INSPECTORS from the Care Quality Commission (CQC) have lowered the safety rating of the Cumberland Infirmary's Emergency Department (ED) in a new report, leaders say they are "disappointed" but are taking proactive steps to address the concerns raised.
Findings, published in full today, relate to inspections of Carlisle's ED in February and March.
CQC inspectors initially visited the ED on February 16 and 17, providing early feedback to leaders at the close of the second day.
A follow-up inspection took place on March 18 and the CQC wasn't satisfied that the trust had addressed previously raised concerns.
It therefore issued North Cumbria Integrated Care (NCIC) with an enforcement warning notice related to those issues, including care and supervision of mental health patients and those with deteriorating illnesses in the emergency department; infection prevention and control and the assessment of patient needs.
The full report, lowers the rating for safety at the ED to 'inadequate' and the rating for caring to 'requires improvement.'
Immediate action
Leaders say they take the enforcement warning "very seriously" and immediate actions were taken around the care and supervision of mental health patients at the ED.
They include:
- A healthcare assistant or registered nurse being assigned to the ED waiting room to supervise patients while they wait and identify and support any patients with deteriorating conditions.
- The dedicated mental health assessment room has been reviewed and works have been completed including removal of a sink and new furniture.
- New processes have been put in place to ensure that mental health risk assessments are carried out quickly when a patient arrives in the ED and any safeguarding measures are put in place to protect that patient during their time in the department.
- Ligature risk assessment has been updated.
- Emergency Physician in Charge (EPiC) now undertakes senior review of mental health risk assessments each shift.
- Updated mental health risk assessment training has been delivered to ED staff.
Doctor Gill Findley, Chief Nurse, said: "Some of the improvements will take time to put in place but we are determined they are resolved on a permanent basis and not just a temporary fix.
"We are also undertaking a number of improvements to the facilities and environment in the ED, including painting and decluttering the cubicles and making improvements to our toilet facilities."
Confidence in care
The Chief Nurse said: "While we fully accept the findings of the CQC report, naturally we are disappointed as we know that all of our colleagues come to work to do a good job for their patients."
She said that the trust wants "patients to feel confident that they will receive good care when they come into our hospitals.
"I am particularly disappointed that the CQC found that areas were cluttered which prevents effective cleaning and that some staff were not demonstrating good hand hygiene practices and were not bare below the elbow.
"We all agree that there is no excuse for this and we have been working hard to reiterate the importance of adhering to infection prevention standards."
She thanked ED staff "for their ongoing response to the CQC’s findings."
Ageing facilities
Dr Findley said: "The ED was originally designed to accommodate 30,000 patients a year and we are now seeing around 70,000.
"This is why we have invested £4million into our Urgent and Emergency Care (UEC) services to help us to stream less urgent cases to the most appropriate place and free up ED for critically ill patients.
"The Urgent Treatment Centre (UTC), which is co-located with the ED, is now up and running following successful recruitment efforts."
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