1
STAFF BRIEFING
Care Quality Commission (CQC)
Essential Standards of Quality and Safety
Preparing for inspection
2
STAFF BRIEFING
The purpose for this briefing is to:
• Help staff familiarise themselves with the new
inspection model
• Explain how the CQC will inspect so that the
actual visit feels less daunting
• Shine a light on the areas of risk identified through
our own quality inspections
• Provide practical advice on how to prepare
3
The role of the Care Quality Commissioner:
Independent regulator of all health and social care services in England
• The independent regulator of all health and
social care services in England
• Care provider registration
• Set National Essential Standards of Quality
and Safety
• Compliance monitoring and regulation of
services against standards through:
• Data and surveillance pre inspection and
at regular times during the year
• Direct observations and interviews at
inspection
• Action – where standards are not being met.
4
St George’s CQC inspection
• The Care Quality Commission (CQC) inspection starts on Monday 10th
February 2014
• It will last for one week but there could be shorter follow-up visits in the
terms of unannounced inspections
• Inspection will cover St George’s and Queen Mary’s Hospital and our
community services
• 40-50 inspectors divided in to 12 teams. Inspectors will be wearing colored
id badges
• Six teams will focus on St George’s and six will focus in the community
• The inspectors will observe care in practice, also talk to staff, patients and
our key stakeholders
• A rating of ‘good’ or ‘outstanding’ is required for us to continue our path to
becoming a Foundation Trust.
5
CQC Inspection model
• Since our last inspection a new, more rigorous, inspection model
has been devised by the Chief Inspector of Hospitals
• The new regime and approach to inspections will be based around 5
key domains
5 inspection questions
Four point scale used for all ratings
• Are they safe?
• Outstanding
• Are they effective?
• Good
• Are they caring?
• Requires Improvement
• Are they well led?
• Inadequate
• Are they responsive
6
NEW CQC INSPECTION REGIME
Chief Inspector of Hospitals
• Decisions on where and when to inspect will be made
by using information in a more focused and open way,
responding quickly to services that are failing
• National and local data sources will continue to be used
along with intelligence from local authority overview
and scrutiny committees
• A set of 118 indicators to provide information on each
element of the new surveillance model. “Smoke
detectors” by which they will decide where and when to
inspect - which helps to develop their key lines of
enquiry
• Mortality data features highly in the proposed data set
along with patient / public comments posted on various
web sites.
7
CQC Inspection model
During an inspection the CQC Inspectors will:
• Hold focus groups with people who use services (including
relatives) about their experiences of receiving care
• Hold small group meetings with leaders of key services
• Hold focus groups with staff (multidisciplinary teams – including
students)
• Interview individual directors as well as staff of all levels
• Observe patient care to check that the right systems and
processes are in place, and patients are treated with kindness,
dignity and respect and staff work well and communicate
effectively with each other and patients
• Look for evidence that care is meeting national standards
• Look at documentation – have observations been done,
medication given, risk assessments completed, plans of care
• Observe staff interaction – are teams supportive and respectful
of each other
• Look at environment – is it clean, uncluttered and safe
• Look at patient information available – are notice boards up to
date, relevant, tidy.
8
Promoting high-performance and excellence
• The CQC revisit in August found a much improved position
across the St George’s Hospital site
• The majority of the patients they spoke said that they had a
good experience at St George’s and were very positive about
the care they received from staff
• Don’t forget that these inspections are an opportunity for us
to nationally showcase the quality and safety of care we
provide
• We continue to use each inspection as a driver for quality
improvement. For example CQC inspections have now
become quality inspections and form part of our internal
assurance processes to check that we are consistently
achieving good standards of care.
9
Advice from a senior nurse
It’s important to remember
that getting the little things
right quickly accumulates into
getting the big things right. It’s
also worth remembering the
opposite is true…
Be prepared, be receptive to
change and learn from any
shortcomings the inspectors
might raise…
It’s about flexibility because
what may be important during
one inspection may not be an
issue at another…
Ensure all members of staff are
aware of the identified areas of
concern and all members of
staff have a ‘voice’…
It’s important not to take things
personally or think inspectors are nitpicking. You need to listen to what they
have to say, address any issues raised…
10
If you speak to an inspector
•
Maintain a professional manner at all times. There is no such thing as a ‘throw away’
comment
•
Think carefully about how you speak about yourself, your colleagues and your environment.
