Dr Gray's Jun 17

“During our inspection of Dr Gray’s Hospital we found areas of good practice, such as good completion of risk assessments for falls. We also saw good evidence of multidisciplinary team working and feedback from patients about the care they receive was good.

“We also identified areas for improvement. For example, NHS Grampian must ensure that all older people, who are being treated in the emergency department or are admitted to hospital, are accurately assessed within the national standard recommended timescales"

Ian Smith, Senior Inspector

Dr Gray's Hospital

Older people in acute hospitals unannounced inspection

Inspection dates: 18 -20 April 2017.

Summary of inspection

We carried out an unannounced inspection to Dr Gray’s Hospital from Tuesday 18 to Thursday 20 April 2017 and we inspected the following areas:

  • ward 5 (female surgical, urology, ophthalmology and gynaecology)
  • ward 6 (orthopaedics and medical)
  • ward 7 (medical)
  • stroke rehabilitation ward, and
  • acute medical admissions unit (AMAU).

We also visited the emergency department.

Before the inspection, we reviewed NHS Grampian’s self-evaluation and gathered information about Dr Gray’s Hospital 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 Grampian on 20 May 2015. Based on our review of this information, we focused the inspection on the following outcomes:

  • treating older people with compassion, dignity and respect
  • screening and initial assessment
  • person-centred care planning
  • cognitive impairment
  • food, fluid and nutrition
  • falls
  • pressure area care
  • care transitions
  • skills and accountability
  • leadership and management, 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 four 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 is important to them. We spoke with 18 patients and four relatives during this inspection. We received completed questionnaires from nine patients and five family members, carers or visitors.
  • reviewed 17 patient health records to check the care we observed was as described in the care plans. We reviewed these patient health records for cognitive impairment, food, fluid and nutrition, falls, pressure ulcer care, do not attempt cardiopulmonary resuscitation forms and medicines reconciliation.

Areas of strength

We noted the following areas where NHS Grampian was performing well in relation to the care provided to older people in acute hospitals.

  • Falls risk assessments were well completed.
  • There was good evidence of multidisciplinary team working.
  • Patient feedback was good.

Areas for improvement

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

  • Not all assessments were completed within the recommended standard timeframes.
  • There was a lack of person-centred care plans.
  • There were some concerns around the completion of the assessment of capacity to consent and staff understanding of Adults with Incapacity documentation.

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

This inspection resulted in seven areas of good practice and 12 areas for improvement.

We expect NHS Grampian 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: 28 June 2017

Scrutiny

Dr Gray's Hospital overview

Find out more about this hospital, including the latest inspection report, on the Dr Gray's Hospital overview page.