Ninewells Hospital Jan 2013

OPA

"“We observed areas where Ninewells Hospital, NHS Tayside is performing well when providing care to older people. For example, improvements have been made to the ward environment for people with dementia or a cognitive impairment. However, we also identified a number of areas for improvement. During our announced inspection, we had significant concerns about the care provided to vulnerable, older people in the acute medical assessment unit.

In particular, we were concerned about patients’ privacy and dignity being compromised due to the mixed sex facility and the lack of space in the unit. Our unannounced follow-up inspection assured us that progress is being made to address the issues we identified and that actions are being taken to improve the care provided to patients in this unit.

We expect NHS Tayside to address the areas for improvement we have identified as a matter of priority."

Susan Brimelow - Chief Inspector

Ninewells Hospital

Older people in acute hospitals inspection

Inspection dates: 24-26 September 2012 (announced)

Follow-up inspection: 21 January 2013 (unannounced)

This report covers both inspection dates.

We carried out an announced inspection to Ninewells Hospital, Dundee 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

Scrutiny

Ninewells Hospital overview

Find out more about this hospital, including the latest inspection report, on the Ninewells Hospital overview page.


Types of inspections

Inspections may be announced or unannounced and will involve physical inspection of the clinical areas, and interviews with staff and patients. We will publish a written report 8 weeks after the inspection.

  • Announced inspection: the service provider will be given at least 4 weeks’ notice of the inspection by letter or email.
  • Unannounced inspection: the service provider will not be given any advance warning of the inspection.
  • Follow-up inspection: the NHS board and hospital may or may not be given advance notice of the inspection. A safety and cleanliness follow-up inspection will take place no later than 26 weeks from the publication of the initial report.