Areas for improvement identified at hospital

NHS Shetland has received a largely positive inspection report regarding its care of older people in hospital. But hospital chiefs have been told they must tighten up on record-keeping and on making plans for discharging people.

The Healthcare Improvment Scotland inspection, which was announced in advance, took place in March and focused on patients in Ronas Ward, Ward 1 and Ward 3.

It formed part of a national programme to ensure older people are safe while in hospital, and that their care is effective and meets their individual needs.

Inspectors checked that patients were being treated with compas­sion, dignity and respect, and their care met national standards for nutrition and hydration, prevention of pressure ulcers, cognitive impairment and falls prevention and management.

Patients were interviewed in the inspection, and patient and carers questionnaires were also used – in 100 per cent of cases it was stated staff gave clear information, patients were checked regularly and the care was good. Many mentioned staff “kindness”, and there were no negative comments.

The inspectors praised the care and attention patients received, finding “evidence that patients

They observed “good communication” be­tween patients and staff, and also noted “effective leadership on the wards from the nurses in charge, creating a calm environment and well co-ordinated care.”

Staff were seen to emphasise the importance of ensuring patients’ nutrition, and the report stated: “Mealtimes were protected and there was evidence that patients received appropriate support with their meals and were given a good range of choices to suit their nutritional requirements.”

Documentation regarding nutritional care, falls and cognitive impairment was “generally well completed”, according to inspectors, and they saw evidence that pressure-relieving equipment was available and used.

However, 11 areas were earmarked for improvement. The hospital should ensure discharge planning starts at admission and where needed this should be done with the social work department; the language of bed-rail care plans should promote dignity; and management of “patient flow” should not compromise care.

On admission patients should be screened for dementia; if they have dementia there should be a personalised care plan; legislation to protect patients with incapacity should be implemented.

Screening for under-nutrition should also be carried out on admission and the care plan should indicate if patients need help to eat.

Screening for pressure sores should take place on admission and personalised care plans should identify sores management.

The one area identified for “continuous improvement” was that the plan for emergency snack boxes for patients should carry on.

Head inspector Jacqui Macrae said: “This inspection has highlighted areas where Gilbert Bain Hospital is performing well.

“We observed friendly and polite interactions between staff and patients and mealtimes were well-managed. Patients spoke positively about the quality of care received and we saw the use of dementia friendly [environment] in ward areas.

“However, we also identified a number of areas where NHS Shetland must improve. Personalised care plans did not reflect individual patient needs, and we saw an inconsistent approach to the completion of documentation including discharge planning checklists and adult with incapacity certificates.

“This inspection resulted in three areas of strength, 11 areas for improvement and one for continuing improvement. We expect NHS Shetland to address the areas for improvement as a matter of priority.”

These concerns will be followed up.

NHS Shetland chief executive Ralph Roberts said: “I am pleased to note that all patients who talked to the inspectors said their care in hospital was good and this report demonstrates that we provide high quality older people’s care in Shetland. This is testimony to the efforts of staff who strive to provide high standards of care every day.

“A number of areas for improvement were also highlighted, about ensuring consistency in completing record keeping, clinical assessments and discharge planning. Staff will continue to work on existing improvement plans for older people’s care and incorporate the inspection findings into plans.”

NHS Shetland nursing chief Kathleen Carolan said: “The report is very positive, and inspectors fed back verbally that the standard of care is very high and that the 10 or 11 patients they spoke to were highly complimentary.”

The hospital would now focus on its record-keeping, she said, and making sure patients were discharged in a “timely way”. The “occasional instances” of things needing improvement were “not surprising”, and were already being worked on.

Regarding the inspectors’ finding of lack of personalised care plans, Mrs Carolan said: “I believe we do have personalised care, but our record-keeping did not always reflect this.

“Care is of a good standard across the board, and with 50 or 60 people in hospital there is plenty of opportunity to see consistency.”