DGRI April 17

“During our inspection of Dumfries & Galloway Royal Infirmary we found areas of good practice and areas to improve. Interactions between staff and patients were positive and the majority of patients praised the care they received."

“However NHS Dumfries & Galloway must ensure that all older people, who are being treated in accident and emergency or are admitted to hospital, are assessed within the national standard recommended timescales and that that all documentation is dated, timed and filled correctly."

“We will continue to monitor the situation and will follow up on these at future inspections.”

Ian Smith, Senior Inspector

Dumfries & Galloway Royal Infirmary

Older people in acute hospitals unannounced inspection

Inspection dates: 24 - 26 January 2017

Summary of inspection

We carried out an unannounced inspection to Dumfries & Galloway Royal Infirmary from Tuesday 24 to Thursday 26 January 2017 and we inspected the following areas:

  • ward 3 (general surgery)
  • ward 6 (general surgery)
  • ward 7 (general medicine and medical assessment unit)
  • ward 9 (cardiology)
  • ward 12 (stroke and respiratory)
  • ward 14 (care of the elderly)
  • ward 16 (orthopaedic and gynaecology), and
  • ward 18 (care of the elderly).

Before the inspection, we reviewed NHS Dumfries & Galloway’s self-evaluation and gathered information about Dumfries & Galloway Royal Infirmary from other sources. This included Scotland’s Patient Experience Programme, and other data that relate to the care of older people. We also carried out an NHS board visit to NHS Dumfries & Galloway on 5 November 2014. Based on our review of this information, we focused the inspection on the following outcomes:

  • treating people with compassion, dignity and respect
  • screening and initial assessment
  • person-centred care planning
  • safe and effective care
  • managing the return home
  • leadership and accountability, and
  • communication.

During the inspection, we:

  • spoke with staff and used additional tools to gather more information. In all wards, we used a formal observation tool and the mealtime observation tool, where appropriate. We carried out 12 periods of observation and in each instance, members of our team observed interactions between patients and staff in a set area of the ward for 20 minutes.
  • carried out patient interviews and used patient and carer questionnaires. A key part of the public partner role is to talk with patients about their experience of staying in hospital and listen to what was important to them. We spoke with 21 patients and five relatives during this inspection. We received completed questionnaires from five patients and one family member, carer or friend.
  • reviewed 27 patient health records to check the care we observed was as described in the care plans. We reviewed all patient health records for cognitive impairment, food, fluid and nutrition, falls and pressure ulcer care. We also reviewed the patient health records for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms and medicines reconciliation.

Areas of good practice

We noted the following areas where NHS Dumfries & Galloway was performing well in relation to the care provided to older people in acute hospitals. This included the following:

  • patients and relatives were complimentary about the care,
  • patients were complimentary about the quality of food,
  • staff felt supported by senior management,
  • there was good multi-disciplinary working.

Areas for improvement

We found that further improvement is required in the following areas:

  • in general, assessments were not always completed accurately and within the recommended standard timescales,
  • there was a lack of person centred care plans, and
  • there are concerns around the completion of the assessment of capacity to consent and staff understanding of Adults with Incapacity (AWI).

This report highlights areas of strengh and weakness as well as areas for further improvements.

 

This inspection resulted in six areas of good practice and 12 areas for improvement. A full list of the areas of good practice and areas for improvement can be found in Appendices 1 and 2, respectively, on pages 27 and 28.

We expect NHS Dumfries & Galloway to address all the areas for improvement. The NHS board must prioritise those areas where improvement is required to meet a national standard.

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Published Date: 5 April 2017

Scrutiny

Dumfries & Galloway Royal Infirmary overview

Find out more about this hospital, including the latest inspection report, on the Dumfries & Galloway Royal Infirmary overview page.


Types of inspections

Inspections may be announced or unannounced and will involve physical inspection of the clinical areas, and interviews with staff and patients. We will publish a written report 8 weeks after the inspection.

  • Announced inspection: the service provider will be given at least 4 weeks’ notice of the inspection by letter or email.
  • Unannounced inspection: the service provider will not be given any advance warning of the inspection.
  • Follow-up inspection: the NHS board and hospital may or may not be given advance notice of the inspection. A safety and cleanliness follow-up inspection will take place no later than 26 weeks from the publication of the initial report.