Inspectors at a hospital in Wales had to help a patient who was unwell in its accident and emergency department as they couldn't find any staff, a report has said.
Inspectors from the Healthcare Inspectorate Wales were visiting the A&E at Ysbyty Glan Clwyd in November 2022 when they witnessed busy conditions in the department which was short of both nurses and healthcare assistants. The report also described how inspectors found medicines left unattended and unlocked cupboards containing sharp instruments easily accessible.
During the inspection, patients faced waiting over two hours to be triaged - including those with critical conditions that need to be treated in a timely manner, such as stroke and chest pain, putting patients at "significant risk of harm". It was the second time the department was visited in a year, after an initial inspection in May 2022 resulted in the department being marked as needing significant improvement.
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The report described how inspectors found some improvements during their November inspection, but not enough to remove the department from its service requiring significant improvement (SRSI), a classification applied by HIW to those services where concerns about standards are the most significant
Inspectors found the department to be incredibly busy and struggling with staff shortages as well as high numbers of unwell patients and a lack of space to treat them. Staff told inspectors they often felt unhappy, struggled with the workload and did not feel supported by health board senior leaders.
Ysbyty Glan Clwyd in Denbighshire is under the Betsi Cadwaladr University Health Board which has faced a number of challenges recently relating to its leadership. The health board has been put into special measures and the independent board that run it sacked following a report by Audit Wales raised concerns over "dysfunctionality" at the health board. Health minister Eluned Morgan survived a vote of no confidence in the Senedd over her role relating to the governance of the health board and was accused of failure to take responsibility for problems by the board's ousted chair.
HIW released the report relating to Ysbyty Glan Clwyd on Wednesday. One of its findings described how there were issues with the staff rota, with a heavy reliance on bank and agency staff to cover absences. HIW also identified difficulty with recruiting and retaining staff. Concerns about the varied levels of staff experience on shift were also raised, with times when most staff were junior.
The report said: "On day two of our inspection in November, the department was short of both nurses and healthcare assistants (HCAs). Staff were moved to support the busiest areas of the unit, which meant the corridor area accommodating unwell patients was left unsupervised. During this time HIW inspectors had to support one patient who was unwell and needed help, but no staff could be located.
"This inspection found that again, the flow of patients through the department was extremely challenging. Inspectors found that initial waiting times to see a doctor had improved since our visit in May 2022, but these were still in the region of three hours. Where input from a specialty doctor was requested by ED, our inspection found that there were varying response times. On some occasions, specialty doctors refused to review patients waiting within the ED, leading to further delays in their treatment and longer waits in the department. This was echoed by comments from staff who told us this caused frustration and was a further hindrance to patient flow overall."
The report also raised issues with blood pressure checks, records of pulse and breathing rate on patients at risk of deterioration not being repeated at the frequency in line with national guidelines - which could lead to a delay in time critical treatment. Inspectors also found instances where screening for sepsis was not undertaken and delays in patients being given antibiotics and or pain relief. To get more stories like this direct to your inbox, sign up to our WalesMatters newsletter here.
Serious risks with management of medical equipment were also identified as the following: "There were medicines left unattended, out of date medication, unlocked cupboards containing sharp instruments easily accessible and doors between different areas of the department not secured. We also found empty food trays, used urine bottles and other clinical equipment not cleared away for long lengths of time."
Dr Nick Lyons, executive medical director and interim deputy chief executive of Betsi Cadwaladr University Health Board, said a recruitment day is planned in the next few weeks to attract staff to the emergency department and he recognises the pressure the staff have been under and extended his apologies to patients.
He said: “Firstly, I would like to apologise for the instances where patients did not receive the level of care they deserved. I note the inspection team’s comments surrounding improvements since the last report but it is clear we still have some way to go in providing a service in our emergency department which is consistently good for every patient.
“It is true staff within the ED at Glan Clwyd Hospital have been under enormous strain for the past three years and this has increased since restrictions eased. Attempts to attract permanent members of staff to support the ED’s work continues and another recruitment open day is planned within the next few weeks.
“However, the fragility in staffing and the volume of acutely unwell people we receive each day means we remain a service requiring significant improvement. The vast majority of our colleagues are a credit to our organisation and we value their hard work and professionalism. We will continue to strive to make sure they feel supported by colleagues in other specialties and their hospital management teams.
“I note with pride the inspection team’s comments about how hard our staff work and their commitment. I’m also pleased the majority of patients they spoke to are happy with the care they receive within the department. Record keeping has improved and the inspection team noted the commitment of our staff to give the level of care we would all want to see. Despite the issues raised in the report inspectors acknowledged progress has been made but we know this needs to accelerate. Our colleagues within ED, and in other areas of the hospital, are fully focused on driving this change forward and we are pleased to see the proportion of patients moving through the department within four hours continuing to rise.”
Chief Executive of HIW, Alun Jones said: "This inspection found evidence of a department struggling to cope with the day-to-day demand of providing a safe service to patients. It has highlighted areas such as poor team working between the ED and other departments within the hospital which in turn is compounding nationally recognised challenges around patient flow. The health board will need to take strong and decisive action to tackle the issues identified in our inspection. We will continue to engage with the health board to ensure sustained action is taken in relation to our findings."
Commenting on the report, Welsh Conservative Shadow Health Minister, Russell George MS said: “I am very disappointed to see yet another poor showing from a Betsi Cadwaladr University Health Board-run hospital, particularly given the emergency department still needs serious improvements. When staff are stretched, issues build up. Regular checks of patient vitals skipped, delays in critical treatment, unsecured doors, unattended and out of date medication and sharp instruments. At the end of the day, it is patients who are at risk. There are clearly serious issues at Glan Clwyd and they emanate from the top.”
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