Published Date: 19 November 2013
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
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
- 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
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
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
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
Areas for improvement
We found that further improvement is required in the following
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
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
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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