at Whipps Cross University Hospital in Leytonstone, east London, the Care Quality Commission said.
Bart and the London, Whipps Cross and Newham hospitals merged last year to create Barts Health Trust. The trust must now make "urgent improvements", following unannounced inspections in May and June.
The hospital was failing to meet 10 of the 16 national standards for quality and safety, inspectors found.
On maternity wards, "serious shortfalls" were noted, such as blood-stained equipment, filthy curtains, staff not cleaning their hands and midwives failing to carry out proper checks on newborns.
Resuscitation equipment for babies did not have an oxygen supply and was not checked regularly, while some equipment was not sterile, inspectors found.
We saw examples of poor care, unacceptable staff behavior and poor infection control in maternity services," inspectors said in their report. "In surgery, theater processes and communication arrangements put people's safety at risk. Surgery and maternity were both too busy, did not have enough staff to look after people's needs and lacked bed capacity.
"The management at Whipps Cross are not adequately managing risks in either maternity or surgery," the report said.
During just one visit, inspectors identified "serious shortfalls" in eight out of the 16 essential standards hospitals are required to meet by law.
Staff on postnatal wards were found to be "uncaring.
The report said:
- "We saw a woman in a blood-stained gown and bed. About 10 minutes later we saw the same woman crying in the corridor. The midwife on duty asked the woman 'Why are you crying?' The woman replied 'I am in pain'. 'Pain!' the midwife repeated in a sarcastic manner.
- "The midwife got some medication and handed her a white pot which contained tablets without telling the woman what the tablets were.
- "We observed the same midwife bringing the wrong formula milk (as it was different to what the woman had previously been feeding her baby). When asked by the woman, the midwife did not accept she had brought the wrong milk and did not offer the woman the correct alternative."
- Care to mothers was "not always delivered safely" and some babies were admitted to intensive care, "related to a failure by midwives to carry out the correct observations at the right time and escalating matters when required."
- Staff did not wash their hands enough, putting babies, mothers and visitors at risk of infection.
- "On the labour ward, there were stainless steel bowls on stands in some delivery rooms. We saw a blood-stained bowl in a delivery room which was described as a room ready for use. We found another room, that a midwife had said was ready for use, had stains on the disposable curtains," the report said.
Inspectors also found shortages of staff on elderly care wards, including a lack of qualified nurses.
Care plans were not always updated and there was one fall on Bracken ward and 11 falls on Blackthorn ward, mostly at night, in an 11-week period.
While patients are checked for pressure sores on admission, inspectors found that five patients acquired sores in hospital.
Checks on feeding tubes were also not always carried out properly, the inspectors noted.
There were also problems in A&E with patients spending too long waiting to be seen. The national NHS target is for 95% of patients to be seen within four hours but the hospital has not met this target since November last year.
Between January and March, on 31 occasions patients had to wait more than 60 minutes from the time the ambulance arrived at hospital until a handover was completed, although the hospital said emergency attention was provided on the trolley when required.
The trust has now been told to improve in three key areas: cleanliness and infection control; safety, availability and suitability of equipment; and support given to staff.
Matthew Trainer, regional director of the CQC in London, said: "We have very serious concerns about the care and treatment patients have been receiving at Whipps Cross University Hospital.
"The reports we have published today show a systematic catalogue of failings across the departments we looked at during our inspections in May and June, he said. We found that, in places, the hospital was unsafe and dirty, and that staff didn't always show patients the compassion that people deserve."
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