Trust Board papers November 2012 - Barking Havering and ...
Trust Board papers November 2012 - Barking Havering and ...
Trust Board papers November 2012 - Barking Havering and ...
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CQC Update Report<br />
<strong>2012</strong><br />
RADIOLOGY<br />
31. Develop its planning <strong>and</strong><br />
bed management processes to<br />
ensure all patients are cared for<br />
in appropriate facilities.<br />
Matrons <strong>and</strong> ward sisters are<br />
monitoring this but the <strong>Trust</strong> has<br />
not yet established how best to<br />
measure success in this area. The<br />
X‐Ray department has introduced<br />
appropriate checklists for ensuring<br />
patients are properly prepared.<br />
The Department has developed St<strong>and</strong>ard Operating Procedures<br />
attached below which are evidence based <strong>and</strong> serve as the<br />
baseline expectation for all staff. These have been ratified<br />
internally, <strong>and</strong> are based on good practice examples.<br />
These are well publicised throughout the department, <strong>and</strong><br />
subject to internal review.<br />
• A Plan is in place to ensure publicity <strong>and</strong> accessibility at<br />
ward level<br />
• The impact of these documents is subject to audit in 6<br />
months time.<br />
Stephen<br />
Griffiths<br />
MET<br />
BUSINESS<br />
AS USUAL<br />
RADIOLOGY<br />
32. Put in place clear protocols<br />
for the management of<br />
interventional rradiology<br />
patients with audit <strong>and</strong><br />
improvement cycles to ensure<br />
st<strong>and</strong>ards are attained <strong>and</strong><br />
maintained.<br />
Audit processes are in place <strong>and</strong><br />
are monitored at interventional<br />
radiology meetings <strong>and</strong> at the<br />
Divisional <strong>Board</strong>. SOPs are in place<br />
<strong>and</strong> are being implemented for<br />
each procedure in interventional<br />
radiology.<br />
CQC’s compliance activity supports<br />
the <strong>Trust</strong>’s assessment of<br />
significant progress in this area,<br />
although more audit activity needs<br />
to be delivered for this to be<br />
considered fully met.<br />
The Department has developed St<strong>and</strong>ard Operating Procedures<br />
attached below which are evidence based <strong>and</strong> serve as the<br />
baseline expectation for all staff. These have been ratified<br />
internally, <strong>and</strong> are based on good practice examples.<br />
These are well publicised throughout the department, <strong>and</strong><br />
subject to internal review.<br />
Stephen<br />
Griffiths<br />
MET<br />
BUSINESS<br />
AS USUAL<br />
RECORDS<br />
80. Improve its systems for<br />
records management to ensure<br />
that notes can be retrieved<br />
effectively <strong>and</strong> expediently, <strong>and</strong><br />
reduce the risks associated with<br />
multiple sets of temporary<br />
notes <strong>and</strong> poor data h<strong>and</strong>ling.<br />
The <strong>Trust</strong>’s Medical Records<br />
Committee has been reestablished<br />
with new Terms of<br />
Reference; training levels for<br />
healthcare professionals are<br />
discussed at this Committee on a<br />
regular basis. Weekend transport<br />
for transfer of notes has been<br />
reintroduced <strong>and</strong> a nursing<br />
documentation booklet has been<br />
piloted across several wards <strong>and</strong><br />
will be fully implemented by the<br />
The development of the eH<strong>and</strong>over system will provide a<br />
<strong>Trust</strong>wide joined up reference database for the use in patient<br />
care.<br />
A new PAS is being commissioned in 2013 for implementation<br />
which will improve the availability of Patient records <strong>and</strong> reduce<br />
the incidence of Temporary folders.<br />
It is anticipated that patients will be migrated onto one hospital<br />
number covered by barcode scanning options as part of the rollout<br />
<strong>and</strong> implementation.<br />
Ian Grant<br />
Alex<br />
Hammerton<br />
PART MET<br />
BUSINESS<br />
AS USUAL<br />
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