Worcestershire Royal 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

The service had a strong awareness of the risks to people across their care journey, identifying and managing these risks effectively. Care and support was planned and organised with people and safety and continuity of care was a priority throughout people’s care journey.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

People that we spoke with during the inspection told us that they had felt their safety and continuity of care had been a priority throughout their care journey. They told us they had been involved and kept informed about their care including transferring site, risks to their health and plans for their ongoing care and discharge.

Staff and managers had a strong awareness of the risks to people across their care journeys. Issues had been identified with capacity and flow. Leaders had identified issues with how patients were able to access the stroke unit from the emergency department (ED), cross team working within ED, and other settings as well as being unable to ‘step down’ patients due to a lack of available beds elsewhere. In response to this, a stroke co-ordinator role had been created in 2023 to provide a link between services including the local community stroke, discharge and hospital teams. The effectiveness of this response was monitored and managed as part of the governance process to keep people safe. In addition, a 24 hour 7 day a week clinical nurse specialist role had been created and actively 'pulled' patients suffering from stroke symptoms into the specialty area after first reviewing them and carrying out the necessary diagnostic tests within the emergency department.

Other organisations who worked with the trust told us the trust planned care and support for patients collaboratively to make sure patients received safe treatment. The stroke service worked with other organisations such as local hospitals, patient representative groups and the integrated care board who commissioned the stroke service. This meant the stroke service was available 24/7 to patients. Patients could also access rehabilitation at home which meant they did not need to spend as long in hospital after a stroke. Staff used technology to help diagnose and treat patients more quickly.

Staff had access to policies which helped them to deliver safe care and treatment. Staff reviewed patients on the Hyper Acute Stroke Ward at least once daily 7 days a week. Patients in the other part of the ward, the Acute Stroke Unit were reviewed daily between Monday and Friday. Senior clinicians including clinical nurse specialists were on duty out of hours and an on call consultant was also available if a patient deteriorated and needed review.

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

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

People told us staff came quickly when called, they were regularly seen by therapists and doctors as well. During the inspection we observed one to one staffing and care of patients with nutritional, hydration and emotional support. Patients told us that staff were responsive to their needs

Staff told us, and we saw, that there were enough staff, including nurses and doctors, on the stroke unit to safely care for patients. In the hyper acute part of the stroke unit, nurses had additional training in stroke care to safely look after patients who were more unwell. Staff told us, and we saw, they had completed mandatory training to do their jobs, and they had a yearly appraisal.

The service had a system for recruitment and monitoring of staff. This included reviewing professional registrations and also enhanced disclosure barring checks. New staff completed a 2 week period of supernumerary work (not counted in the staffing numbers) and all staff underwent clinical supervision twice yearly. Agency staff were given a local induction to ensure they were familiar with the practices and environment of the service to be able to carry out their role.

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.

People's medicines were available in the necessary quantities to prevent the risks associated with the non-administration of medicines, such as Parkinson and epilepsy medication.

Staff understood the medicine management procedures within the service. Staff had access to up-to-date information about people’s medicines.

During the inspection we saw that daily medicine and medicine management checks were completed and recorded appropriately. People's medicines were appropriately prescribed, supplied and administered in line with the relevant legislation. Staff rotated medicines to make sure no medicines exceeded their expiry date.

The service had clear roles and responsibilities that supported the safe optimisation of medicines. This included a dedicated full time pharmacist who managed take home medications, medicine reconciliation, clinical screening and also assisting on clinical ward rounds. Medicine audits were undertaken regularly and daily checks were completed in line with best practice guidance. The service had appropriate arrangements and oversight for the safe and secure handling and controlled drugs. Audits of these were carried out every 3 months which reflected current legislation, relevant best practice and professional guidance. A professional screening standard operating procedure was in place within the service which included a transcription check for discharge prescriptions of patients.