Insight into how RD&E coped with Covid outbreaks

At a time when the Royal Devon and Exeter Hospital was battling Covid outbreaks, experiencing severe pressures and working with a significant number of staff absences, an announced visit by inspectors was carried out.

Anita Merritt www.devonlive.com

A focused inspection was carried out at the hospital by independent health and social care regulator the Care Quality Commission (CQC) on January 19, because the trust had experienced more than one outbreak of hospital transmitted Covid-19.

The aim was to observe infection prevention and control measures, and speak to staff.

Just days before, the hospital revealed it was currently in the midst of its biggest surge of coronavirus patients since the pandemic began, with numbers expected to keep rising over the next few weeks.

At that stage, 186 people had died of the virus at the hospital as of January 12, and the total number of beds occupied with Covid-19 patients was 94, as of January 7. The total number of Covid related absences was 300 on January 6.

At the time of the CQC inspection, more than 7,000 of the 8,000 hospital site staff had been vaccinated, and patients were being vaccinated in line with the government directed vaccine program.

Also more staff had been given influenza vaccines than ever before.

The results of the inspection have been published today and the hospital has been praised for the ‘effective’ way it has been dealing with the pandemic.

It was also acknowledged the toll that dealing with the virus has placed upon staff, but that they have continued to deliver great care.

Amanda Williams, CQC’s head of hospital inspection for the South West, said: “I am pleased to report that Royal Devon & Exeter Hospital had effective processes in place to support standards of infection prevention and control, including managing cleanliness and creating a suitable environment.

“Staff received training in safe infection prevention and control procedures in line with national guidance and were aware of the trust’s IPC (infection prevention control) policies.

“In addition, the trust was focused on learning from mistakes and continuously improving IPC practices. There was an action plan in place to meet identified goals. Auditing of all infections had taken place and learnings had been shared across the trust.

“However, there were isolated occasions, particularly during busy periods, when some infection prevention control measures were not being followed according to recommended guidance.

“We have asked the trust to monitor this and take action to assure themselves of compliance regarding the appropriate levels of personal protective equipment, including enhanced personal protective equipment, to ensure its use is in line with national guidance.”

It was confirmed that all frontline staff were Covid-19 tested twice a week, and agency and bank staff were tested on their arrival to the ward, with results provided in minutes.

During the pandemic it was noted elevated levels of staff sickness had been experienced by the trust and it had created increased risk during the ongoing pandemic.

In December 2020 it had caused the trust to raise an internal incident alert.

The report said: “The strain of this was raised during our inspection by staff and leaders and was recognised by all as a strain on staff wellbeing.

“We were provided with data which showed that some improvement in staff sickness levels was evident. Senior team leaders considered this was due in part to improved testing of staff and improved infection prevention and control procedures within the trust.

“We observed support material and access to support services within the hospital. These included posters,leaflets, and screensavers. Staff told us they were able to raise concerns they may have about their physical and mental wellbeing and felt they would be heard.”

It added: “It was evident from speaking with staff that the challenges created by the pandemic had a physical and mental effect on their wellbeing, but they remained passionate about providing quality care to patients.

“We saw staff provide care in a compassionate way regardless of the difficulties created by Covid-19, and patients were comforted and reassured by kind and caring staff.”

Hospital leaders were praised for recognising staff fatigue by making wellbeing a major focus, such as having additional annual leave, rewards, and a full suite of support for staff psychological and physical health.

In terms of combating the numbers of patients with Covid-19, it was reported that all patients were tested for Covid-19 with a test on admission to the hospital, and then on their third and fifth day.

It was noted there was a plan to increase the frequency of patient testing to every other day.

It was added patients were tested 24 hours prior to being discharged to a care home, to their home with a package of care or if going home to a member of the family who was vulnerable.

Key points noted during the inspection included:

  • Leaders operated effective governance processes. Staff at all levels were clear about their roles and accountabilities. Governance structures and the communication within them were effective to ensure that changes and learning supported patient safety across the trust.
  • Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for both patients and staff.
  • Staff felt respected, supported and valued. The service had an open culture where staff could raise concerns without fear.
  • It was evident from speaking with staff that the challenges caused by the pandemic were both physically and mentally challenging, but they remained passionate about providing quality care to their patients.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats. The information systems were integrated and secure.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • All staff were committed to continually learning and improving services. There were systems and processes for learning, continuous improvement, and innovation. Leaders and staff also collaborated with partner organisations to help improve services for patients.

RD&E chief executive Suzanne Tracey said: “We welcome the CQC inspection and report that underlines the excellent work that has gone on across the Trust to keep our patients and staff safe, during one of the most challenging periods ever experienced by the NHS.

“We have worked very hard to ensure that we have followed – and at times gone above and beyond – the national guidelines recommended by PHE in our drive to be safe. As we move into a lower prevalence period we must continue to be vigilant, and we will continue to review our infection control measures to ensure that they are proportionate and effective.”