Royal Alexandra Hospital
Older people in acute hospitals announced inspection
Inspection dates: 14 - 15 March 2012
We carried out an announced inspection to the
Royal Alexandra Hospital on Wednesday 14 and Thursday 15 March
Before the inspection, we reviewed NHS
Greater Glasgow and Clyde’s self-assessment and obtained
information about the Royal Alexandra Hospital from other sources.
This included Scotland’s Patient Experience Programme and other
additional data that specifically relate to the care of older
people. Based on our review of this information, we decided to
focus the inspection on falls prevention and management, and
preventing and managing pressure ulcers.
On the inspection, we used additional tools
to gather more information. We also reviewed patient health records
to establish the context of the care provided and to ensure the
care delivered was as described in the care plans.
Areas of strength
We noted areas where NHS Greater Glasgow and
Clyde was performing well in relation to the care provided to older
people in acute hospitals. We saw many examples of positive caring
behaviour during staff interactions with patients and, overall,
patients spoke positively of the care and assistance they
There are dedicated NHS board falls
prevention and tissue viability (pressure ulcer) services across
NHS Greater Glasgow and Clyde. Ward staff spoke highly of the
advice and support provided by both these services and said that
they were easy to access.
Recognised falls risk assessments and
pressure ulcer risk assessments were in use for the majority of
patients in each ward.
Areas for improvement
We did find areas where further improvement
Both the falls risk assessments and pressure
ulcer risk assessments were not always being fully completed. It
was not always clear what the plan of care was following completion
of the assessments if a patient was identified as at risk of
falling or of developing a pressure ulcer. It was also not clear
how the assessments and care plans were being reviewed, such as
what follow-up care was to be arranged for patients.
We were also concerned about the
interpretation of the use, and purpose of, do not attempt
cardiopulmonary resuscitation (DNACPR) documentation, and the
responsibilities for decision-making and communication between some
of the medical staff within Royal Alexandra Hospital.
From the patient health records we reviewed,
we found little evidence of mental health assessments and no
individualised care planned for patients with confusion or
This inspection resulted in three areas of strength and 12
areas for improvement.
The improvement action plan for this inspection has now been
removed from the HEI website, as the inspection took place more
than 16 weeks ago. Please contact NHS Greater Glasgow and Clyde for
further information on progress against this action plan.
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Published Date: 25 April 2012