Northampton General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff were able to demonstrate good knowledge of their patients’ needs and risks. Systems were in place to make referrals for more specialist assessment. Assessments were undertaken and therapy provided on a regular basis where required. Shift changes and handovers included all necessary key information to keep patients safe including oversight of patients at risk of falling. Staff were able to tell us which patients were at a high risk of falls. Staff knew what incidents to report and reported serious incidents clearly and in line with trust policy. There was learning from incidents. The service had developed an action plan in response to a recent serious incident to prevent a similar incident from reoccurring. However, learning from this incident had yet to be fully embedded and applied consistently to patients who required enhanced supervision. Falls performance information was shared with patients, visitors and staff. This enabled leaders to monitor the effectiveness of the processes in place to prevent falls. Staff commented that the ward layout and environment made it challenging to care for patients who were confused or at risk of falling. Staff made efforts to maintain a clutter free environment around the immediate bedside but found this more challenging on the wider ward due to the environmental constraints. Staff completed and updated risk assessments for each patient. All patients underwent a multifactorial falls risk assessment. However, compliance with enhanced observation risk assessments was variable for patients who were at risk of falling and required a more enhanced level of supervision.

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.

Staff knew what incidents to report and how to report them. Staff were able to describe the incident reporting process and gave examples of falls incidents they had reported, or others had reported. All staff we spoke to were able to describe recent falls, including the last serious incident in December 2023. Staff could tell us what the learning was and how they had implemented this to avoid a fall occurring. Staff told us they discussed this incident in a recent ward meeting with the falls lead present. The falls team had supported ward staff in relation to a recent fall resulting in a serious harm. The falls lead attended the ward to undertake an audit and to share learning and support staff how best to avoid falls. Staff found this support helpful. Staff and managers understood and were able to describe duty of candour responsibilities. They described how they apologised if a patient had a fall, whether there was harm or no harm. They also described how they contacted family or carers, with patients consent, to let them know their family member had a fall.

There was process in place for staff to report serious incidents (SI). Records showed these were reported clearly and in line with trust policy. The ward also had a designated falls link worker who worked with the trust specialist falls lead to implement learning from audits and incidents. Staff could also access the trust falls lead for advice and guidance when necessary. Managers told us they had a debrief following a fall and looked at what the causes and contributory factor were that led to the fall. This also included whether there was any learning or safety concerns. Serious falls incidents were reviewed by the trust incident review group to agree whether a more in-depth investigation was required so that learning could be identified, shared, and implemented. Staff received feedback from investigation of incidents.

People said they felt safe. A patient, who was at risk of falls was fully aware of why they had a falls alarm in place to alert staff should they attempt get up. The patient was happy for this to be in place and understood why it was necessary. People said they had the correct equipment and staff had told them when and how to use it safely. Shift changes and handovers included all necessary key information to keep patients safe. We saw handover included oversight of patients at risk of falling. Electronic handovers were in place which included all relevant information such as falls risks and bedrails risks. Handovers included discussions about tagged bays. Tagged bays are used for patients who requires constant observation and should be manned at all times. The nurse in charge assigned bays to specific staff to ensure tagging was effectively implemented. During our inspection, staff were able to tell us who their high risk of falls patients were.

Staff were able to demonstrate good knowledge of their patients' needs and risks. They knew how to seek advice and support from specialist teams and ensured patients requiring mobility assessments had them in place.

Systems were in place to make referrals for more specialist assessment. For example, we saw staff referred patients for a physiotherapist and occupation therapy assessment when required. This was included in patients' risk assessments. We saw evidence assessments were undertaken and therapy provided on a regular basis where required. This supported nursing staff who were responsible for day-to-day care to meet the patients needs better and understand their mobility and transfer needs. This was recorded on the patient whiteboard above their heads.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

All staff had a good oversight of their patients and those who were at risk of falling. Staff knew how to assess patients who were at risk. Staff were able to describe confidently how they assessed the risk of falling. All staff we spoke to had received falls prevention training and use of bedrails training. Staff we spoke with generally understood how to undertake an assessment and could articulate the risks of bedrails to patients. Staff assessed risk by gathering information from the patient direct and through family/carers should they need more information. Staff utilised support from allied health professionals to undertake specialist assessments.

Patients told us staff were visible and generally responded in a timely manner when they pressed their call bells. Patients told us staff were kind and caring.

Staff were aware of the environmental challenges which they attempted to mitigate. Staff placed patients who were high risk of falls where possible in beds which were easier to see. Staff told us a patient at risk would not be placed in a side room. Staff commented that the ward layout/environment was not ideal and made it challenging to care for patients who were confused or at risk of falling. Staff made efforts to maintain a clutter free environment around the immediate bedside but found this more challenging on the wider ward due to the environmental constraints. Staff told us equipment was easily accessible such as falls alarms, call bells, anti-slip socks and mobility equipment. Processes were in place to escalate when equipment was immediately available. If a risk assessment indicated a patient was at risk of falls, a falls alarm was an option provided so people could alert staff if they fell or felt at risk. of falling. Staff were able to describe the process for requesting a falls alarm and said they were quick to arrive Staff knew how and when to use them.

