Royal Alexandria Sep 17

 “During our inspection of Royal Alexandra Hospital, despite being busy, wards appeared calm and organised, and with evidence of team working. We also saw evidence of a good fracture liaison service and that the hospital was proactively looking at different ways that staff can receive education. However, not all patient assessments were completed within the recommended standard timeframes, and we saw a lack of person-centred care plans. We will follow up on these issues at future inspections.”

Ian Smith, Senior Inspector for Healthcare Improvement Scotland

Royal Alexandra Hospital

Older people in acute hospitals unannounced inspection

Inspection dates: 26 - 27 July

Summary of inspection

We carried out an unannounced inspection to Royal Alexandra Hospital from Monday 3 to Wednesday 5 July 2017 and we inspected the following areas:

  • ward 3 (elderly assessment/rehabilitation)
  • ward 4 (stroke/stroke rehabilitation)
  • ward 6 (older adults assessment unit)
  • ward 11 (respiratory/general medicine)
  • ward 23 (orthopaedics)
  • ward 26 (general surgery)
  • ward 27 (general medicine), and
    acute medical unit.

Before the inspection, we reviewed NHS Greater Glasgow and Clyde’s self-evaluation and gathered information about the Royal Alexandra 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 Greater Glasgow and Clyde on 29 October 2014. 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 a mealtime observation tool, where appropriate. We carried out nine 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 17 patients during this inspection. We received completed questionnaires from 29 patients and 27 family members, carers or friends.
  • reviewed 33 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 and food, fluid and nutrition, medicines reconciliation and do not attempt cardiopulmonary resuscitation forms. We reviewed 31 patient health records for falls and pressure ulcer care.

Areas of good practice

We noted areas where NHS Greater Glasgow and Clyde was performing well in relation to the care provided to older people in acute hospitals. This included the following:

  • a good fracture liaison service

  • proactively looked at different ways that staff can receive education.

Areas for improvement

  • not all assessments were completed within the recommended standard timeframes, and 

  • a lack of person-centred care plans.

This inspection resulted in four areas of good practice and 14 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 Greater Glasgow and Clyde 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: 13 September 2017

Scrutiny

Royal Alexandra Hospital overview

Find out more about this hospital, including the latest inspection report, on the Royal Alexandra 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.