Date Published: 30 October 2008

Watchdog triggers action to improve services at Sussex orthopaedic NHS treatment centre

The Healthcare Commission today (Thursday) said Sussex Orthopaedic NHS Treatment Centre has taken action to improve safety of patients after inspections earlier this year identified serious concerns. The treatment centre has now made significant improvements and the Commission is satisfied that its concerns have now been addressed.
The independent watchdog is publishing findings from its inspection on 18 June, which included a thorough assessment of the centre's operating theatre.

Sussex Orthopaedic NHS Treatment Centre is an independent sector treatment centre (ISTC), run by Care UK. It provides orthopaedic surgery, such as hip and knee replacements, to NHS patients on the site of the Princess Royal NHS Hospital, Haywards Heath.

The Commission was concerned about poor processes for the prevention of serious incidents, gaps in staff training, management practices and hygiene procedures, following its inspection in February.

During its June inspection, the Commission found progress in the management of serious incidents and staff training had been made. It also found that the majority of required actions had taken place within the specified time scale, and that in some cases had exceeded them.

However, the Commission's assessment of the operating theatre showed lapses in decontamination practices and operating theatre procedures.

The Commission ensured that where the breaches required immediate attention, Sussex Orthopaedic Treatment Centre addressed them prior to the Commission's assessors leaving the hospital.

The Commission made 15 recommendations to the provider following the June inspection detailing the actions needed to remedy the areas of non-compliance across decontamination practices, management of theatre equipment and record keeping.

Nigel Ellis, the Commission's Head of Investigations, said:

"We are satisfied that Sussex Orthopaedic NHS Treatment Centre has now made vital improvements to its service, and that the safety of patients is not compromised.

The centre has implemented the actions required to become compliant with decontamination and operating theatre regulations. They must now continue to drive improvement in staff training and management of serious incidents and we will maintain close contact with the centre, keeping up the pressure to make sure this happens."

During the June inspection, the Commission found that some of the decontamination practices at the centre did not comply with the regulations required by the Care Standards Act, such as:

* inconsistent checks of equipment used for the decontamination of instruments. For example, no daily checks of washing equipment and no documentation of filter changes
* brushes for manual cleaning of equipment were very worn and were changed at the request of the assessor
* staff did not wear gowns and shoes were not changed when working in the equipment assembly and packing room.

The Commission also found lapses in operating theatre practices in June. For example, it found that:

* written policies and procedures for theatre practice were incomplete and several were absent. This includes counting of items such as swabs, needles, operative instruments and blades, and what to do if items cannot be accounted for. If items cannot be accounted for, staff need to be able to take appropriate action to ensure the safety of patients. However, observation of practice demonstrated that, despite the absence of these policies, a good standard of checks were carried out.
* patient consent forms and theatre lists contained abbreviations, which are not best practice. The use of abbreviations can increase the risk of misinterpretation.
* exact times of administration of controlled drugs were not documented in the controlled drugs register and alterations were not initialled
* some equipment did not contain any manufacturer information, expiry date, or any information as to the number of uses or evidence of decontamination
* signs showing that X-ray equipment is in use were not used during radiological procedures. This could lead to unnecessary exposure to radiation.

The Commission stresses that the issues above have now been addressed. The centre has implemented all actions and is now fully compliant with all relevant regulations pertaining to all issues identified during the June inspection.

The Commission says it will continue to monitor progress and keep up pressure on the provider to drive further improvement in these areas. It conducted reviews on 5 September and 8 October and will continue to monitor and visit the ISTC as necessary.

Actions taken by the centre following the Commission's June inspection include the introduction of a grading system for incidents. Senior nursing staff and senior management are responsible for recording and reviewing all incidents and near misses, in order to identify trends and patterns and ensure lessons are learnt.

In addition, the provider reported that training on manual handling has been delivered to 86% of staff, exceeding the target of 56%. Training on infection control policies is also now included within the staff induction programme.


Source: The Healthcare Commission (England, UK).

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