Unannounced Inspection at Altnagelvin Area Hospital, November 2016

RQIA has published the findings of its unannounced inspection at Altnagelvin Area Hospital, as part of RQIA’s ongoing programme to provide public assurance on hospital quality, and to drive and support improvements in the delivery of care. During the inspection, which took place in early July, RQIA spoke to patients, relatives and staff; observed how care was being delivered; and examined care records.

RQIA’s healthcare inspectors visited the Emergency Department, and medical and surgical wards, and were joined by doctors, nurses, pharmacists and allied health professional peer reviewers and members of the public. The team assessed whether the care was safe, effective and compassionate, and considered how each area was being led and managed.

At Altnagelvin Hospital’s medical and surgical wards inspected we identified good adherence to best practice in the delivery of patient care, with some areas noted for improvement. However, our inspection of the ED identified a range of areas that required improvement.

In each area inspected we observed caring and committed staff, showing empathy to their patients. While patients told us they were satisfied with the standard of care they received, in some cases relatives highlighted the need for up-to-date information on their family member.

In the medical ward we observed good clinical leadership from the ward sister. While staff told us that morale was good, we were advised that this was affected by increasing work as a result of staffing shortages. Our inspection team observed good compliance with hand hygiene and patient early warning scores were well completed. We also noted good medicines management, with a pharmacist involved from admission to discharge.

In the surgical ward there was also strong leadership, and morale was good. The ward was operating with a full complement of staff and we were told that staff retention was good. However, we were advised that there was no integrated medicines management service on the ward and delays in access to pharmacy services could impact on discharge. We also advised the trust that the system for delivery and service of patients’ meals requires immediate review and improvement, to ensure patients nutrition and hydration needs are met.

In the Emergency Department while leadership was good, staffing levels were concerning, there were delays in recruitment and bank or agency staff could not always be secured. Staff told us they were feeling tired, ‘burnt out’ and stressed as a result of low staffing levels. RQIA’s inspectors considered that at busy times the Emergency Department was not adequately staffed to ensure appropriate patient care.