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Unannounced Inspection Report 22 & 23 October 2018 Mater Infirmorum

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Unannounced Inspection Report 22 & 23 October 2018 Mater Infirmorum Unannounced Inspection Report 22 & 23 October 2018 Mater Infirmorum Hospital Belfast Health and Social Care Trust Type of Service: Outpatients Department and Macular Clinic Address: 45-51 Crumlin Road, Belfast, BT14 6AB Tel No: 028 9074 1211 www.rqia.org.uk Assurance, Challenge and Improvement in Health and Social Care RQIA ID: 020172 Inspection ID: IN035694 Membership of the Inspection Team Dr Lourda Geoghegan Director of Improvement and Medical Director Regulation and Quality Improvement Authority Hall Graham Assistant Director Regulation and Quality Improvement Authority Sheelagh O’Connor Senior Inspector, Healthcare Team Regulation and Quality Improvement Authority Lynn Long Senior Inspector, Independent Healthcare Team Regulation and Quality Improvement Authority Thomas Hughes Inspector, Healthcare Team Regulation and Quality Improvement Authority Jean Gilmour Inspector, Healthcare Team Regulation and Quality Improvement Authority Lorraine O’Donnell Inspector, Healthcare Team Regulation and Quality Improvement Authority Dr Leanne Morgan Clinical Leadership Fellow Regulation and Quality Improvement Authority Paulina Spychalska Inspection Coordinator Regulation and Quality Improvement Authority Judith Taylor Inspector, Pharmacy Team Regulation and Quality Improvement Authority Ronan Strain Project Manager Regulation and Quality Improvement Authority Robert Mercer Support Project Manager Regulation and Quality Improvement Authority Chris Mercer Management Intern Regulation and Quality Improvement Authority Ann Pratt Peer Reviewer Richard Knight Peer Reviewer Marion Thompson Peer Reviewer Alan Craig Lay Assessor 2 RQIA ID: 020172 Inspection ID: IN035694 Abbreviations IPC Infection Prevention and Control NEWS National Early Warning Scores QIP Quality Improvement Plan RQIA Regulation and Quality Improvement Authority ANTT Aseptic Non Touch Technique GMC General Medical Council PTSD Post-Traumatic Stress Disorder QUIS Quality of Interaction Schedule PGD Patient Group Direction 3 RQIA ID: 020172 Inspection ID: IN035694 It should be noted that this inspection report should not be regarded as a comprehensive review of all strengths and areas for improvement that exist in the service. The findings reported on are those which came to the attention of RQIA during the course of this inspection. The findings contained within this report do not exempt the service from their responsibility for maintaining compliance with legislation, standards and best practice. 1.0 What we look for 2.0 Profile of service The Mater Infirmorum Hospital (MIH) is an acute hospital delivering a wide range of services including Emergency Department care, acute in-patient facilities, day procedures, mental illness and maternity services. The hospital’s main Outpatients Department is located within the general hospital building and comprises of a reception, waiting areas, a blood room and consultation rooms. Outpatient services delivered include cardiology, respiratory and hepatic medicine. In addition to these services, the Macular Clinic, located in Fairview House, opposite the main hospital site, provides clinics for patients with a range of eye conditions including wet macular degeneration and diabetic macular oedema. 4 RQIA ID: 020172 Inspection ID: IN035694 3.0 Service details Responsible person: Department Manager: Mr Martin Dillon (BHSCT) Bernie Mooney/Martin McComb Person in charge at the time of inspection: Bernie Mooney Outpatients Department Manager Fionnuala Gallagher Deputy Manager, Macular Clinic 4.0 Inspection summary An unannounced inspection of the Outpatients Department and the Macular Clinic at the MIH took place over a period of two days from Monday 22 October to Tuesday 23 October 2018. This inspection was underpinned by The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003, and The Quality Standards for Health and Social Care DHSSPSNI (March 2006). For the purpose of this inspection, an outpatient service was considered as one which enables patients to see a consultant, their staff and/or associated health professionals for assessment in relation to a specific condition but where patients are not admitted into hospital. The inspection was completed as part of phase 3 of the Regulation and Quality Improvement Authority’s (RQIA) Hospital Inspection Programme. It was one of five unannounced inspections carried out in the Belfast Trust during October 2018. Inspections were undertaken across 60 specialities and 5 hospital outpatient departments. The other sites inspected were: Royal Victoria Hospital, Musgrave Park Hospital, Royal Belfast Hospital for Sick Children and Belfast City Hospital. Reports from