Always talk about colleagues and services in a professional manner
•
Listen to what is being asked – ask for clarification if need be. Think about your reply. It’s ok
to pause to collect your thoughts
•
If you aren’t certain how to respond to a question or feel compromised by any line of
questioning, or if you can’t answer a question, say so but also say that you will find out.
•
As well as being asked about what you do or what you know you may be asked about things
that concern you. It is absolutely right that you are open and honest. Try to balance your
concerns with information about what is being done.
•
Think about the positive effects your care provides to families and patients who you work
with on a day-to-day basis and over the long-term.
•
Remember, if you make a comment about the service, inspectors may check the validity of
what you said against other evidence.
11
Tips for working under inspection
It is a fact of life that people act/work differently whilst being
observed. The following points are suggestions to help you whilst
working under observation
• Don’t get paralysed by perfection
•Be yourself, and use the inspection to showcase your work
• Stay in the moment?- if you feel overwhelmed (like pretty much everyone) it might
not be because you have so much to do rather you trying to do so much at the same time.
• Keep calm
• Even though you may feel you are being watched always
consider the patient needs first
12
Are we safe?: CQC Key Lines of Enquiry
Domain – Safety
Be safe, we mean that
people are protected
from both abuse and
avoidable harm and
that there is an open
and just culture, which
promotes continual
learning.
No.
KLOE
S1
How safe has care been in the past?
S2
Can the provider demonstrate that they consistently
learn when things go wrong and improve standards
of safety as a result?
S3
How reliable are systems, processes and practice?
S4
How safe is care today?
S5
How confident are we that care will be safe?
What does this mean in your daily practice?
13
What does this mean in your daily practice
PRACTICAL APPLICATION
• Complaints posters
• Learning from incidents
• Audits - Results and where to improve
• ID bands in place
• IC - Hand gel & hand washing/
equipment
• Sluice - clean and tidy
• Call bells near patient
• Clutter free ward - Dump the junk
• Handling linen
• Safe surgery checklist
• Patient surveys
POLICES AND PROCDURES
•
•
•
•
•
•
•
•
•
•
•
Mental Capacity Act
Independent Mental CA
Safeguarding Adults
Safeguarding Children
Infection Prevention and Control
Medicine Safety
Monitoring Drug and Fridge
Temperatures
Health and Safety
Waste Management
Medical Equipment
Safe Staffing
Available via the intranet
homepage
14
What can you do prior to inspection
Consider the following questions:
•
•
•
•
•
•
•
•
•
•
•
Do I report/act on concerns about unsafe equipment?
Do I know how to report a safety incident?
Do I always wash my hands or use hand gel between patients?
Do I follow Trust policies in relation to medication?
Do I know how to resolve or advise a patient who has concerns?
Do I ensure written and electronic patient information is kept secure?
Do I keep the information available to patients up to date?
Do I observe the dress code or uniform policy including bare below elbows
Do encourage patients to provide feedback on our services?
Do I complete all appropriate risk and document assessments ?
Do you assess your patient acuity / dependency at handover and ensure you have
sufficient staff to cover the required work for the shift
• Do I know the procedure to follow for a patient who might have a lack of mental
capacity?
• Do I provide bank, temporary, agency or junior staff with adequate support at the
start of a shift?
15
Quality Inspections: Identified Safety Risks
• Not all staff are aware of how access an interpreter.
• Cleaning & Decontamination green labels are not always on equipment
to identify it has been cleaned.
• Not all staff have completed 'Basic Awareness of Safeguarding
Vulnerable Adults and Adult Protection', which is part of mandatory
training for all staff working within the Trust.
• The target of 96% of VTE risk assessments to be fully completed within
24 hours of admission has not been delivered in Quarter 2. Certain
divisions have performed poorly, dropping from a completion rate of
70% to 53%
• The outcome of the WHO Checklist Compliance has shown poor
compliance rate for Briefing and Debriefing and the common reasons
documented were “the team do not do the debriefing regularly”,
16
Are we effective ? CQC Key Lines of Enquiry
Domain – Effective
By effective, we mean
that care and treatment
provided to people is
evidence based and
achieves good outcomes
for them, whether that
is the prevention of
premature death, the
achievement of a good
quality of life for those
with long term
conditions or following
ill health/ injury, or
indeed the achievement
of a ‘good death’.
No.
KLOE
E1
Is care and treatment planned and delivered in line with
current legislation, standards and nationally/ internationally
recognised evidence-based guidance, in a manner which
doesn’t just meet patient’s needs but tries to deliver the
best possible outcomes for them?
