Macclesfield District General Hospital, Macclesfield

General Services Information

Hospital Questions

• How many single rooms are available to NHS patients at this hospital: 64 Includes Congleton War Memorial Hospital

• Of these how many have an ensuite toilet: 29

• Of these how many have an ensuite toilet and shower or bath: 8

• Does this hospital operate an accident and emergency unit:

• How many specialist palliative care beds are available at this hospital: 0

• Does this hospital have a named private unit/service:

Trust Questions

• Does the Trust treat private patients:

Patient Safety

Trust Questions

• Is there a system for recording operations that resulted in a foreign body being left post surgery:

• What is the reporting system for a foreign body being left post surgery: Incident reporting system, Serious Untoward Incident (SUI) reporting policy, adherance to following the Never Events list, SUI reporting flowchart, escalation of incidents onto the Strategic Executive Information System.

• Is there a system for recording operations that were cancelled due to missing notes:

• What is the reporting system for operations that were cancelled due to missing notes: Incident reporting system, Serious Untoward Incident reporting flowchart and escalation of incidents onto the Strategic Executive Information System.

• Is there a system for recording operations that resulted in wrong site surgery taking place:

• What is the reporting system for operations that resulted in wrong site surgery taking place: Incident reporting system, Serious Untoward Incident (SUI) reporting policy, adherance to following the Never Events list, SUI reporting flowchart, escalation of incidents onto the Strategic Executive Information System.

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in a foreign body being left post surgery: 0

• During the period 01 April 2010 - 31 March 2011, how many operations were cancelled due to missing notes: 0

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in wrong site surgery taking place: 0

• How many incident investigations using a full Root Cause Analysis did were carried out in 2010/11: 25 25 Serious Untoward Incidents were reported and all were subject to a full Root Cause Analysis.

• What percentage of patient safety incidents resulting in severe harm or death had a full RCA initiated/completed: 100%

• What percentage of acute inpatients have a track and trigger warning system in place for the duration of the admission: 100% The observations charts in use at the trust are all compliant with track and trigger monitoring for patients.

• What percentage of patients are risk assessed for venous thromboembolism on admission: 91-99%

• Compliant with all relevant NPSA safety alerts issues in 2010/11 (you can find a full list of alerts issued at http://www.nrls.npsa.nhs.uk/resources/?p=3). :

• Does the Trust have a policy for providing educational programmes on using and interpreting clinical indicators: The Trust has a Learning and Development policy and training needs analysis that has been developed to identify the training needs of all staff at all levels. Training is available to staff on the use of track and trigger and the identification of the deteriorating patient via the outreach service.

• Does the Trust have a designated member of staff who supports teams in locating and analysing safety and quality data? (support): The Trust has a Governance Team (Risk Manager/Health & Safety Manager) who supports the Trust teams with locating and analysing safety and quality data along with Governance Facilitators in two Business Units. The Matrons also undertake analysis of quality metrics at a local level.

• Is safety and quality data available on a central platform and actively disseminated to users: Data is held on a number of platforms but is disseminated widely to Trust staff. For example: Monthly performance reports to Trust Board, monthly performance reports to trust Safety and Quality Standards committee, monthly and quarterly performance reports to senior clinicians and managers at Business Unit level, plus Nursing metrics and Infection Prevention and Control audits.

Infection Control

Trust Questions

• Does the Trust employ an antibiotic pharmacist: Part time

• Does the Trust operate a pre-admission assessment clinic or equivalent system where patients are screened and results returned in advance of the day of admission:

• Elective patient groups screened at the pre-op assessment clinic: All elective surgical and medical All elective medical and surgical patients are screened. Some of these patients are not admitted via Pre-op assessment clinic but via outpatients. Therefore the screen is undertaken in the outpatients department.

• Are all oncology patients screened at the pre-op assessment clinic: Not Applicable

• Are all chemotherapy patients screened at the pre-op assessment clinic: YES Patients are screened on admission to the Cancer Resource Centre at the start of their treatment. They are re-screened according to policy requirements.

• Are all elective neurosurgery patients screened at the pre-op assessment clinic: Not Applicable

• Are all patients with past history of MRSA screened at the pre-op assessment clinic:

• What method of MRSA screening is used when screening at admission: Culture based in 24-48hrs

• On admission, does topical suppression take place immediately:

• Does the Trust have at least one accident and emergency unit:

• Are all patients admitted through A&E screened: Trust has now implemented a programme of emergency screening

• Is screening done according to individual risk assessment:

• Does the Trust have a dedicated isolation ward:

• Protocol for isolating patients with infections: Patients are assessed by the Infection Control team and moved into isolation or cohort nursed in accordance with the Isolation Policy and the Specific Organism Policy e.g. Clostridium Difficile Policy.

