Older people in acute hospitals announced inspection
Inspection Dates: 25-27 June 2012
Monklands Hospital is a district general hospital in Airdrie,
North Lanarkshire, with a 24-hour accident and emergency
department. It has 463 acute inpatient beds. Services include a
renal unit, and a range of medical and surgical services.
We carried out an announced inspection to Monklands Hospital
from Monday 25 June to Wednesday 27 June 2012.
Before the inspection, we reviewed NHS Lanarkshire’s
self-assessment and obtained information about Monklands Hospital
from other sources. This included Scotland’s Patient Experience
Programme, and other data relating to the care of older people.
Based on our review of this information, we decided to focus the
inspection on dementia and cognitive impairment, and preventing and
managing pressure ulcers.
On the inspection, we spoke with staff and used additional tools
to gather more information.
Areas of strength
We noted areas where NHS Lanarkshire was performing well in
relation to the care provided to older people in acute hospitals.
An acute care of the elderly (ACE) nurse is available in the
emergency medical receiving unit to carry out a comprehensive
assessment of older patients who meet an agreed set of criteria.
This includes liaising with a patient’s relative or carer to gather
information on the patient and understand the reason for their
admission to hospital. This helps to ensure patients are placed in
the most appropriate care setting. Healthcare Improvement Scotland
Announced Inspection Report (Monklands Hospital, NHS Lanarkshire):
25–27 June 2012) 6
A designated member of nursing staff is recognised as a
‘dementia champion’ within their ward area. This has been recently
introduced. It is proposed that they will lead on making changes to
the ward environment and working practices to promote better care
for people with dementia. Both ward staff and hospital management
staff spoke positively about this work.
A co-ordinator for carers is available on-site to provide
support to carers. They assess the individual needs of carers and
ensure they are involved in discharge planning, as well as
providing information on carers’ organisations in the
We saw picture signage on bedroom, toilet and bathroom doors to
help orientate and improve the environment for people with dementia
or a cognitive impairment.
A system had been implemented to highlight and identify where
capacity assessments are required. This acts as a prompt for staff
to ensure patients’ capacity to consent to treatment is
Areas for improvement
We did find that further improvement is required in the
Staff are not consistently complying with the national guidance
on do not attempt cardiopulmonary resuscitation (DNACPR).
We identified delays and gaps in staff training on moving and
assisting patients. This mandatory training should be carried out
on an annual basis.
We found an inconsistent approach to cognitive impairment
(mental health) screening and assessment across the hospital. We
found limited information in the care plans outlining the
individual needs of people with dementia or other cognitive
impairments and what interventions or treatment staff should use to
meet these needs.
There is a reactive approach taken following pressure ulcer risk
assessments with staff not always taking preventative measures to
reduce risk. For example, we found staff waited for pressure ulcers
to develop before ordering specialist pressure relieving equipment,
delays before the equipment was put in place, or before the skin
care bundles were started.
This inspection resulted in seven areas of strength, 15 areas
for improvement and four areas for continuing improvement. A full
list of the areas for improvement can be found in Appendix 1 on
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 Lanarkshire for further
information on progress against this action plan.
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Published Date: 6 August 2012