Scrutiny

Published Date: 19 November 2013

Raigmore Hospital

Older people in acute hospitals announced inspection

Inspection dates: 24-26 September 2013

Raigmore Hospital, Inverness, is an acute general hospital with 454 beds. Services include accident and emergency, outpatients, a coronary care unit and an intensive care unit. There are 11 operating theatres.

We carried out an announced inspection to Raigmore Hospital from Tuesday 24 to Thursday 26 September 2013.

We inspected the following areas:

  • ward 2A (stroke/rehabilitation)
  • ward 3A (orthopedics)
  • ward 4A (surgical admissions)
  • ward 4C (surgical)
  • ward 5A (medicine for the elderly)
  • ward 6A (acute medical admissions unit, with medical high dependency unit)
  • ward 6C (medical admissions), and
  • ward 11 (medical/respiratory medicine).

Before the inspection, we reviewed NHS Highland’s self-assessment and gathered information about Raigmore Hospital from other sources. This included Scotland’s Patient Experience Programme, and other data that relate to the care of older people. Based on our review of this information, we focused the inspection on the care of people with dementia and cognitive impairment, nutritional care and hydration, and preventing and managing pressure ulcers. Ensuring that older people are treated with compassion, dignity and respect is a focus on all our inspections.

On the inspection, we spoke with staff and used additional tools to gather more information. In all wards inspected, we used a formal observation tool. We carried out 34 periods of observation during the inspection. In each instance, members of our team observed interactions between patients and staff in a set area of the ward for 20 minutes.

We also carried out patient interviews and used patient questionnaires. We spoke with 28 patients during the inspection. We also received completed questionnaires from 48 patients.

As part of the inspection, we reviewed 39 patient health records to check the care planned and delivered was as described in the care plans. For this inspection, we reviewed 36 of the 39 patient health records for dementia and cognitive impairment. We also reviewed all patient health records for nutritional care and hydration, and 35 of the 39 patient health records for preventing and managing pressure ulcers.

Areas of strength

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

We saw good examples of warm, caring and friendly interactions between staff and patients. Patient care was carried out in a way that maintained patient dignity and respect. Healthcare Improvement Scotland Announced Inspection Report (Raigmore Hospital, NHS Highland): 24-26 September 13.

Dementia champions and the Alzheimer’s nurse consultant are working together to improve the care of people with dementia. Nursing assistants have also carried out the ‘best practice in dementia care’ training course. This has a positive impact on patient care.

Some wards have appointed a mealtime co-ordinator to provide clear direction to staff, to ensure that patients receive the meal they had ordered and were given appropriate help when necessary. Other wards have appointed a housekeeper who makes sure that menus are given out, completed and returned to the kitchen in a timely manner.

Areas for improvement

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

There is no routine screening for cognitive impairment taking place when older patients are admitted to hospital.

The ward and hospital environment needs to be made more suitable for people with dementia and cognitive impairment. Raigmore Hospital needs to ensure that signage is appropriate to meet the needs of all patients and helps them to find their way around the hospital.

Although we found that care delivered to patients appeared to be appropriate and of a good standard, we were not assured that patients, identified as having a cognitive impairment, had a personalised care plan in place. This care plan should identify the specific needs of the patient and how staff will meet these needs.

The improvement action plan for this inspection has now been removed from the Healthcare Improvement Scotland website, as the inspection took place more than 16 weeks ago. Please contact NHS Highland Board for further information on progress against this action plan.

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Raigmore Hospital overview

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

Raigmore Hospital Nov 13