CQC highlights record access problems

Princess Royal University Hospital in Bromley must urgently address problems with access to medical records, England's chief inspector of hospitals has said.

The Care Quality Commission has published his first report on the quality of care provided at the hospital, which was taken over by King’s College Hospital NHS Foundation Trust following the dissolution of South London Healthcare NHS Trust in October last year.

The report identifies significant failings in the management of patient records.

It says the lack of availability of medical records in the outpatients department meant that at times patients were undergoing complex medical procedures without clinicians having access to a complete set of notes.

On one day of an inspection of the Princess Royal last December, 25% of the medical records were not available in two outpatients clinics visited.

“Staff told us this was a longstanding problem since June 2012 when the system was reorganised. Non-availability of medical records is noted in the clinical and operational due diligence report and rated “red”,” the report says.

“There is limited space to store records and many are kept off-site and prepared elsewhere for clinics and inpatients. The problem is compounded by clinical and administrative staff not recording the location of the records in the IT system.

“The trust has developed an action plan with immediate and medium-term actions, but at the time of the inspection although some action had been taken there was little impact on the situation.”

Inspectors also found inaccurate recording on the medical wards of some patients who were not for resuscitation.

“On the medical wards, on two occasions, we found contradictory information about decisions to resuscitate patients had been recorded. For example, information boards or handover records stated that patients were for resuscitation but they also had a ‘do not resuscitate’ form in place.”

The report also identifies a “significant lack of data available about the quality and effectiveness of the care and treatment provided to patients”.

“Some areas such as the critical care unit were able to demonstrate that they provided effective care through the collection and analysis of data. However, we were unable to obtain this data for many areas,” it adds.

Chief Inspector of Hospitals for CQC, Professor Sir Mike Richards, said: “the scale, number and longstanding nature of many of the problems that King’s College Hospital NHS Foundation Trust inherited at the Princess Royal University Hospital should not be underestimated.

“The trust has told us that it is already aware of the issues and has developed action plans to begin to address them," he said.

“We did find areas in which we thought the trust needed to take swift action to fix some of the problems, for example, improving the availability of medical records and waiting times in the A&E department. Since the inspection, the trust has taken some action and further action is planned. We will return in due course to check that this has been done."

A King’s spokesperson said that before acquiring the hospital last year, it  carried out a comprehensive due diligence process, which flagged up many of the same issues identified in the CQC report.

“We have robust plans in place to drive up standards at the PRUH, and since October we have already started the process of improving the standard of patient care which our doctors and nurses are providing.”

The Princess Royal has more than 500 beds and serves a population of around 300,000.