Forth Valley Royal Feb 17

“During our inspection of Forth Valley Royal Hospital 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.

“The integrated care ward offers a good therapeutic environment for patients with cognitive impairment. It should be commended for the work that has been done and continues to be implemented within what is a very busy ward.

“However, there are a number of areas where improvements must be made. NHS Forth Valley must improve documentation and 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.

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

Claire Sweeney, Interim Director of Quality Assurance

 

 

 

 

Forth Valley Royal Hospital

Older people in acute hospitals unannounced inspection

Inspection dates: 15-17 November 2016

Summary of inspection

We carried out an announced inspection to Forth Valley Royal Hospital from Tuesday 15 November  to Thursday 17 November 2016.

We inspected the following areas:

  • Acute assessment unit
  • A11 – Ageing and health
  • A22– Stroke
  • A32 – Acute medical ageing and health
  • B11– Surgical
  • B12 – Medical (including respiratory)
  • B21/B22– Ageing & Health integrated care
  • B32 – Medical/gastrointestinal, and

We also visited the discharge lounge

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 10 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 was to talk with patients about their experience of staying in hospital and listen to what was important to them. We spoke with 38 patients during the inspection. We received completed questionnaires from 37 patients and 24 family members, carers or friends.
  • reviewed 32 patient health records to check the care we observed was asdescribed 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

  • The majority of patients praised the care that they had received.
  • The ageing and health integrated care ward should be commended for the work it is undertaking in working with patients who have a cognitive impairment.
  • Interactions are positive between staff and patients, and assistance is provided in a timely manner.
  • There is good flexibility in providing alternative or additional meals. There is also a good range of snacks and fluids available.
  • During our inspection, despite being busy, wards appeared calm and organised.

Areas for improvement

  • Documentation is an essential part of a patient’s care; it is a legal requirement and ensures that patient care is safe. Throughout the inspection we identified areas of poor documentation. It is important to stress that poor documentation does not mean that the care is also poor.
  • Initial assessments need to be completed accurately and within the standard recommended timescales. On completing the Malnutrition Universal Screening Tool (MUST), there is a lack of recording if weights are estimated or measured,resulting in inaccurate scoring of MUST. Correctly completed assessments areneeded to ensure that correct patient care is given.
  • The completion of person-centred care plans is variable. These should detail the interventions required to meet patients’ identified care needs but didn’t always.
  • There are concerns around the completion of the assessment of capacity to consent and staff understanding of Adults with Incapacity (AWI).

The report highlights areas of strength and weakness as well as areas for further improvement.

This inspection resulted in three areas of good practice and 10 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 29 and 30. We expect NHS Forth Valley 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: 14 February 2017

Scrutiny

Forth Valley Royal Hospital overview

Find out more about this hospital, including the latest inspection report, on the Forth Valley Royal Hospital 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.