‘Lack of consistent safe care’at A&E department

PATIENTS at an accident and emergency department in Wales were “not consistently receiving safe care” a report has found.

An inspection carried out by Healthcare Inspectorate Wales (HIW) at Glangwili General Hospital in Carmarthen found staff were working extremely hard to provide good quality care for patients under considerable pressure.

However, a “number of improvements” were identified, and require immediate action by the health board.

HIW carried out three unannounced inspections at the A&E department in December 2022.

According to the report released today, they discovered areas where the pressure and challenges within the department and wider hospital were leading to an “increased risk to patients”.

Issues identified included overcrowding, a lack of toilet and washing facilities, and patients waiting in non-designated areas of the unit including outside cubicles with no privacy curtains.

The report said: “This was having a negative impact on the ability of staff to maintain patients’ privacy, dignity, and to follow infection prevention and control procedures.” The report did find that patients and carers were generally satisfied with the services they had received, and they were treated with respect and courtesy.

But frustration was expressed around waiting times and the lack of updates on patients’ care and treatment.

HIW also found concern with the Paediatric Care and Assessment Unit (PACU), where there were delays in children being seen.

The report said: “This meant children were sometimes required to wait in the main waiting area, which was unsuitable for them.

“Some patients told inspectors they had to sleep on chairs or the floor for long periods.

“Despite adequate arrangements in place to assess and monitor patients arriving by ambulance, we were not always assured that patients self-presenting to the unit were being triaged in a timely manner.

“We were also not assured patients within the waiting room were being regularly reassessed, as there was not always evidence of the triage nurse reviewing their records.

“However, it was noted that patient records were easy to navigate, handwritten entries were legible and logically set out.”

While medicines were seen to be safely managed in the unit, inspectors found storerooms were not secured to prevent unauthorised access – which may have presented a risk to patients.

Inspectors also found that checks to resuscitation equipment trolleys were not always being recorded, and therefore inspectors were not assured the necessary equipment was ready or available to be used in the event of an emergency.

The report said: “The health board must take suitable action to improve staff compliance with mandatory training to improve such matters.

“There was a suitable management structure in place with clear lines of reporting, and staff were generally positive about their immediate line managers.

“Staff told us the health board takes positive action on health and wellbeing.

“However, staff were not as happy with the way issues they escalated were handled, nor with staffing levels within the unit.”

The health board has produced a comprehensive plan with detailed actions on how improvements will be made within the emergency department.

Chief executive of HIW Alun Jones said: “The pressure on NHS services continues to be extraordinarily high and as in other emergency department inspections we have undertaken, we have again found evidence of a service struggling to meet demand and to maintain patient safety with the resources available.

“I acknowledge the hard work and dedication of staff within this service, and our report provides an opportunity to highlight the challenges that patients and staff within this service are facing on a daily basis.

“The specific recommendations for action we have set out will support the health board to reduce risks to patients and staff while they continue to deal with this challenging period.

“We will continue to engage with Hywel Dda University Health Board to ensure progress against our findings.”

Hywel Dda University Health Board was asked to comment.