Western General Hospital
Older people in acute hospitals announced inspection
Inspection dates: 11 - 13 April 2012
We carried out an announced inspection to the Western General
Hospital from Wednesday 11 April to Friday 13 April 2012.
Before the inspection, we reviewed NHS Lothian’s self-assessment
and obtained information about the Western General 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 dementia and cognitive
impairment. We also inspected nutritional care and hydration due to
concerns noted during the inspection.
On the inspection, we spoke with staff and used additional tools
to gather more information. We used a formal observation tool in
nine wards. We carried out 12 periods of observation during the
inspection. In each instance, two members of our team observed
interactions between patients and staff in a set area of the ward
for 20 minutes.
Areas of strength
We noted areas where NHS Lothian 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 received.
NHS Lothian has an elderly care assessment team that screens
patients within 24 hours of admission to the acute receiving
assessment unit. The team provides expert advice to staff to ensure
patients over the age of 65 are placed in the most appropriate care
setting as quickly as possible.
Within the medicine for the elderly directorate, we saw good
examples of patients and their families being consulted and
involved in decisions about a patient’s care. In particular, there
was good communication about do not attempt cardiopulmonary
resuscitation (DNACPR) decisions, and decisions around consent to
treatment for adults with incapacity issues. However, we noted that
decisions around these issues were not as well communicated and
documented across other wards and departments inspected.
Overall, patients told us they were happy with the quality of
food and the choices on offer. We saw many examples of good
practice with staff assisting patients to eat and drink in an
encouraging, positive and unhurried manner. One ward inspected had
a ‘meal co-ordinator’ whose role is to supervise mealtimes and
ensure that patients have the appropriate assistance to eat and
drink when required.
Areas for improvement
We found areas where further improvement is required.
We found an inconsistent approach to cognitive impairment
(mental health) screening across the hospital. There are various
assessment and screening tools in use and we found a lack of
clarity about who is responsible for screening and what should
happen with the results of a cognitive screening assessment. We
also found limited information in the care plans outlining the
individual needs of patients with dementia or other cognitive
impairments and what interventions or treatment staff should use to
meet these needs.
There is no bed management system in place to track the number
of bed or ward moves for patients with dementia.
We observed delays of 10–25 minutes between meals being given
out and patients being given assistance to eat and drink. Many
patients told us that portion sizes were too large and there was
Not all patients are having a nutritional risk assessment
carried out within 24 hours of admission to assess their
nutritional status. We also saw no evidence of individualised care
plans in place highlighting patients’ eating and drinking likes and
dislikes, dietary requirements and food allergies.
This inspection resulted in four areas of strength, twelve areas
for improvement and two areas for continuing 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 Lothian for further
information on progress against this action plan.
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Published Date: 21 May 2012