Hospital warned over maternity unit
Wednesday 23rd October 2013, 12:10AM BST.
A hospital trust which is already in special measures has been told it must take “urgent action” to improve safety on a maternity unit.
The Care Quality Commission (CQC) has issued three formal warnings to Medway NHS Foundation Trust following an unannounced inspection at Medway Maritime Hospital in Gillingham, Kent.
The hospital failed to meet any of the six standards checked by the CQC and was found to have too few midwives to properly care for mothers and babies.
One woman whose waters had already broken was told she could not be induced due to a lack of midwives, despite the risk she and her baby could develop an infection, the report from inspectors said.
The CQC team also witnessed midwives being told they had to help in delivery suites, leaving other wards with too few staff.
There was an “almost constant demand for extra midwives to staff the delivery suite”, a lack of equipment for monitoring blood pressure in women who had undergone Caesareans and problems with emergency equipment.
The CQC report said: ” We looked at emergency equipment for mothers and babies, which included a defibrillator on the postnatal ward, the resuscitation trolley on both wards, and some resuscitaires used for babies.
“This equipment should be checked and cleaned daily. The records showed that emergency equipment was not checked appropriately.
“This did not demonstrate reliable procedures, and potentially put mothers and babies at risk that equipment may not be in correct working order when an emergency occurred.”
On one of the wards, inspectors “observed an open box on the floor of the dirty utility room which contained used intravenous bags of fluid with intravenous giving sets still attached”.
The door was not locked and the room was accessible to anyone, including children visiting their mothers who had just given birth.
Medicines were not kept safely, the report went on, saying: ” On one ward the intravenous fluids were stored on the floor under a sink.
“The temperatures of the medicine refrigerators were not being monitored at weekends on any of the units and on one ward only one temperature was being monitored.”
The inspectors said this meant medicines might not have been stored at correct temperatures and might not be safe to use.
A bereavement room for mothers who had lost their babies did not have any sound proofing and was not in an area away from the delivery rooms, their report went on.
“This meant that women and their partners would be able to hear the cries of other newborn babies, heightening their sense of loss.
“Similarly, we found that for women in four-bedded bays on the wards, there was nowhere private for staff to speak with them confidentially or break bad news, unless a single room was vacant.
“Sometimes the staff had to use the staff room which meant asking staff to leave during their break times.”
Inspectors also found women did not have clear information on accessing care during pregnancy and were expected to book appointments online.
Adrian Hughes, regional director of CQC in the south, said: ” While patients and relatives we spoke to said that the care they received was good, we have serious concerns about the care and treatment that women have been receiving in maternity and midwifery services at Medway Maritime Hospital.
“The report we have published today shows that the trust needs to deal with staffing levels as a matter of priority – and also to support the midwives who already work there better to perform their roles.
“We found that governance systems and management oversight of the services were not good enough, and this needs to change.
“The treatment and care provided by Medway NHS Foundation Trust has already been identified by Professor Sir Bruce Keogh and his team as being of concern and the trust has been placed in special measures by the Secretary of State on that basis.
“We are committed to returning to the trust in due course to check whether general improvements required by that process have been made.
“In the meantime, our inspectors will return unannounced in the near future to check that the hospital has made the changes required by the warning notices.”
Professor Hasib Ahmed, clinical director for women’s services at the trust, said: “Thousands of mothers choose to give birth at Medway Maritime Hospital and our specialist staff safely deliver over 5,000 babies every year.
“The safety of women in our care is paramount.”
He added: “With the support of the new chief nurse, we are making positive progress with our midwifery recruitment, appraisal and mandatory training.
“We are also reminding staff of our local governance processes and systems which ensure that we continuously improve and enhance our maternity services to build on the excellent patient feedback we receive.”
Pat Gould, regional head for southern England at the Royal College of Midwives, said: “This report is a cause for concern.
“Good staffing levels are fundamental to ensure delivery of high quality care, as is on-going training for staff in maternity services and good communication between all parts of the service.
“The RCM has been arguing for some time about the impact of inadequate staffing levels on care across England, particularly in areas such as antenatal and postnatal care as staff are pulled away from these areas to staff labour wards.
“We recognise and welcome the efforts the trust has made to recruit more midwives and we will continue to support our members and work with the trust.
“However, this is an important wake-up call for the management of this trust to focus on maternity services, support their midwives who are doing a very good job under what appear to be very difficult conditions and ensure that the women of the area get the service they need and deserve.”