Inspectors critical of Royal Oldham Hospital for social distancing and PPE lapses

Hospital staff in an emergency department failed to stick to social distancing guidance, good hand hygiene and appropriate use of personal protective equipment (PPE), inspectors found.

One staff member at the Royal Oldham Hospital "interacted closely" with patients without using gloves, washing hands or changing PPE between patients, while another took a patient's history on the respiratory corridor without wearing eye protection, the Care Quality Commission (CQC) said.

Inspectors also saw a relative being directed to the urgent treatment centre without any Covid screening.

The emergency department - on which the inspection was focused - was downgraded from a rating of good to requiring improvement following the November 30 visit.

The CQC wrote to the Pennine Acute Hospitals NHS Trust afterwards "because we were concerned about the potential significant risk of harm to patients".

They said the trust "took immediate action to address our concerns and developed an action plan to make and embed improvements to the service".

The CQC acknowledged that at the time the North West was experiencing "significant levels of Covid 19-related pressure" but said it had carried out its unannounced inspection partly due to concerns from staff and members of the public about the safety and quality of services.

Inspectors said they had seen department staff "on multiple occasions" not adhering to hand hygiene protocols and while alcohol gel was used, it was not consistent.

On cleanliness, they found that while staff cleaned cubicles and equipment between patients, "cleaning of the floor area was not consistent", nor was the decontamination of the department's patient assisted transfer board after being used by external staff, which the CQC said "increased the risk of cross contamination or cross infection of patients and staff".

They said staff did not always change PPE when moving between different areas and that in some cubicles PPE storage was at the foot of the bed, meaning staff were not always able to maintain "appropriate social distance from the patient" when putting it on or taking it off.

Inspectors also found that staff did not always maintain social distancing between patients or themselves, saying that at one stage six staff members were seen not appropriately spaced out while in an office next to the non-Covid resuscitation area.

Social distancing was also identified as a problem in corridors for staff, patients and ambulance crews, with patients on trolleys positioned head-to-toe.

Inspectors found space was limited in the department, with staff saying it was a regular occurrence for doorways to be temporarily blocked.

They also said that while people could access the urgent and emergency care service when they needed it, they did not always receive the right care promptly, with one patient having been in the emergency department for 14 hours at the time of their inspection.

While there were generally enough registered nurses on duty on most shifts, there were not enough health care support workers with medical staffing levels often reliant on locum and agency staffing, the inspectors found.

Ann Ford, CQC's deputy chief inspector for the north, said that while most staff training was up to date, not all staff had received training on life support and safeguarding.

On a positive note, inspectors said staff were quick to identify and act upon patients at risk of deterioration, that there was an open culture where staff felt respected, supported and valued and that the service used systems and processes to safely prescribe, administer, record and store medicines in line with their policy.

Ms Ford, said: "During our inspection in November, we could see that staff at the Royal Oldham Hospital were working hard to provide care to patients in very challenging conditions, when the North West as a whole was experiencing significant levels of Covid-19 related pressure.

"Given the pressure the trust were under, the decision to inspect during this period was a difficult one.

"However, both staff and patients told us they were concerned about the safety of care being delivered in the urgent and emergency department and we had a duty to inspect to support the trust in knowing where to make improvements."

The CQC said it will continue to monitor the trust and will be back to check on the progress of improvements. 

Libby McManus, Group Chief Nursing Officer & Director of Infection Prevention and Control for the Northern Care Alliance NHS Group, which runs The Royal Oldham Hospital, said:

“On the day the CQC inspected our Emergency Department in November last year, the inspection team saw some infection control practice which is neither acceptable nor our usual high standard and for this we are sorry to our patients and public.

 “We pride ourselves on the care we provide and take the safety of our patients and staff extremely seriously. We did not wait for this report to be published. I want to reassure those who depend on our services that immediate and decisive action was taken to address the areas of improvement required. We continue to monitor and manage the small yet significant detail of all our practice."

She goes on to say: “Overall the CQC found that the Emergency Department at Oldham was ‘well led’ and scored highly in this area, rated overall as ‘Good.’  However, in the CQC’s ‘safe and responsive’ category the service and department was rated as ‘Requires Improvement.’

“Our teams have used this report to make the necessary improvements and share learning across our organisation. We are committed to listening to our patients and staff when it comes to continuing to improve the safety and quality of care in our hospitals. I am encouraged that the CQC found that our staff felt respected, supported and valued and had an open culture where they felt they could raise any concerns. We continue to do everything we can to support our people.

“The CQC’s inspection has highlighted the significant challenges and demands our staff and staff right across the NHS are under in dealing with not only high attendances, but also the impact the pandemic is having on our staff and services. We remain focused on protecting and separating Covid patients, avoiding overcrowding in A&E, and dealing with the challenge in the reduction in bed capacity due to the need for additional Covid-19 beds.

“Our work with our local health and care partners in primary care and in social care continues to focus on improving how patients flow in and out of our hospital. We must support people in the community to avoid being admitted to hospital wherever possible.

“People should continue to feel safe and confident in accessing care and treatment at our hospital services.”