• Does the Trust have an isolation policy:

• Where medically appropriate, are patients with C Diff isolated in single rooms as a matter of priority:

• Does the Trust have a policy to guide the use of metronidazole and vancomycin for C.difficile infected patients:

• Does the Trust routinely isolate all patients with diarrhoea: A clinical review of the patient is requested to rule out any medical conditions i.e. colitis, use of aperients. Patients with diarrhoea of unknown origin are isolated until asymptomatic for 48hrs.

Stroke Medicine

Hospital Questions

• Does the hsopital have a specialist stroke unit:

• What type of stroke unit does the hospital have: combined acute and rehabilitation stroke unit

• Number of beds in the unit: 24

Trust Questions

• Does the Trust have a specialist stroke unit or units:

• Is the Trust part of a stroke care network:

• Details: The trust falls on the boundary of two Stroke Networks and is a member of both Cheshire and Mersey Stroke Network and Greater Manchester and Cheshire Stroke Network. Through the networks the trust has access to training, paperwork and clinical developments. Trusts share data through the network and attend meetings. The Cheshire and Mersey network has funded a Stroke Audit and Improvement Facilitator post at East Cheshire NHS Trust for the last two years.

• How many emergency admissions with a primary diagnosis of stroke (ICD10 codes I60 - I64) did the Trust receive in the financial year (period 01 April 2010 - 31 March 2011): 262

• Of these, what was the number of patients given a Computerised Tomography (CT) scan within 24 hrs of admission: 248 94.7%

• Is thrombolysis for stroke patients provided 24 hours per day and 7 days a week : Thrombolysis is provided Monday to Friday, 9am to 5pm at present.

• Are there any formal arrangements with neighbouring hospitals for the emergency transfer of stroke patients who would benefit from thrombolytic treatment: Work is in progress at present to create a telemedicine system for out of hours between Macclesfield District General Hospital and the Countess of Chester Hospital.

Trauma & Orthopaedics

Trust Questions

• Does the Trust offer a trauma service: A full range of upper and lower limb Orthopaedics

• Does the Trust have a dedicated trauma list available 24 hours a day for the duration of the week, (Sunday to Sunday): Dedicated trauma list 7 days per week / plus access to emergency theatre out of normal working hours

• Does the Trust offer an orthopaedics service: A full range of upper and lower limb Orthopaedics

• Do all the Trust's orthopaedic ward/team have a linked geriatric team with whom they have regular meetings at least once a week: Weekly Multi-disciplinary Team meetings. Weekly ortho-geriatrician ward round

• Does the Trust run a pre-operative patient education session/class for patients to attend prior to Total Knee Replacement (TKR) and Total Hip Replacement (THR)? : On a Friday there are 'Hip Op' and 'Knees Up' clinics which are a combination of investigations and education. All THR and TKR patients attend.

• Not able to put a figure on the percentage of all patients that attend the class prior to surgery: We pre-request that all patients attend prior to THR or TKR

• Does the Trust have a standardised anaesthetic protocol for Total Knee Replacement (TKR) and Total Hip Replacement (THR) patients: Individualised according to each patient's needs.

• Not able to put a figure on the percentage of the Trusts total knee replacement (TKR) and total hip replacement (THR) patients walk within 24 hours of surgery: East Cheshire NHS Trust length of stay for total knee replacements is 5.8 days, compared to the national average of 6.5 days. Length of stay for total hip replacements is the same as the national average: 7.8 days.

• Does the Trust have a specialist orthopaedic physiotherapy service which is available 7 days a week:

• Not able to put a figure Patients' discharge delayed due to lack of physiotherapy services at weekends: We estimate this to be very little or none at all. The trust employs Rehabilitation Assistants whose role covers Physiotherapy to aid mobility and facilitate early discharge. Rehabilitation Assistants work 7 days a week.

• Are patients for total knee replacement (TKR) and total hip replacement (THR) admitted prior to the day of surgery: All patients admitted on the day of surgery

• Are patient records routinely recorded using a specific multi-disciplinary team THR/TKR pathway document:

• Is this data used to monitor compliance with the agreed pathway:

• Is criteria-based discharge used: A nurse led discharge system is used, with certain criteria needing to be achieved before discharge.

• Are patients routinely phoned in the first 48 hours after discharge to check on their progress: Patients are seen in the community by the district nurse/practice nurse for wound checks, by the community physiotherapy team if needed, and on the 6 week post op clinic with the consultant team. We also advise that if there are any concerns to contact the Ward for telephone support or the GP to arrange an appointment.

