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Watchdog warns elderly care still not good enough

Jul 26, 2013

CONTINUING shortcomings in elderly care have been highlighted by Scotland's hospital watchdog

CONTINUING shortcomings in elderly care have been highlighted by Scotland's hospital watchdog which criticised staff for not treating older patients with respect and failing to comply with do not resuscitate notices.

The report by Healthcare Improvement Scotland, HIS, said that six months on from its first overview into the treatment of older people in acute care, there were still several areas of concern, including staff risking patient confidentiality and using inappropriate language on wards.

It identified 87 areas for improvement and 12 areas for continuing improvement during its most recent visits to seven units at six hospitals between September 2012 and June this year.

The hospital inspectorate's report said: "Across four of the hospitals inspected, we saw and heard some instances where staff were not always using appropriate and respectful language when referring to older people in hospital.

"We also saw instances when patient confidentiality was not always fully considered. For example, staff would share care and treatment information with each other in front of other patients.

"In one hospital, we noted specific instances where patient health records were left open and unattended in ward areas or computer screens displaying patient information were left unlocked."

The Herald has been carrying out its own investigation into how hospitals are coping with the ageing population.

Our campaign, Time For Action, is calling for a capacity review looking at the availability of beds, and also whether the right staff are in the right place at the right time in hospitals and the community.

HIS's first six-month overview report, published in October last year, also criticised hospital staff for using "childlike" language towards older patients and warned that medical staff did not always comply with do not resuscitate (DNR) guidance.

Most recently, inspectors visited Glasgow Royal Infirmary, Dumfries & Galloway Royal Infirmary, Royal Infirmary of Edinburgh on two separate occasions, Ninewells Hospital in Dundee, Western Isles Hospital and Aberdeen Royal Infirmary.

Problems with DNR notices – when a patient has requested doctors do not attempt to revive them if their heart stops or they stop breathing – were also highlighted by inspectors.

The report said: "In three hospitals, we found examples when clinical staff were not always complying with the national DNACPR [Do Not Attempt Cardiopulmonary Resuscitation] policy and were not completing the appropriate documentation correctly. This could have a potential impact on a patient's specific wishes about resuscitation."

Inspectors also raised concerns about "a lack of meaningful stimulation" for patients at three of the hospitals, with dayrooms often "univiting or - used as storage areas for ward equipment".

Five of the six hospitals inspected were also falling short in their dementia care, with older people not always being routinely screened for cognitive impairment on admission to hospital.

The inspectors also noted that protected mealtimes had been introduced across the six hospitals but in all but one this was "not well observed", with mealtimes interrupted by blood samples being taken, visits from occupational therapists and porters, and on one occasion "an en-suite toilet being cleaned while patients ate their meals".

Jacqueline Macrae, head of quality of care at HIS, said: "Through the majority of our observations on wards, we found that staff treated older people with compassion, dignity and respect.

"We saw many examples of warm, caring interactions between staff and patients and we heard directly from patients who were satisfied with the care they received.

"However, we also identified areas for improvement. For example, staff did not always use appropriate and respectful language when referring to older people in hospital and patient confidentiality was not always fully considered.

"Nutrition is important for older people and risk assessments to identify whether a patient is at risk of malnutrition need to be more consistently carried out. We will continue to work with NHS boards to ensure all older people receive the best care possible."

Midsteeple, High Street
Dumfries DG1 2BH
t: 01387 257770
e: info@dgvoice.co.uk

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