All patients could reach call bells and staff responded quickly when called. The ward layout was challenged with space to store equipment. There was significant equipment in corridors such as desks and filing cabinets. These posed a potential trip hazard especially to patients at risk of falling or suffered confusion. We found 2 areas where there was damage to the floor. The damage was in a walkway and posed a potential trip hazard. It was not taped down. Managers told us they had reported it and were awaiting a temporary fix. Due to the ward design, staff could not always observe patients at risk of falling. Bay 2 was not visible to staff and was isolated. There were 4 beds in the HDU (high dependency unit) bay . One bed was noted as being the most visible and was was used to care for patients with a higher risk of falls or confusion. Staff had ensured bed spaces were tidy and clutter free. Patients only had the equipment needed, such as mobility aids, at their bedside. All patients had call bells to hand, falls risks and mobility needs were recorded on patient information board above bed. Bed bays did not have dedicated bathrooms or toilets, however we saw staff supported patients to walk to the toilet when required and avoid obstacles. There were 3 communal toilets/bathrooms on the ward. One was out of order. The bathrooms had equipment to support patients with mobility issues. There was sufficient space to mobilise and in generally free from slip hazards. One shower had a slight step in. Staff told us they would wheel a patient on a commode or assistance to shower if at risk of falls. The second shower was walk in and had anti-slip flooring.

Processes were in place to check the patient environment and equipment being to ensure it was clutter free and safe. For example, there was a daily health care assistant and registered nurse checklist to check key information was up to date, the environment was clear and clutter free and equipment needed to mobilise, such as walking frames, were to hand. We saw these had been completed daily. Staff undertook daily bed safety checks. This included checking the equipment and bed rails were in good condition. This was completed by the HCA and included checking any falls alarms and call bells. During our inspection we checked 3 beds and they appeared to be in good condition and working order. All the patients who were high risk of falls had beds in the lowest position when checked. Processes were in place to order and safety check equipment such as falls alarm mats when required. There was 1 falls alarm and mat being used by a patient at the time of our visit. The alarm was attached to the mat and this was clipped onto the bed bars. The patient told us what the mat was for and told us it worked when they stood up. Another patient confirmed this. We also heard it go off during our visit from outside the bay, demonstrating it was loud enough for staff to hear. We saw there was a maintenance receipt on it to confirm it had been sanitised and maintenance checked. The person's name was included on the receipt to ensure it was allocated to the correct patient.

Patients told us staff were visible and generally responded in a timely manner when they pressed their call bells. Patients told us staff were kind and caring.

There were 3 Registered Nurses (RN) for 14 patients which equaled a 1:5 ratio. 1 RN was co-ordinating and the ward sister was supporting the ward clinically. There was 1 Health Care Assistant (HCA) on the rota and an additional HCA designated to a patient requiring enhanced 1:1 care. The ward had recently filled all registered nurse (RN) vacancies. Feedback from senior staff about planned staffing levels was inconsistent. The ward sister and RNs told us there were 3 RN and 1 HCA planned for each shift. Additional staff could be requested where enhanced care was required. However, the matron told us there were 2 HCAs planned each shift. If they didn’t have enhanced care, they reduced it to 1. This meant it was unclear what the requirement was for healthcare assistants. Staff told us when they had more than 1 patient who was at risk of falls this was difficult to manage. The ward did not have any high visibility beds due to the layout of the ward and separation of the bays. It was not always possible for a staff member to be present in a bay at all times as they had to leave the bay throughout the shift to support patients across the ward, administer medicines and to cover staff breaks. This meant there were times when those patients deemed to be at risk were not always observed. Bay tagging, a practice where high risk patients are continually observed by staff, was not always effective. During our inspection a patient who required bay tagging, as stated in her falls risk assessment, did not have this consistently in place. However, staff mitigated this risk through use of a falls alarm. Staff could only request additional staff if a patient was assessed as meeting the threshold for enhanced supervision. Staff told us that this was usually only possible where the patient did not have capacity and a DoLS was in place.

During our assessment, we saw staff were constantly in and out of bays, however, there were periods of time where staff did not visit a bay such as when they were undertaking clinical tasks elsewhere on the ward. However, we observed staff were responsive to patients needs and did regular checks of patients and quickly responded to call bells.

There were systems and processes to assess, plan and review staffing levels, including staff skill mix. A staffing tool was used to calculate the number of nurses and health care assistants required for each shift based on the acuity (level of care a patient requires) and needs of the patients. Processes were in place to assess daily staffing requirements which considered patients at risk of falling. Where a patient had been assessed as requiring one to one enhanced supervision, additional staff were added to the planned numbers to provide dedicated one to one care. This was usually a healthcare assistant. At the time of our assessment, there was 1 patient on the ward assessed as requiring enhanced supervision. The patient had an MCA assessment and DoLS in place. The 1:1 supervision was to prevent the patient from coming to harm through falling as they was assessed as high risk. An additional HCA was booked to care for this patient and was existing an staff staff member familiar with the needs of the patients on the ward. We saw 1:1 supervision was continually in place.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.