Paediatrics

Hospital Questions

• Does the hospital have a paediatrics service: Outpatient clinics are located not only at Macclesfield Hospital but also in Congleton, Handforth, Knutsford, Poynton and Wilmslow.

Trust Questions

• Is the Trust's elective paediatric surgery carried out only by designated surgeons with at least six months training in a specialist unit: Elective paediatric general surgery is undertaken at Manchester Children's Hospital. There is an elective ENT service for paediatrics at Macclesfield. Emergencies are undertaken in children above the age of eight.

• Do the Trust's anaesthetists with responsibility for paediatric anaesthesia participate in at least one paediatric list per week:

• Is a paediatrician on site (SpR or higher) 24 hours per day, 7 days per week:

• Are at least two registered children's nurses on duty 24hours per day in each children's ward:

• Is there a designated facility on site for parents or guardians to stay overnight: Parents stay at child's bedside. Parents' rest room available.

Palliative Care

Trust Questions

• Does the Trust provide a palliative care service:

• How is specialist palliative care delivered at the hospital: Other (please specify) Integrated community / hospital multidisciplinary specialist palliative care team

• Does the hospital's specialist palliative team includes: A consultant in palliative medicine,A palliative care nurse,Counsellor(s),Other (please specify) Counselling is available via the Macmillan Cancer Resource Centre based at Macclesfield District General Hospital. Macmillan Pharmacist split 50/50 between specialist palliative care and oncology

• Is the Trust's specialist palliative care team available 24 hrs a day seven days a week: Hospice Helpline is available out of hours along with 24/7 access to District Nursing.

• Are facilities provided to support relatives and carers who wish to stay with a patient in hospital: A visitors' room is provided on ICU with comfy chairs and occasionally the endoscopy suite cubicles have been used to support overnight stays. There are however no formal facilities for visitors to stay overnight although ward staff will make every effort to support relatives who wish to stay particularly when their loved one is nearing the end of life.

• Does the Trust routinely survey and evaluate the views of patients and bereaved relatives and carers regarding the delivery of care on the end of life programme: The views of carers and relatives is soon (due Autumn 2011) to be sought through a tear out questionnaire/or internet site detailed within our new bereavement booklet. Patients/ carers are routinely surveyed as part of feedback on satisfaction of the specialist palliative care service but views are not yet being collated from patients about end of life care specifically.

Maternity Care

Maternity Sites

• Macclesfield District General Hospital - Consultant Led

• How many women gave birth in the unit during the year? (not including home births): 1988

• How many babies were born in the unit during the year? (not including home births): 2018

• How many women were booked for a home birth: 78

• How many women had a home birth? (not including births at home by accident): 45

• Number of antenatal rooms: 1

• Total antenatal beds: 6

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 6

• Number of delivery rooms: 5

• Total delivery beds: 5

• Number of postnatal rooms: 5

• Total postnatal beds: 16

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 9

• Amenity rooms; Are women able to book a single room in advance of their birth: However single rooms are available on the day.

• If women can pay for a single room what is the average cost per night (GBP): 100

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women Women can arrange for a support partner to come in and deliver massage.

• Pain relief available - Aromatherapy: Provided by women Women can arrange for a support partner to come in and deliver aromatherapy.

• Pain relief available - TENS: Provided by unit Women can also provide their own if preferred.

• Pain relief available - Epidural: Provided by unit

• Pain relief available - Mobile epidural: Provided by unit

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Other pain relief: Oral Meptid

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 58.8 Whole Time Equivalent (WTE)

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 62.42 Whole Time Equivalent (WTE) This is made up of 58.8 WTE staff in post and the equivalent of3.62 WTE bank midwives utilised in 12 month period.

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On site Midwives are available on site 07:15 - 21:00 and are on call outside of these hours.

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On site

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On site

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week: On site

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week: On site This post is shared with the Intensive Care Unit.

Trust Questions

• Do all women have a choice about where they receive their antenatal appointments (i.e. at hospital or local health centre):

• Are NHS antenatal classes available (e.g. Parentcraft):

• Available during the daytime (until 5pm):

• Available in the evenings (after 5pm):

• Available at weekends (Saturday and/or Sunday):

• Available for women only groups:

• Available for other groups:

• Also available for: Home birth support group, Vaginal birth after caesarean (VBAC) and Teenage 4 times per year.

• Are all women routinely offered ultrasound scans:

• Scan 1 available between: Between 11 weeks 2 days and 13 weeks 6 days

• Scan 2 available between: Between 18 weeks and 20 weeks 6 days

Trust Statistics

Trust Questions

• You can view various measures relating to the Trust's performance by clicking the following link: East Cheshire NHS Trust