E2
How does the provider support and facilitate multidisciplinary working among services and organisation?
E3
How does the provider work with other health and social
care providers and support networks (including volunteer
organisations and individual carers) to manage and meet
peoples’ needs?
E4
How does the provider ensure that staffing arrangements
enable the delivery of care and treatment an do not
compromise on quality?
E5
How does the provider monitor and improve the quality of
its care and treatment?
What does this mean in your daily practice?
17
What does this mean in your daily practice?
PRACTICAL DEMONSTRATION
• Safe storage of records
• Clear documentation
• Accurate records
• Assessing pain
• Incident reporting
• Up to date charts
• Lock trolleys
• Who is who in the trust
• Confidentiality
• Keep all informed
POLICIES AND PROCEDURES
• Information Governance
• Consent
• Records Management
• Accessing Policies
Available via the intranet
homepage
18
How to prepare for a CQC visit
Consider the following questions:
• Is my mandatory (MAST) training up to date?
• Do I keep the information available to patients up to date?
• Do I document verbal discussions about care, treatment and support on the
patient’s file?
• Do I link new patient records with any previous records that exist for that
patient?
• Do I ensure that all patient records are up to date, accurate, and kept
confidential?
•Are records stored and transferred securely according to our policy?
• Have I completed Record Keeping training?
• Do I know where to access all mandatory policies relating to quality, safety and
clinical governance?
19
Quality Inspections: Identified Risks
• Nursing documentation to be addressed – Risk assessments
incomplete or not reviewed, accuracy and completeness of observations,
individualised patient care plan
• DNAR notices are not always completed
• MUST assessments not always completed on all patients
• Escalation as a result of an EWS score are not always well
documented
• Completion of fluid balance charts and weight charts.
20
Are we caring? CQC Key Lines of Enquiry
Domain – Caring
No.
KLOE
ALLHow
STAFF
are patients, their relatives and those close to them,
involved as ‘partners’ in their care – taking part in decisions
C1
• What
does this mean in your daily practice?
By caring, we mean
that people are
treated with
kindness and
respect and are
supported to
manage their
treatment and care
with dignity.
about their care, with support where needed?
• The
CQC Inspector can and will approach any
How do staff develop trusting relationships and communicate
member
doctors,
nurses,
respectfully
withincluding
people and those
close to
them, throughout
C2staff
their hospital
stay? services, allied health
managers,
hotel
How are patients,administrative
their relatives and those
professionals,
staffclose to them, able
C3 to understand what is going to happen to them and why, at
• If approached
ortreatment
observed
a CQC Inspector
each stage of their
and by
care?
would
you
be able
answer
these
questions?
How are
patients,
theirto
relatives
and those
close
to them
• Bereceive
prepared!
the support they need to cope emotionally with their
C4
treatment and hospital visit/ stay?
C5
How are patients made to feel safe and comfortable and
treated with dignity while they receive treatment and
personal care?
What does this mean in your daily practice?
21
What does this mean in your daily practice?
PRACTICAL DEMONSTRATION
POLICIES AND PROCEDURES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Privacy & dignity
Tone of voice
Attitudes & behaviour
Listen to patients
Noise at night
Support at mealtimes
Learning disability/ vulnerable
patients
Dementia patients
End of life care and DNAR
Access to Interpreters
Intentional rounding
•
•
•
•
Equality and diversity
Interpreting Service
Complaints
Communicating effectively with
patients
End of life care and DNAR
Patient Information
Friends and Family Test
DNAR properly
documented and communicated
Available via the intranet
homepage
22
What can you do prior to inspection
Consider the following questions:
•
•
•
•
•
•
•
•
•
•
•
•
•
Do I give relevant information leaflets/contact details to patients?
Do I involve patients in their care plans by explaining their treatment, options and care?
Do I help patients to understand what is going to happen to them and why
Do I give patients information about the risks and benefits of alternative treatments?
Do I effectively communicate with a patient’s relatives to ensure they are involved in the decisionmaking about the patients care?
Do I document in the patient’s record when they have discussed their treatment options or when
they have given them information?
Do patients sign their care plan/assessment to confirm that they have been involved and understand
their treatment?
Am I up to date with my Equality and Diversity training?
Does the care environment make patients/families feel safe, comfortable and private?
Do I ensure multi-disciplinary team handovers include all parties to ensure consistence of care –
including relatives?
Do I always pull curtains properly around the bed?
Do I always introduce myself ?
Do I always check what patients liked to be called?
