Ninewells Hospital
Older people in acute hospitals inspection
Inspection dates:
24-26 September 2012 (announced)
21 January 2013 (unannounced follow-up)
This report covers both inspection dates.
We carried out an announced inspection to Ninewells Hospital
from Monday 24 September to Wednesday 26 September 2012. Due to
concerns we had about the acute medical assessment unit, we carried
out a further unannounced follow-up inspection on Monday 21 January
2013.
During the announced inspection in September 2012, we inspected
the following areas:
- acute medical assessment unit (also known as wards 14 and
15)
- ward 3 (respiratory)
- ward 5 (medicine for the elderly)
- ward 6 (medicine for the elderly)
- ward 17 (orthopaedics), and
- ward 31 (stroke/general medicine - temporarily moved from ward
4).
We also visited the accident and emergency department.
During the unannounced follow-up inspection in January 2013, we
inspected the acute medical assessment unit. We also visited the
accident and emergency department.
Areas of strength (from announced inspection in
September 2012)
We noted areas where NHS Tayside was performing well when
providing care to older people in acute hospitals.
Improvements have been made to the ward environment for people
with dementia or a cognitive impairment. People with dementia or a
cognitive impairment can benefit from environments that are adapted
to limit potential confusion and distress. We saw that colours,
shapes, numbers and pictures were being used to help patients
distinguish each bay area and help them find their way around the
ward. New, larger size clocks were in place, many of which had a
sign underneath with the name of the hospital. This also helps to
orientate patients. NHS Tayside plans to continue with these
improvements.
We saw examples of good multidisciplinary teamworking during our
inspection.
Areas for improvement (from announced inspection in
September 2012)
We noted areas where further improvement is required when
providing care to older people in acute hospitals.
During our announced inspection in September 2012, we had
concerns about how NHS Tayside provided care to vulnerable older
people in the acute medical assessment unit. We were concerned
about patients’ privacy and dignity being compromised due to the
mixed sex facility, the lack of space in the unit and the short
curtains. We were also concerned about the busy nature of the unit.
We saw patients waiting on trolleys and in wheelchairs in the unit
corridor. Patients told us that they waited in the acute medical
assessment unit for a long time.
We found that screening for cognitive impairment was not
routinely carried out in patients over 65 years when admitted to
hospital.
We also found that risk assessments for nutritional care and
hydration were not accurately carried out within 24 hours of
admission.
We found that mealtimes were not always protected and seemed
poorly organised on some wards.
Unannounced follow-up inspection in January
2013
Following our unannounced inspection, we feel assured that
progress is being made to address the issues we identified in the
acute medical assessment unit. This gives us assurance that actions
are being taken to improve the care provided to patients within
this unit.
The number of beds in the unit has increased and the unit is
being redesigned to better assess and meet the needs of patients
and improve the capacity and patient flow through the unit.
These inspections resulted in two areas of strength, 17 areas
for improvement and two areas for continuing improvement. A full
list of the areas for improvement can be found in Appendix 1 on
page 24.
We expect NHS Tayside to address all the areas for improvement.
Those areas where improvement is required to meet a recognised
standard must be prioritised.
Supplementary information
In addition to the inspection report and NHS
Tayside action plan, we have also published supplementary
information on 27 February relating to the announced inspection of
the care of older people at Ninewells Hospital on 24 -26 September
2012.
This is now included in the response to a
freedom of information (FOI) request, issued on 1 January
2013. This is available on the Healthcare Improvement
Scotland website:
http://www.healthcareimprovementscotland.org/our_work/inspecting_and_regulating_care/opah_tayside/ninewells_hospital_jan_2013.aspx
An up to date improvement action plan is available from NHS
Tayside
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Published Date: 30 January 2013