these inspections are available on our website https://www.rqia.org.uk These inspections also formed part of RQIA’s Review of Governance Arrangements in Outpatients Services in the Belfast Trust, with a Particular Focus on Neurology and Other High Volume Specialties. This review was announced by the Department of Health in May 2018 following the announcement of a recall of patients under the care of a Consultant Neurologist in Belfast Trust. We employed a multidisciplinary inspection methodology during this inspection. A Lay Assessor supported the inspection in respect of patient feedback. Our Lay assessor engaged directly with patients and their relatives to gather feedback on their experiences in relation to their outpatient appointment. Our multidisciplinary inspection team examined a number of aspects of each department, from front-line care and practices, to management and oversight of governance across the organisation. We met with various staff groups, spoke with patients and their relatives, observed care practice and reviewed relevant records and documentation used to support the governance and assurance systems. 5 RQIA ID: 020172 Inspection ID: IN035694 We have identified good front line care within the Outpatients Department and Macular Clinic in the MIH. Patients and their relatives advised us they were happy with their care and spoke positively regarding their experiences and interactions with all staff. We observed staff treating patients and their relatives with dignity; staff were respectful of patients’ right to privacy and to make informed choices. We found that staffing levels and morale in the Outpatients Department was good; however we noted a high staff sickness rate in the Macular clinic. There was evidence of good multidisciplinary team working and open communication between staff in both departments. Staff feedback was positive; they told us that they were happy, well supported and that there were good working relationships throughout the hospital. We undertook a review of the current arrangements for governance and managerial oversight within the Outpatients Department and the Macular Clinic in MIH. We identified concerns in relation to information and learning shared between outpatient managers; and improvements required to the fabric of the environment and facilities for patients and relatives. We also identified concerns in relation to staff knowledge, training and audit in relation to adult and child safeguarding and the displaying of safeguarding information for staff, patients and relatives. 4.1 Inspection outcome Total number of areas for improvement 5 Five areas for improvement were identified, these related to: sharing of information and learning between outpatient managers; governance arrangements for specialist nurses; fabric of the environment and facilities for patients; Safeguarding; and availability and display of safeguarding information for staff, patients and relatives. This report sets out findings which are specific to our inspection of the Outpatients Department OPD) and Macular Clinic in MIH. Recommendations relating to wider issues across the Trust’s outpatients services will be presented in the report of RQIA’s Review of Governance Arrangements in Outpatients Services in the Belfast Trust, with a Particular Focus on Neurology and Other High Volume Specialties. On 29 January 2019, we provided local feedback to Ms J Quinn, Assistant Services Manager, OPD, Ms B Mooney, OPD Manager, Mr M McComb, Manager, Macular Clinic and a number of representatives from the management team regarding the inspection findings. During the meeting we discussed the Outpatients Department and the Macular Clinic in MIH strengths and the areas identified for improvement identified during our inspection. The areas for improvement arising from this inspection are detailed in the Quality Improvement Plan (QIP). The timescales for completion of these actions commence from the date of our inspection. 6 RQIA ID: 020172 Inspection ID: IN035694 4.2 Enforcement action taken following our inspection. We were concerned about the safeguarding arrangements within the Outpatient Departments in the Belfast Trust. We identified concerns relating to staff knowledge, awareness and understanding of safeguarding issues within outpatient departments/services and the ability of staff to recognise such issues and respond appropriately to ensure vulnerable patients and service users are protected. This issue was escalated by RQIA’s Director of Improvement/Medical Director directly to the Trust’s Chief Executive and relevant Executive Directors and three escalation/update meetings were held with the Trust (13 March, 25 July, and 3 September 2019) to discuss implementation of a targeted action plan to address these findings. Following these meetings, and on review of additional evidence
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