Healthcare Improvement Scotland Blog

Posts from the “Inspections and Reviews” Category

What it’s like to support inspections to help keep care homes safe during COVID-19 – Agnes Chirozvi

Posted on March 10, 2021

Agnes Chirozvi is a new inspector with the Quality Assurance Directorate of Healthcare Improvement Scotland. Working with the Care Inspectorate on their inspection of care homes, Agnes shares her story of how she became an inspector and what it’s like to go into care homes during the pandemic, whilst ensuring safety for residents and staff, as well as the inspection teams themselves.

When the COVID-19 pandemic broke out I was working as a scrub nurse for a private company working in trauma and orthopaedics operating theatres in a major NHS hospital in Scotland. Although I loved working in trauma and orthopaedics, fixing the broken bones and making people whole again, there was something missing.

Earlier in my career I was in a nursing management role for nearly seven years. I realised that I missed the partnership working and quality assurance aspects of the job, including my focus on infection prevention and control (IPC). This is what inspired me to join Healthcare Improvement Scotland as an inspector in mid-November 2020. I was excited to know that I would help to make a huge difference in people’s lives through driving safety to improve the quality of their lives. I knew Healthcare Improvement Scotland was exactly where I was meant to be.

Building relationships virtually in a new role

On my first day with Healthcare Improvement Scotland it felt a bit strange to be sitting in my home in front of a computer by myself, and not going to an office full of people which I had done before. It felt like a huge contrast to my nursing career and I had all sorts of mixed emotions. But in my second week I was able to get out into the field, shadowing two Care Inspectorate inspectors and one Healthcare Improvement Scotland inspector as part of my supervised induction into my new role. I was excited to meet these experts in the flesh and felt privileged to be able to tap into their vast knowledge.

At the end of January this year, I was ready to take part in my first care home inspection, alongside colleagues from the Care Inspectorate. Since then, I have represented Healthcare Improvement Scotland on eight inspections. My first four months as an inspector have been an exciting time in my life as the learning never ends.  

The challenges of carrying out inspections during the pandemic

The Care Inspectorate is the lead agency for the inspection of care homes across Scotland – at the start of the pandemic, the Scottish Government asked Healthcare Improvement Scotland to provide additional support to the IPC dimension of their work, with our joining them for about 30% of their inspections. Since May of last year, Healthcare Improvement Scotland inspectors have supported over 300 inspections of care homes across the country.

Many of the care homes we have visited have been dealing with outbreaks of COVID-19, so taking extra precautions to keep risks at a minimum was and is an absolute priority. One of the main challenges of carrying out inspections during the pandemic are the complexities of trying to achieve safety for myself, my colleagues, care home staff and the residents.

We take appropriate Personal Protective Equipment (PPE) with us on visits and wear it for each activity we carry out and afterwards, immediately remove our PPE and clean our hands. Inspectors have to carry out a self-administered COVID-19 Lateral Flow Device Test twice a week and before each inspection. If a test is positive, the inspector is taken off an inspection and replaced by someone who is negative. On arrival at a care home, we have our temperature checked as this could be an indication of the onset of symptoms of the virus. We also change into scrubs that can be washed at high temperatures and reverse this process at the end of the inspection. Throughout the inspection, we socially distance from colleagues, care home staff and residents. We also wash our hands in between activities and apply alcohol rub to ensure our hands are clean before and after applying gloves. This can be taxing, but we are all conscious of how it is important it is for individual safety and good public health – and it is no more than we are expecting from the staff working within the care homes we are visiting.

Infection prevention and control

A key difference between a hospital and a care home is that the latter are people’s homes – a place where they should be and should feel safe, comfortable and at home.

As a Healthcare Improvement Scotland inspector, my primary role is to determine whether the infection control practices in place support a safe environment for residents and for staff. We use a standard inspection tool to guide this process, based on the most up to date national guidance available. Our assessments include cleanliness of the physical environment; furnishings and equipment; observation of staff practices; and checking of audits, systems and processes. Speaking with care home staff also provides an invaluable insight into each care home’s understanding of IPC and its use of current national guidance. As inspectors our job is to help keep people safe – and so where we can offer advice and guidance to staff on how to improve IPC we always seek to do so.

It is extremely fulfilling to be part of such an important process and to be a member of a very committed team. By working in partnership with our colleagues from the Care Inspectorate, Healthcare Improvement Scotland staff have made an important contribution to our national COVID-19 response – and we will continue to play our part in helping to keep people safe as the social care sector looks to re-mobilise, recover and re-design.

Agnes Chirozvi is an inspector with Healthcare Improvement Scotland.

Categories: COVID-19 blogs, Inspections and Reviews

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Ensuring that radiation in healthcare is used as safely as possible – Alastair McGown

Posted on August 28, 2020

We used to think of radiation as being a highly dangerous substance and thoughts of historical international disasters would possibly spring to mind. As an invisible and powerful force, it can certainly be harmful when not handled correctly, but there are many benefits to its use in healthcare, and it plays a vital role in diagnosis and treatment. Most people will know of someone who has had an x-ray and some of use will know someone who has gone through radiotherapy. These are common healthcare procedures that most of us will consider safe and effective. Regulation of the use of radiation is about making something that is already very safe into something that’s extremely safe.

Safety is at the heart of what we do

But how do we know these procedures are safe and that we’re protecting patients from the potential harms of radiation? That’s where the IR(M)ER inspectors come in! IR(M)ER stands for Ionising Radiation (Medical Exposure) Regulations, and it’s our job to ensure that ionising radiation for medical exposure is as safe as practicable across both the NHS and private healthcare in Scotland.

In this role we work for Healthcare Improvement Scotland to inspect services throughout Scotland, but we carry out these regulatory duties on behalf of the Scottish Government. IRMER regulations cover the UK, so whether we are in Scotland or other parts of the UK we are all inspecting to the same regulations. We work together to drive consistency where possible. The UK safety standards are based on international standards and countries all over Europe and globally have agreed to implement these into their regulations. A recent international review of how the UK manages radiation safety was undertaken by the International Atomic Energy Agency. As part of that review we had to demonstrate how we were fulfilling our international obligations as a regulator. This was a unique experience and offered a chance to meet regulators from all over the UK. The reviewer that looked at our work was from Sweden. We were delighted with the outcome from the visit and will use the results to continually improve how we deliver our work.  

A rare and unique role in healthcare

This type of role requires a lot of specialised training and on the job experience. For me, it’s a fantastic opportunity that’s also enjoyable and rewarding, plus I get to learn from other bodies like Public Health England and to develop relationships with colleagues in other countries. We work alongside radiologists and radiographers around the country to ensure that they have all the safety measures in place. These include rigorous controls to make sure that when ionising radiation is used it is appropriate to do so and as safe as possible.

I’ve been inspecting for over a decade, and have experienced a variety of receptions when I arrive on site. Inspecting in IRMER has been really enjoyable. Every department we’ve visited has been extremely welcoming to us, and have made every inspection a pleasant and rewarding experience.

My role, alongside fellow inspectors, is to ensure that each provider complies with the regulations, and to support and encourage compliance where necessary. We do this through inspections, responding to notifications of incidents and through engagement with national groups.

What we’ve found is that there is a true focus on improvement, and any recommendations are for the safe use of ionising radiation are accepted with a commitment to implement them. We have had the opportunity to see at first hand the different type of equipment and the truly remarkable work that’s undertaken. Everyone we visit has a passion for their work, and safety and improvement is always a priority.  

Training is vital

The regulation of IRMER is a very important area of work, and requires us to have sound, specialist working knowledge of diagnostics, nuclear medicine and radiography. These include x-rays, nuclear medicine, CT scanning and mammography. 

Before I started undertaking IR(ME)R inspections, I had to complete a robust training programme. The main part of this was a fantastic week delivered by Public Health England (PHE) experts, who carry out this training for regulators across the UK. We learnt about the various aspects of ionising radiation and its use in medicine, as well as the regulation and monitoring of it. It’s really beneficial to learn alongside regulators from all over the UK. We can also call on the support of colleagues from PHE and the CQC whenever it’s required.

It’s been a fascinating but steep learning curve to understand such a highly specialised area of work. However, the learning is never finished. In the same way that we’re always expecting providers to improve, we endeavour to do the same. It’s satisfying to know that the work that we all do together helps to keep patients safe, enabling them to be protected from the harms of radiation, and instead to receive only the benefits.  

Alastair McGown is a Senior Inspector with Healthcare Improvement Scotland

More information

To find out more visit the Healthcare Improvement Scotland website

Categories: Inspections and Reviews

Tagged: Inspections, Quality Assurance

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Healthcare Improvement Scotland Blog

The purpose of Healthcare Improvement Scotland is to enable the people of Scotland to experience the best quality of health and social care.

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