Optical Express Liverpool is operated by Optical Express Limited. The clinic has pre-screening facilities, counselling rooms and a laser suite consisting of a small surgeon’s treatment room, a larger surgery treatment room and utility rooms.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 July 2017, along with an unannounced visit to the clinic on 20 July 2017.

The service provides laser correction surgery for patients over the age of 18, and does not provide treatment for children.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to patient’s needs, and well led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what patient’s told us and how the provider understood and complied with the Mental Capacity Act 2005.

We regulate refractive eye surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• The service did not use a safer steps surgery checklist or equivalent before, during or after laser surgery treatments. The service had recently developed a surgery checklist, which was not embedded into practice yet.
• There was not always a registered nurse on duty during surgery days. There was no evidence that risk assessments were completed to access the impact of this on patient care and safety. However, on our unannounced visit, staff informed us that they had developed a risk assessment tool to monitor and access this impact. This needed to be embedded into practice.
• There was no evidence of regular local quality audits. The service undertook medicine and record audits and had recently introduced a monthly hand hygiene audit but this was not embedded into practice yet.
• There was no evidence of local or regional learning, there were no regular team meetings, team briefs or shared learned forums. However, staff had recently introduced team brief meetings on surgery days.
• There was no evidence of a local, regional or national staff survey to assess staff motivation, experience and well-being.
• There was no formal system in place to record and document safe disposal of expired drugs at the clinic. However, on the unannounced visit, staff had developed a recording system to ensure dispose of drugs properly to help reduce harm from accidental exposure or intentional misuse.
• There was a lack of local oversight for training and competencies for all rotational staff attending the clinic.
• Patient information leaflets, documents and consent forms were only provided in English.
• There were no formal interpreter services available for patients. Patients were advised to bring their own interpreter in to the clinic with them or use a family member. Staff informed us that some staff were bi-lingual and were used to interpret information.
• Although a local risk register was in place, it was based on a standard list of complications relating to refractive surgery. It did not reflect local risk issues or risks related to local incidents. Senior staff informed us that there was no corporate risk register.
• The consent policy stated a “cooling off” period of three days prior to surgery procedure. Staff also undertook remote telephone patient consent. However, the new Professional Standards for Refractive surgery (April 2017) recommends a “cooling off” period of one week and consent should not be conducted by telephone.
• Clean sharps boxes were stored on shelving in the same room as gas cylinders and dirty waste. This was not following corporate policy on storage. However, on the unannounced visit, these had been removed to a more suitable utility room.

However, we found the following areas of good practice:

• We observed that nurses had close working relationships with their patients. Interactions were positive, friendly and professional.
• All areas of the clinic were tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
• Information about the outcomes of patients’ care and treatment was collected and audited annually by the corporate statistician to review quality care and patient outcomes. This process was completed through data imputed by the main surgeon at the clinic, in relation to patients who undertook surgery.
• Emergency equipment was checked on surgery days and staff documented all checks.
• We found that fridge temperatures, air humidly and room temperatures were recorded to ensure they were all within normal ranges.
• We observed that staff undertook appropriate Aseptic Non Touch Techniques (ANTT) to minimise the occurrence of infection during surgery.
• We looked at nine paper patient records and three electronic patient records (EMR) and found that all information was completed and information corresponded between the two versions of records. Every patient had consent forms, patient information leaflets and a health questionnaire completed in their paper records.
• The EMR system was accessible to all appropriate staff in all Optical Express clinics across the country.
• Mandatory training was made available to all staff to enable them to provide safe care and treatment to patients. Some of the training was completed through e learning, which staff could access at a time to best suit their needs.
• All patients we asked reported the staff were caring and respectful.
• Patients told us that that all risks and benefits were discussed thoroughly with them prior to surgery and that they all received good discharge and aftercare information. Patients also informed us that they received adequate time from their first consultation appointment, time of consent and day of surgery.

Following this inspection, we told the provider that it should make other improvements, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals