Two patients each spent three weeks on trolleys in a hospital where hundreds of health and safety issues were recorded by staff in just one month, documents seen by RTÉ Prime Time show.
During October - when overcrowding reached dangerously high levels - staff working in the UL Hospital Group made 442 notifications of incidents and near miss incidents.
These are logged when health and safety does, or could, become an issue - and hospital administrators point out that it is good practice that these incidents are recorded, so that problems can be addressed.
Four of the incident forms seen by Prime Time relate to people aged over 75 who spent more than three days on trolleys in University Hospital Limerick, with two of these mentioning the risk of the patients developing pressure sores as a result.
Some patients spent more than 24 hours in emergency departments before being discharged or assigned to a bed, while patients with diarrhoea were nursed on trolleys.
Isolation beds were not available for many patients with superbugs, leading to an increased risk of the spread of very dangerous infections.
Throughout the country overcrowding affected 11,452 patients awaiting a bed in October - many on trolleys - which was the second highest monthly figure since the Irish Nurses and Midwives Organisation began keeping a TrolleyWatch record in 2006.
The highest was 12,395 in January 2018.
University Hospital Limerick had the highest figure, with 1,450 patients waiting for a bed.
Prime Time examined the incident forms for UHL, University Maternity Hospital Limerick, Nenagh and Ennis.
The investigation shows:
- Two records from 1 October relating to UHL patients on trolleys in the Acute Medical Unit for three weeks, increasing the risk of pressure sores - one admitted on 10 September and the other admitted on 13 September.
- Four records from 1 October of over-75s being nursed on trolleys in the acute medical unit at UHL for greater than 72 hours.
- "Severe overcrowding" with 15 patients in the Clinical Decision Unit corridor of UHL on 14 October while on the same date there was a "delay in triage" due to no trolleys available for patients.
- An "unsafe nursing staff level" on the Cystic Fibrosis Unit on 31 October at UHL.
- One incident form from 16 October tells of a UHL patient who had a "grade one pressure sore" who was waiting 114 hours for a bed.
- Another patient with "restricted mobility" was on a trolley for over 48 hours at UHL and was at a "high risk of developing pressure ulcer".
- Three trolleys were "placed in unsafe environment" in a ward on 30 October and on the same day three trolleys - including two patients who were "very unwell" - were sent to a ward, which was already down a staff nurse.
- On 29 October a "patient banged into patient trolley" in the maternity antenatal clinic.
- On 28 October a patient in a ward developed a temperature of 37.8 degrees but was "unable to move out due to no beds available" even though the patient next to her was undergoing chemotherapy.
- Staff were "unable to isolate" a patient with diarrhoea in UHL on 26 October while on 22 October a patient with diarrhoea was "admitted to trolley" in UHL and on 17 October a patient with diarrhoea was "nursed in a trolley with no isolation".
- There were also cases of nurses being unable to keep patients with superbugs away from other patients.
- One UHL nurse complained on 25 October of an inpatient - who had MDRO (multi drug resistant organisms), the superbug ESBL and E-Coli - being put in a two-bedded room "as no single room was available".
- On that same date a patient with "MRSA / VRA" was on a trolley. While a child with a history of MRSA was placed in a four-bedded area on 1 October at the maternity unit.
- A UHL patient with MDRO was "on corridor amongst other patients" on 11 October while on the same day staff were unable to find a single room for a patient who "had MDRO in her urine from a sample on the 2/10/19".
- On 10 October in UHL a "KPC-contact patient" was "nursed in main ward". KPC or Klebsiella pneumoniae Carbapenemase can cause pneumonia and urinary tract infections.
- A patient who had just undergone coronary artery bypass grafting was "admitted into two-bedded room with KPC contact patient" on 8 October at UHL.
- As a result of the overcrowding, a pregnant patient on 21 October was in the same room as a patient who had undergone a nuclear medicine ventilation perfusion (VQ) scan. An angiogram "wasn't done due to no bed available" on 9 October at UHL.
- There were tensions between UHL staff and management with one incident log showing on 24 October a "night bed manager accused staff of delaying patient treatment in A&E because bed not cleaned even though bed logged at 1am".
- Some patients self- discharged while one was "very angry" after being admitted onto a trolley on 23 October saying he "was told by A&E he was going to a bed". A patient's daughter said to a nurse manager "it's her fault her mother had a stroke" on 8 October in UHL.
- A number of other incidents related to the usage of trolleys. On 23 October there was no "storage or charts" in UHL as the existing trolleys were deemed "inappropriate" while there were "three trolleys on corridor outside isolated rooms".
- On 18 October in UHL, a "trolley jammed while positioning patient". The next day in UHL a patient "slid from end of trolley and hit ground".
- On 21 October, in UHL, a patient had a seizure and fell off a trolley while on 17 October a "patient had fall from trolley and hit head".
- On 2 October at UHL a patient reported to staff that his box of Kapake tablets - which contain codeine - is "missing from his own meds on the back of his trolley since yesterday".
- There were also cases where equipment was not up to standard. On 13 October a "wheel fell off infant cot causing it to fall over" at the Maternity while on 10 October at UHL a "telemetry plug fell from socket and hit patient in head".
In response to Prime Time, a spokesperson for the UL Hospital Group said incident reporting is "actively encouraged".
They added that: "Due to increased awareness and training of incident reporting, monthly trends have shown an increase in incident reporting, which is in line with other hospital groups. This is a positive outcome as it indicates a culture of openness, transparency, and learning which supports improved patient care and safety."
The spokesperson said: "Of the total incidents reported during October 2019, over 90% were 'no harm' or 'near miss' incidents. One incident was categorised as a serious incident. Approximately 100 incidents were raised in relation to the Emergency Department, which sees approximately 6,000 presentations per month.
"We commend our staff for the increase in reporting of incidents, which is in line with the national trend ... Over the course of a year there will be millions of patient contacts and opportunities for something to go wrong. The important thing when this happens is that we respond immediately and ensure patients come to no harm - and that incidents continue to be reported as part of an overall culture of patient safety and learning."
The spokesperson also said that data shows the UL Hospitals Group does better than the national and OECD averages in terms of hospital mortality rates for myocardial infarction (heart attack) and ischaemic stroke.
The hospital is also "consistently above average" when it comes to readmission rates within 30 days of discharge, a key indicator.
The spokesperson added: "We acknowledge and apologise for the anxiety and distress faced by patients who face long waits for admission, particularly in our Emergency Department.
"This is not the level of care we wish to provide. But we hope that the evidence on patient outcomes will provide reassurance that management and staff are doing everything possible to maintain high standards of care in spite of the acknowledged challenges we face around bed capacity and shortage of isolation facilities.
"A 60-bed ward block is under construction at UHL and will open at the end of 2020. This will help us begin to address the shortage of bed capacity in the midwest. A separate 96-bed block at UHL has also been included in the national capital plan Project Ireland 2040."
The spokesperson also responded to some of the individual cases we are highlighting.
On the two patients on trolleys for three weeks their response said one of them, a young man, had wished "to stay on the unit rather than transfer to another ward" while for the other patient "all nursing care and treatments were received while in the unit and the patient was successfully discharged home".
Referring to the patients on trolleys with diarrhoea, the spokesperson said: "While every effort is made to give each patient that require isolation a single room, this cannot always be achieved due to infrastructure.
"Decisions are made based on clinical presentation and information, recommendations from Infection Prevention and Control and risk assessment .All patients waiting for a bed on a ward are offered privacy screens which allow for a level of privacy to be maintained while awaiting a bed.
"Bathroom (toilet/shower) facilities are identified to them for their use on admission. Patients waiting for a bed are given all treatment and care they require."