Northampton General Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service generally had enough nursing and support staff to keep patients safe. However, the layout of the environment and number of bays/side rooms meant it was sometimes challenging for staff to maintain line of sight of patients who were at risk of falling and to implement falls prevention measures. We received conflicting information about the number of healthcare assistants required as part of planned daily numbers. We saw there were sufficient staff to respond to patients’ needs, conduct regular checks of patients, and quickly responded to call bells. There were systems and processes to assess, plan and review staffing levels, including staff skill mix. All staff had a good oversight of their patients and those who were at risk of falling. Staff knew how to assess patients who were at risk. Staff completed and updated risk assessments for each patient including a multifactorial falls risk assessment. However, compliance with assessment processes for patients who required a more enhanced level of supervision was variable. Safe bedrail usage risk assessments were routinely completed on admission to the ward and regularly reviewed, however care plans were not always updated accurately to reflect the changing needs of patients.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A patient we spoke to was fully aware of why they had a falls alarm in place to alert staff should they get up due to their risk of falling. The patient was happy for this to be in place and understood why it was.

All staff had a good oversight of their patients and those who were at risk of falling. Staff knew how to assess patients who were at risk. Staff were able to describe confidently how they assessed the risk of falling. All staff we spoke to had received falls prevention training and use of bedrails training. Staff we spoke with generally understood how to undertake an assessment and could articulate the risks of bedrails to certain patients.

Staff completed and updated risk assessments for each patient. However, compliance with enhanced observation risk assessments was variable for patients who were at risk of falling and requiring a more enhanced level of supervision. During our assessment we reviewed 7 patient records. Four people had been identified at risk of falls. In each record there was evidence of a falls risk assessment, including multifactorial falls risk, being completed on admission and on admission to the ward within 12 hours. Risk assessments had been reviewed in line with trust policy. Compliance with assessment processes for patients who required a more enhanced level of supervision was variable. We observed good practice in 1 case where a patient was high risk of falls and displaying signs of confusion. The patient was appropriately assessed as requiring enhanced care through 1:1 supervision. An enhanced care assessment and mental capacity assessment had been completed and there was a deprivation of liberty safeguard in place. There was an hourly enhanced supervision check list completed demonstrating compliance with the trust's policy. In contrast, another patient with a similar condition did not have an enhanced observation risk assessment. There was no evidence of a mental capacity assessment having been completed or evidence that the falls mitigation, including bay tagging, on the risk assessment had been implemented. Bay tagging is for patients at risk of coming to harm and require constant uninterrupted observation to maintain safety. However, the patient did have a falls alarm on the seat they were in. Bedrail use risk assessments were completed in line with trust policy in most records we reviewed. Assessments were routinely completed on admission to the ward and regularly reviewed. However in 1 record we reviewed, the assessment incorrectly identified bedrails were required. Where bedrails were used, the beds were in the lowest positions in line with best practice.

We were only able to speak to 1 patient who was at risk of falling. The patient understood they were at risk of falling and understood what was in place to prevent them from falling.

Staff knew about specific risk issues to prevent patients from falling. Staff were aware of policies and procedures in place to mitigate the risk of falls and to manage a fall should it occur. Staff were also aware of the safe use of bedrails policy and enhanced care policy. Staff knew how to access these policies and procedures electronically. Resources in relation to policies associated with falls were kept in a folder at the nurses station for easy access. Staff understood the importance of assessing whether a patient had a postural drop in blood pressure by undertaking lying and standing blood pressures. In general, these were completed in the records we reviewed. Staff also understood the importance of undertaking a visual assessment and were aware of the risks of using bed rails.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The trust’s, ‘Management of slips, trips and falls’ policy was approved in April 2022 and referenced the latest National Institute of Health and Care Excellence (NICE) falls guidance for older people. The trust's ‘Using bedrails safely and effectively’ policy. The trust’s ‘Safe and supportive observation of adult patients (enhanced observation)’ policy was up to date and due for review in October 2024. The ‘Management of slips, trips and falls’ policy also referenced NICE guidance. It recommended all patients aged 65 and over received a multifactorial falls assessment and intervention plan and we saw these assessments were included in care plans. Nursing documentation in general supported staff to assess risk and implement evidence-based actions. We saw evidence the falls and bedrails policies were implemented. Assessments of holistic needs were undertaken to support effective falls prevention. For example, all patients had mobility and continence assessments completed. This ensured staff understood the patients’ individual needs and how to reduce the risk of falls while providing personal care. Preventative measures were generally implemented to prevent patients from falling. All patients had a whiteboard above their bed which was populated with key information to alert staff to risks such as falls and mobility. Patients’ falls risks and mobility status had been recorded in all cases. Patient bed spaces were clutter free and walkways were clear. All patients had a call bell and walking aids and told us they knew how to use them. In 1 record, we found bay tagging was selected as a preventive measure, but this was not in place at the time of our assessment. The risk was mitigated with a falls alarm mat but was not recorded in the risk assessment. Staff unfamiliar with the patient may not know this should be in place.

Staff were aware of the needs of people who arrived on the ward. Care plans contained information for staff about people's needs and how to reduce specific risks. There were multi disciplinary ward rounds which meant the current care people were receiving was reviewed by staff who had provided care while they were in other areas. Records contained pre-assessment information so staff could provide care in line with people's specific needs and wishes.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.