Wishaw General Hospital
Older people in acute hospitals announced inspection
Inspection Dates: 28 - 30 May 2012 and 19 June 2012
We carried out an announced inspection to Wishaw General
Hospital from Monday 28 May to Wednesday 30 May 2012. Due to
concerns we had about one ward of the hospital, we carried out a
further unannounced follow-up inspection on Tuesday 19 June
Before the announced inspection, we reviewed NHS Lanarkshire’s
self-assessment and obtained information about Wishaw General
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 decided
to focus the inspections on dementia and cognitive impairment, and
nutritional care and hydration.
On the inspection, we spoke with staff and used additional tools
to gather more information. We also carried out patient
interviews and used patient and carer questionnaires.
Areas of Strength
We noted areas where NHS Lanarkshire was performing well in
relation to the care provided to older people in acute
An acute care of the elderly (ACE) nurse is available in the
accident and emergency department to carry out a comprehensive
assessment of older patients who meet specific 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.
We saw some good examples of staff using key personal
information about patients to inform personalised care plans. This
can improve the care experience and provide better outcomes for the
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 carer organisations in the community.
We saw picture signage on bedroom, toilet and bathroom doors to
help orientate and improve the environment for people with dementia
or cognitive impairments.
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 found an inconsistent approach to cognitive impairment
(mental health) screening and assessment across the hospital. We
found limited information in the care plans which outlined the
individual needs of patients with dementia or other cognitive
impairments and the interventions or treatment staff should use to
meet these needs.
We noted a gap of 15–16 hours between patients receiving their
evening meal and breakfast the following morning. There is little
provision made to provide suitable snacks for patients outwith
There was insufficient information contained in patient’s care
plans about the level of assistance they may need with eating and
drinking. We saw some examples of poor eating experiences by
patients. We had to request that staff assist patients on two
These inspections resulted in six areas of strength, 15 areas
for improvement and two areas for continuing improvement. Areas for
continuing improvement are improvements that the NHS board has
already identified and started to address. A full list of the areas
for improvement can be found in Appendix 1.
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: 19 July 2012