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'Considerable' improvement in care needed at Edinburgh hospital


An unannounced inspection has uncovered a number of serious issues in older people’s care at Edinburgh Royal Infirmary.

Healthcare Improvement Scotland published a report earlier this week on a visit to the hospital in August, which was carried out as part of a programme of inspections into care for older patients in Scottish acute settings (attached, right).

The programme was requested by the Scottish Government to “provide assurance” that older people were being treated with “compassion, dignity and respect” in acute settings.

The inspection at the Royal infirmary, which is run by NHS Lothian, identified four areas of “strength” but 23 areas for “improvement”.

Ian Smith, acting chief inspector at HIS, said: “We observed areas where NHS Lothian is performing well including the provision of a service to advise and support staff on wound care and preventing and managing pressure ulcers.

“However, we also identified a considerable number of areas for improvement. For example, staff should ensure that patients’ experience of attending the hospital is as positive as it can be, and that they are treated with dignity and respect at all times.”

The inspection report highlighted concerns about whether staff ensured patient dignity and comfort was maintained at all times in the hospital’s combined assessment area.

“This is a mixed sex area and patients can be there for a number of days before being discharged or transferred to a ward. We had to intervene on three occasions whilst inspecting this area of the hospital,” the report said.

It added: “Due to the busy nature of the ward, we saw instances where nursing staff would start to care for a patient and then be called away before they were able to complete their tasks. Patients were interrupted on several occasions while treatment and care was given.”

The report also said some mealtimes “seemed poorly organised” and that patients needing help with meals waited for a long time.

“We had significant concerns about the provision of meals across several wards and how some patients were assisted to eat their meals,” the report said. “On a number of occasions, we had to intervene and ask staff to provide help for patients at mealtimes.”

In addition, it highlighted that there was no routine screening for cognitive impairment taking place when patients were admitted, including for those over 65.

Inspectors also found risk assessments for nutrition and hydration, and pressure ulcers were not carried out in a timely fashion and care plans lacked information outlining the individual needs of older people.

“Across the hospital, the ward environments inspected were not helpful for people with dementia and cognitive impairment,” the report added.

Mr Smith said: “We expect NHS Lothian to address the areas for improvement we have identified as a matter of priority.”

Royal College of Nursing Scotland director Theresa Fyffe said: “While the report makes clear that patient feedback on care was largely positive, it also reveals a number of serious issues that amount to a picture of unacceptable standards in care for older people at the Royal Infirmary of Edinburgh.

“There are a number of factors behind this poor situation. Staffing appears to be one contributory factor – which is why we call for a minimum of one professionally qualified nurse per seven older patients in all hospitals, to reflect the complexity of the care required.”



Readers' comments (2)

  • How many more times will the Senior Nurse Mangers escape being named, shamed and struck from the register ?

    “Due to the busy nature of the ward, we saw instances where nursing staff would start to care for a patient and then be called away before they were able to complete their tasks."

    I would ague that this observation is indicative of inadequate staffing.

    An inquiry would most likely discover all the the incident forms drawing attention to poor staffing which put patients at risk.

    Such forms are of course filed under the "to difficult - no further action " category.

    What MR Ian Smith, acting chief inspector at HIS actually observed was a gross failure of management !
    Why not say so !

    The answer is that it is easier to blame the Ward/Dept. Nurses who are struggling to provide care in an environment which management has created !

    The Trade Unions and Professional organisations should be demanding that disciplinary action be taken against managers on each and every occasion that patients are found to be at risk as a result of managerial action/inaction

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  • "How many more times will the Senior Nurse Managers escape being named, shamed and struck from the register ?" - for ever!
    Having been treated in the same unit this comes as no surprise. I was treated in a mixed sex bay, with shared toilet with no lock or engaged sign. Other incidents in my stay led me to complain within days of discharge (in a letter that also highlighted positives (the junior doctors' communication)). I waited 6 months for a response that then said "We do not keep records re when mixed sex bays used and the length of time since incident prevents us investigating" -useful get out from the senior nurse for the department. Has been organisational policy/culture (see Scottish Government report highlighting bullying culture after waiting list fiddling issues).

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