Care Quality Commission on Marie Stopes International, Date of inspection visit: 17 May 2016 Date of publication: 02/10/2017
“Infection control systems, processes and practices were not delivered in line with the current national guidance. There was poor hand hygiene, poor use of personal protective equipment and poor pre-surgical preparation. ….
Services at MSI Maidstone were very process centric with staff showing limited empathy for how the patients might be feeling. Support from a partner, friend or parent was discouraged and accompanying supporters were asked to leave the premises whilst the patients were being treated.
Staff sometimes failed to consider patient’s privacy and walked into the the theatre whilst procedures were taking place.
There were complaints about staff being abrupt and blunt towards patients……
Staff did not take adequate infection prevention and control (IPC) precautions with hand hygiene … We observed a surgeon wearing a large, stoned ring during surgery and not washing their hands between patients…..
The corporate policy of ensuring there was an appropriate adult escort post procedure was not followed at MSI Maidstone and placed patients at significant risk….
There was inconsistent use of sedative medication such that staff had raised concerns about over sedation with Midazolam. Specific occurrences relating to oversedation were not acted upon or recorded as incidents; instead staff voicing concerns were removed from theatre work….
Unsupervised healthcare assistants (HCAs) were used to supplement and replace trained nurses by completing pre-procedure assessments, scanning patients, taking consent, making decisions regarding safeguarding and providing post-operative care….
We also noted that the sink in the theatre was not used by any member of staff throughout the entire list of 21 patients. We saw a surgeon wore sterile gloves but kept their large, stoned costume rings on when undertaking surgical procedures. This surgeon did not wash their hands or use alcohol gel between patients and failed to follow good hand hygiene practice. Other theatre staff changed their gloves but did not wash their hands or use hand gel between patients…..
The surgeon did not wear an apron to protect their theatre clothing from potential contamination and to reduce the risk of cross contamination during surgical procedures.
We observed that poor practice in the theatre meant that the sterile gloves were contaminated by being removed from the outer wrapper with unwashed hands. The contaminated gloves were dropped by the surgeon from unwashed hands onto the trolley, which contaminated the sterile field.
We observed poor practice in pre-operative preparation of the genetalia. This posed a risk of introducing an infection.
Staff we spoke with said that the 15 minutes allotted to each consultation was insufficient to allow proper cleaning of the room and equipment, which they did whilst the patient was still signing consent forms.
We observed that in the theatre, a member of staff used a single antiseptic wipe to clean all equipment, the couch and the floor between patients….
[T]here was no direct access from the theatre to the room containing the locked specimen freezer used to store pregnancy remains, which was on another floor within the centre. Staff had to carry an unsealed bucket of pregnancy remains through a patient waiting area, upstairs to a records cupboard where the fridge was sited. This was poor infection prevention and control practice as well as potentially being offensive to patients waiting.”
Nursing staff reported to us that they had tried to discuss two recent cases of oversedation with the anaesthetist but they wouldn’t listen. They felt there was inadequate support to address concerns about anaesthetists not following the corporate sedation policy and no senior back up in case of an emergency….
Patients could travel home after surgical treatment with conscious sedation without a responsible adult to accompany them. We were told by several nursing staff that his included children travelling by public transport on long journeys
The corporate policy on surgical terminations under conscious sedation required staff to ensure that a responsible adult accompanied patients home. This policy was not being followed in practice. Direct observation showed that staff discharging patients did not check whether they had an accompanying adult…..
Staff were concerned about this practice and one said they worried about young girls getting buses and trains without anyone with them for journeys of up to two hours.”
This facility did abortions up to 14 weeks.