23
Quality Inspections: Identified Risks
• On some wards the nursing staff need to be
more sympathetic when responding to
patients concerns
• On some wards patients felt that they had not
been involved in their care plans.
24
Are they responsive? CQC Key Lines of Enquiry
Domain – Responsive
No.
KLOE
How does the provider plan its services on the basis of
ALL
R1 STAFF
the needs of the local population
By responsive we mean
that people receive the
treatment and care to
meet their needs, at the
right time without
avoidable delay, and
that they are involved in
a way that responds to
their needs and
concerns to improve the
services provided
• WhatHow
does
this
in enable
your daily
practice?
does
themean
provider
people
from all its
R2 CQC
communities
to access
services
response to
their
• The
Inspector
can and
willinapproach
any
staff needs
member including doctors, nurses,
How dohotel
staff take
accountallied
of patients
needs at each
managers,
services,
health
stage of their treatment, especially patients who are in
R3
professionals,
administrative staff
vulnerable circumstances or who lack the capacity to
• If approached
ortheir
observed
communicate
needs. by a CQC Inspector
would
you
able
answer
these questions?
How
dobe
staff
taketo
account
of patients’
needs and
• Be prepared!
wishes so that they are ready to leave hospital at the
R4
R5
right time, when they are well enough and with the
right support in place?
How does the provider involve patients, the public and
their representatives, in planning its services, and
routinely learns from people’s experiences, concerns
and complaints to improve the quality of care?
25
What does this mean in your daily practice?
PRACTICAL APPLICATION
POLICIES AND PROCEDURES
• Call bells answered in a timely way
• Adverse incidents
• Discharge planning
• Nutrition and hydration
• Clinical leadership
• Intentional rounding
• Team working
• Productive ward
• Decision on mental capacity
• Handing over vital information from shift
to shift
• Staff safety forums
• Quality rounds
• Ward information
Available via the intranet
• Don’t take your troubles home - resolve
homepage
concerns and issues proactively
26
What can you do prior to inspection
Consider the following questions:
• Do I take account of patients’ needs and wishes so that they are ready to
leave hospital at the right time?
• Do I provide patients and their families with the sufficient information to
leave hospital with?
• Do I ensure nutritional and hydration needs are met (red trays, red beakers
and water jugs with red lids)?
• Do I ensure multi-disciplinary team handovers include all parties to ensure
consistence of care – including relatives?
• Do I take account of patients needs at each stage of their treatment?
• Do I ensure the patient has made adequate arrangements for leaving
hospital?
• Do I encourage patients to complete patient survey's or signpost to make
complaints?
• Do I ensure the welfare needs of patients extends beyond the hospital back
in to the community?
27
Are they well-led? CQC Key Lines of Enquiry
Domain – Well Led
By well-led, we mean
that the leadership and
governance of the
organisation is effective
in holding itself and
others to account for
decisions, performance
and actions; it welcomes
and seeks challenge and
feedback and strives for
improvement to deliver
high quality, patient
focused care through a
supportive culture of
fairness, openness and
transparency.
No.
KLOE
W1
Is the governance framework coherent,
complete, clear well understood and functioning
to support delivery of high quality care?
W2
How are staff concerns dealt with; risks
identified, managed and mitigated in a manner
that ensures quality care and promotes
innovation and learning; and what assurances
are sought and provided?
W3
How does the provider make sure that the
leadership within the organisation is effective,
maintained and developed?
W4
Are there high levels of staff engagement;
cooperation and integration; responsibility and
accountability; and do HR practices reinforce the
vision and values of the organisation.
28
What does this mean in your daily practice?
PRACTICAL APPLICATION
POLICIES AND PROCEDURES
• Who is your matron?
• Who is your head of
Nursing/DDNG
• Tidy ward
• What are patients saying
• Assistance at mealtimes
• White boards above bed
• Supporting Staff
• Temporary Staff
Available via the intranet
homepage
29
What can you do prior to inspection
Consider the following questions:
•
•
•
•
•
•
Have I had an appraisal?
Am I up to date with my MAST training?
How do I keep my knowledge and skills up to date?
Do I know what the trust values are?
What areas of my work am I proud of?
What worries me? How am I addressing my concerns?
30
Quality Inspections: Identified Risks
• Not all staff have had Individual performance
reviews
31
CONCLUSION
• We must meet the essential standards, for the
sake of our patients
• We got much of it right in August
• We need to get it right, everywhere, for all of our
patients – consistency
• This is our responsibility to our patients
• This presentation and further resources are
available via the intranet homepage