Great Western Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed 3 quality statements in this key question relating to assessing needs; monitoring and improving outcomes, and consent to care and treatment. Care was planned with patients, considering their preferences. The division aimed for high-quality care and treatment. Consent was obtained and documented, and additional assessments were conducted to support decision-making.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The electronic system used at the service flagged patients with additional needs, which were also noted on ward round whiteboards. Staff had access to learning disabilities support. A relative praised the exceptional care and support provided.

Staff worked collaboratively to benefit patients. For example, red trays were used at mealtimes, in order to identify patients who needed additional support with their meals. New staff needed reminders about feeding patients and completing food and fluid charts. Regular multidisciplinary meetings were held to discuss patients and improve care. Staff collaborated across healthcare disciplines and with external agencies. For example, the palliative and pain teams worked closely together to meet patient needs. Patients’ care pathways were reviewed by relevant consultants. However, some staff told us they lacked knowledge of how to access communication tools for patients with additional communication needs. This was fed back to senior leaders at the time of the assessment.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff described new processes implemented through learning and improvement. For example, additional cleaning processes for commodes were embedded to meet IPC guidelines. Commodes were dismantled twice daily for thorough cleaning. Body maps were completed daily for all patients with wounds. A body map is a visual representation of a person's body, used to document the location and appearance of wounds. Staff told us they conducted monthly falls and pressure ulcer audits in order to monitor and improve outcomes.

Staff monitored care effectiveness and used findings to improve outcomes. The service participated in national clinical audits. Managers and staff conducted repeated audits to improve patient outcomes. For example, our review identified repeated incidents, like pressure ulcers. The trust had an updated and ongoing improvement plan for pressure ulcers.

People felt supported by staff, who took time to explain treatment and decisions. Staff were sensitive and knowledgeable when giving updates to families. Patients observed staff supporting others with reassurance and kindness when making decisions.

Staff told us they obtained consent for care and treatment, ensuring informed decisions. Staff made sure patients consented to treatment based on all the information available. Staff understood how to assess a patient’s capacity to make decisions.

Staff received Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training. They understood relevant consent and decision-making requirements. Staff knew how to access policy and advice on these topics. Managers monitored compliance with the MCA and made necessary changes. Staff implemented DoLS according to approved documentation. Our review of patient records found clear consent documentation and appropriate decision-making when patients could not consent.